Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Saturday, September 17, 2016

Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis: A Randomized Trial

So what if it does? Useless without a protocol being written for it. Does no one ever think of the survivors?
http://stroke.ahajournals.org/content/strokeaha/early/2016/09/08/STROKEAHA.116.013791.full.pdf
1
N
euromuscular electrical stimulation (NMES) of the paretic wrist and finger extensors is routinely used in
stroke rehabilitation to promote recovery of muscle strength and upper extremity function. A recent review of 31 randomized controlled trials concluded that there is strong evidence that NMES applied in the context of task practice improves upper extremity function in subacute and chronic stroke.
1
This is corroborated by a recent systematic review with meta-analysis that concluded that functional electrical stimulation improves activity compared with training alone.
2
Cyclic NMES (cNMES) is a commonly used and widely available method of administering NMES in stroke rehabilitation.
3
With cNMES, stimulation is delivered according to an on–off cycle, with the cycle timing, repetitions, and intensity of stimulation set by the therapist. Thus, cNMES requires no active participation from the patient, and because the patient does not control the timing or intensity of stimulation,
cNMES is not easily used to assist functional task practice (FTP). Nevertheless, several studies have shown that cNMES can reduce upper limb motor impairment compared with control groups
4,5
although the longevity of effect is inconsistent across studies.
6
Contralaterally controlled functional electrical stimulation (CCFES) is a new NMES modality that enables the patient to actively open their paretic hand and perform functional tasks. With CCFES, the patient controls the stimulation to their paretic hand in real-time by opening and closing their strong hand. An instrumented glove worn on the strong hand modulates the stimulation intensity to the paretic hand extensors so that both hands open synchronously (Figure I in the online-only Data Supplement
).
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CCFES may be more effective than cNMES because the stimulation is intention driven; the patient
Background and Purpose
It is unknown whether one method of neuromuscular electrical stimulation for poststroke
upper limb rehabilitation is more effective than another. Our aim was to compare the effects of contralaterally controlled functional electrical stimulation (CCFES) with cyclic neuromuscular electrical stimulation (cNMES).
Methods
Stroke patients with chronic (>6 months) moderate to severe upper extremity hemiparesis (n=80) were randomized to receive 10 sessions/wk of CCFES- or cNMES-assisted hand opening exercise at home plus 20 sessions of functional task practice in the laboratory for 12 weeks. The task practice for the CCFES group was stimulation assisted. The primary outcome was change in Box and Block Test (BBT) score at 6 months post treatment. Upper extremity Fugl–Meyer and
Arm Motor Abilities Test were also measured.
Results
At 6 months post treatment, the CCFES group had greater improvement on the BBT, 4.6 (95% confidence interval
[CI], 2.2–7.0), than the cNMES group, 1.8 (95% CI, 0.6–3.0), between-group difference of 2.8 (95% CI, 0.1–5.5),
P
=0.045. No significant between-group difference was found for the upper extremity Fugl–Meyer (P
=0.888) or Arm Motor Abilities Test (P=0.096). Participants who had the largest improvements on BBT were <2 years post stroke with moderate (ie, not severe) hand impairment at baseline. Among these, the 6-month post-treatment BBT gains of the CCFES group, 9.6 (95% CI, 5.6–13.6), were greater than those of the cNMES group, 4.1 (95% CI, 1.7–6.5), between-group difference of 5.5 (95% CI, 0.8–10.2), P=0.023.
Conclusions
CCFES improved hand dexterity more than cNMES in chronic stroke survivors.
Clinical Trial Registration
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00891319.
(
Stroke
. 2016;47:00-00. DOI: 10.1161/STROKEAHA.116.013791.)
Key

1 comment:

  1. Dean,
    I thought this was an interesting study. I like that it is a bi-lateral training method that should not be expensive and could be done independently by the patient as much they are able.

    I agree with your comment though. I copied this from the study report:

    Results
    From March 2009 to October 2014, 304 patients were screened,
    125 underwent a formal eligibility assessment, and 80 were
    enrolled and assigned CCFES or cNMES (Figure 1).

    Many people were involved for over 5 years. Significant positive findings, but no concrete protocol or benefit to patients. At this rate, treatment for stroke survivors will take decades!

    ReplyDelete