Upper-Limb Recovery After Stroke A Randomized Controlled Trial Comparing EMG-Triggered, Cyclic, and Sensory Electrical Stimulation

What protocol came out of this?
http://nnr.sagepub.com/content/30/10/978?etoc

1. Richard D. Wilson, MD1,2,3⇑
2. Stephen J. Page, PhD4
3. Michael Delahanty, D.O.5,6
4. Jayme S. Knutson, PhD1,2,3
5. Douglas D. Gunzler, PhD2
6. Lynne R. Sheffler, MD1,2,3
7. John Chae, MD1,2,3

1. ¹MetroHealth Rehabilitation Institute, MetroHealth Medical Center, Cleveland, OH, USA
2. ²Case Western Reserve University, Cleveland, OH, USA
3. ³Cleveland FES Center, Cleveland, OH, USA
4. ⁴The Ohio State University, Columbus, OH, USA
5. ⁵Akron General Medical Center, Akron, OH, USA
6. ⁶Northeast Ohio Medical University, Rootstown, OH, USA

1. Richard D. Wilson, MD, MetroHealth Rehabilitation Institute, 4229 Pearl Road, Cleveland, OH, USA. Email: rwilson@metrohealth.org

Abstract

Background and purpose. This study compared the effect of cyclic neuromuscular electrical stimulation (NMES), electromyographically (EMG)-triggered NMES, and sensory stimulation on motor impairment and activity limitations in patients with upper-limb hemiplegia.  

Methods. This was a multicenter, single-blind, multiarm parallel-group study of nonhospitalized hemiplegic stroke survivors within 6 months of stroke. A total of 122 individuals were randomized to receive either cyclic NMES, EMG-triggered NMES, or sensory stimulation twice every weekday in 40-minute sessions, over an 8 week-period. Patients were followed for 6 months after treatment concluded.  

Results. There were significant increases in the Fugl-Meyer Assessment [F(1, 111) = 92.6, P < .001], FMA Wrist and Hand [F(1, 111) = 66.7, P < .001], and modified Arm Motor Ability Test [mAMAT; time effect: F(1, 111) = 91.0, P < .001] for all 3 groups. There was no significant difference in the improvement among groups in the FMA [F(2, 384) = 0.2, P = .83], FMA Wrist and Hand [F(2, 384) = 0.4, P = .70], or the mAMAT [F(2, 379) = 1.2, P = .31].  

Conclusions. All groups exhibited significant improvement of impairment and functional limitation with electrical stimulation therapy applied within 6 months of stroke. Improvements were likely a result of spontaneous recovery. There was no difference based on the type of electrical stimulation that was administered.