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

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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.

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This is corroborated by a recent systematic review with meta-analysis that concluded that functional electrical stimulation improves activity compared with training alone.

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Cyclic NMES (cNMES) is a commonly used and widely available method of administering NMES in stroke rehabilitation.

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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

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although the longevity of effect is inconsistent across studies.

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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

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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

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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

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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

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CCFES improved hand dexterity more than cNMES in chronic stroke survivors.

Clinical Trial Registration

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URL:

http://www.clinicaltrials.gov

. Unique identifier: NCT00891319.

(

Stroke

. 2016;47:00-00. DOI: 10.1161/STROKEAHA.116.013791.)

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