Sensory amplitude electrical stimulation (SES) and repetitive task practice reduce impairments and arm dysfunction when delivered separately following stroke.
Objective:
To determine if home-based, task-specific arm exercise was more effective when administered concurrent with SES.
Methods:
Thirty-eight subjects with chronic stroke and mean Fugl-Meyer Assessment (FMA) score 28/66 (15–45) participated. Subjects were randomly assigned to an SES (n = 20) or sham stimulation (n = 18) group. Subjects engaged in task-based home exercise for 30 minutes, twice daily, for four weeks while wearing a glove electrode on the impaired hand. Experimental subjects received SES while control subjects received sham stimulation during exercise. Primary outcome measures: FMA and Arm Motor Ability Test (AMAT).
Results:
There were no significant between-group differences for outcome measures. There was a significant difference between the pre- and post-test scores in the SES group AMAT median time (P = 0.003 95% confidence interval (CI): −14.304, −6.365; effect size: 0.84). Practice time was not associated with changes in outcomes. Subjects with more sensorimotor dysfunction had significantly greater improvements on AMAT median time (P = 0.037). There was a significant relationship between baseline FMA score and FMA change score (r = 0.402; P = 0.006).
Conclusions:
This study describes a unique SES delivery system via glove electrode that enabled delivery of SES during home-based arm task practice in stroke survivors. Task practice with concurrent SES did not demonstrate significantly better effects than task practice with sham stimulation, however there was a trend for greater improvement in one activity measure.
MuntnerPGEKlagMJCoreshJ. Trends in stroke prevalence between 1973 and 1991 in the US population 25 to 74 years of age. Stroke2002; 33: 1209–1213.
2.
LawrenceESCoshallCDundasR. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke2001; 32: 1279–1284.
3.
NakayamaHJorgensenHSRaaschouHO. Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994; 75: 852–857.
4.
WyllerTBSveenUSodringKM. Subjective well-being one year after stroke. Clin Rehabil1997; 11: 139–145.
5.
ButefischCHummelsheimHDenzlerP. Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand. J Neurol Sci1995; 130: 59–68.
6.
van der LeeJHSnelsIABeckermanH. Exercise therapy for arm function in stroke patients: a systematic review of randomized controlled trials. Clin Rehabil2001; 15: 20–31.
7.
PageSJ. Intensity versus task-specificity after stroke: how important is intensity?Am J Phys Med Rehabil2003: 730–732.
8.
TeasellRFoleyNBhogalSKSpeechleyMR. An evidence-based review of stroke rehabilitation. Top Stroke Rehabil2003; 10: 29–58.
9.
BrosseauLWellsGAFinestoneHM. Clinical practice guidelines for task-oriented training. Top Stroke Rehabil2006; 13: 21–27.
10.
de KroonJRvanderLeeJHIJzermanMJ. Therapeutic electrical stimulation to improve motor control and functional abilities of the upper extremity after stroke: a systematic review. Clin Rehabil2002; 16: 350–360.
11.
PopovicMBPopovicDBSinkjaerT. Clinical evaluation of functional electrical therapy in acute hemiplegic subjects. J Rehabil Res Dev. 2003; 40: 443–453.
12.
PowellJPandyanADGranatM. Electrical stimulation of wrist extensors in poststroke hemiplegia. Stroke1999; 30: 1384–1389.
13.
AlonGSunnerhagenKSGeurtsACH. A home-based, self-administered stimulation program to improve selected hand functions of chronic stroke. NeuroRehabilitation. 2003; 18: 215–225.
14.
SullivanJEHedmanLD. Effects of home-based sensory and motor amplitude electrical stimulation on arm dysfunction in chronic stroke. Clin Rehabil2007; 21: 142–150.
15.
SullivanJEHedmanLD. A home program of sensory and neuromuscular electrical stimulation integrated with upper-limb task practice in a patient who is stable after a stroke. Phys Ther2004; 84: 1045–1054.
16.
HedmanLDSullivanJEHilliardMJ. Neuromuscular electrical stimulation during task-oriented exercise improves arm function for an individual with proximal arm dysfunction after stroke. Am J Phys Med Rehabil2007; 86: 592–596.
17.
PeuralaSHPitkanenKSiveniusJ. Cutaneous electrical stimulation may enhance sensorimotor recovery in chronic stroke. Clin Rehabil2002; 16: 709–716.
18.
KlaiputAKitisomprayoonkulW. Increased pinch strength in acute and subacute stroke patients after simultaneous median and ulnar sensory stimulation. Neurorehabil Neural Repair2009; 23: 351–356.
19.
ConfortoABCohenLGSantosRLD. Effects of somatosensory stimulation on motor function in chronic cortico-subcortical strokes. J Neurol2007; 254: 333–339.
20.
LauferYElboim-GabyzonM. Does sensory transcutaneous electrical stimulation enhance motor recovery following a stroke? A systematic review. Neurorehabil Neural Repair2011; 11: 799–809.
21.
TinazziMZarattiniSValerianiM. Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation (TENS) of forearm muscles: evidence of reciprocal inhibition and facilitation. Exp Brain Res2005; 161: 457–464.
22.
EekEEngardtM. Assessment of the perceptual threshold of touch (PTT) with high frequency transcutaneous electrical nerve stimulation (Hf/TENS) in elderly patients with stroke: a reliability study. Clin Rehabil2003; 17: 825–834.
23.
RiddingMCMcKayDRThompsonPD. Changes in corticomotor representations induced by prolonged peripheral nerve stimulation in humans. Clin Neurophysiol2001: 112: 1461–1469.
24.
Kaelin-LangALuftARSawakiL. Modulation of human corticomotor excitability by somatosensory input. J Physiol (Lond)2002; 540: 623–633.
25.
GolaszewskiSMSiedentopfCMKoppelstaetterF. Modulatory effects on human sensorimotor cortex by whole-hand afferent electrical stimulation. Neurology2004; 62: 2262–2269.
26.
GolaszewskiSMBergmannJChristovaM. Modulation of motor cortex excitability by different levels of whole-hand afferent electrical stimulation. Clin Neurophysiol2012; 123: 193–199.
MeesenRLJCuypersKRothwellJC. The effect of long-term TENS on persistent neuroplastic changes in the human cerebral cortex. Hum Brain Mapp2010; 32: 872–882.
29.
McDonnellMNHillierSLMilesTS. Influence of combined afferent stimulation and task-specific training following stroke: a pilot randomized controlled trial. Neurorehabil Neural Repair2007; 21: 435–443.
30.
ConfortoABCohenLGSantosRLD. Effects of somatosensory stimulation on motor function in chronic cortico-subcortical strokes. J Neurol2007; 254: 333–339.
31.
WuCWSeoHJCohenLG. Influence of electric somatosensory stimulation on paretic-hand function in chronic stroke. Arch Phys Med Rehabil2006; 87: 351–357.
32.
KoeslerIBMDafotakisMAmeliM. Electrical somatosensory stimulation improves movement kinematics of the affected hand following stroke. J Neurol Neurosurg Psychiatry2009; 80: 614–619.
33.
SawakiLWuCWKaelin-LangA. Effects of somatosensory stimulation on use-dependent plasticity in chronic stroke. Stroke2006; 37: 246–247.
34.
BhattENagpalAGreerKH. Effect of finger tracking combined with electrical stimulation on brain reorganization and hand function in subjects with stroke. Exp Brain Res2007; 182: 435–447.
35.
KhaslavskaiaSSinkjaerT. Motor cortex excitability following repetitive electrical stimulation of the common peroneal nerve depends on the voluntary drive. Exp Brain Res2005; 162: 497–502.
36.
CelnikPHummelFHarris-LoveM. Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke. Arch Phys Med Rehabil2007; 88: 1369–1376.
37.
SawakiLWuCWKaelin-LangA. Effects of somatosensory stimulation on use-dependent plasticity in chronic stroke. Stroke2006; 37: 246–247.
38.
ConfortoABKaelin-LangACohenLG. Increase in hand muscle strength of stroke patients after somatosensory stimulation. Ann Neurol2002; 51: 122–125.
39.
CowanCMcKennaJMcCrum-GardnerE. An investigation of the hypoalgesic effects of TENS delivered by a glove electrode. J Pain2009; 10: 694–701.
40.
PeuralaSHPitkanenKSiveniusJ. Cutaneous electrical stimulation may enhance sensorimotor recovery in chronic stroke. Clin Rehabil2002; 16: 709–716.
41.
GladstoneDJDanellsCJBlackSE. The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair2002; 16: 232–240.
42.
MoherDJonesALepageL. Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation. JAMA2001; 285: 1992–1995.
43.
Fugl-MeyerARJaaskoLLeymanI. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med1975; 71: 13–31.
44.
KoppBKunkelAFlorH. The Arm Motor Ability Test: reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living. Arch Phys Med Rehabil1997; 78: 615–620.
45.
UswatteGTaubEMorrisD. Reliability and validity of the upper extremity motor activity log-14 for measuring real-world use. Stroke2005; 36: 2493–2496.
46.
DuncanPWLaiSMBodeRK. Stroke Impact Scale-16. A brief assessment of physical function. J Neurol2003; 60: 291–296.
47.
MehrholzJWagnerKMei. Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study. Clin Rehabil2005; 19: 751–759.
48.
DuncanPWPropstMNelsonSG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther1983; 63: 1606–1610.
49.
DettmersCTeskeUHamzeiF. Distributed form of constraint-induced movement therapy improves functional outcome and quality of life after stroke. Arch Phys Med Rehabil2005; 86: 204–209.
50.
GaubertCSMockettSP. Inter-rater reliability of the Nottingham method of stereognosis assessment. Clin Rehabil2000; 14: 153–159.
51.
LawMBaptisteSCarswellA. Canadian Occupational Performance Measure: an outcome measure for occupational therapy. J Can Occup Ther Assoc1990; 57: 82–87.
52.
DurlakJA. How to select, calculate, and interpret effect sizes. J Pediatr Psychol2009; 34: 917–928.
53.
NgSSHui-ChanCW. Does the use of TENS increase the effectiveness of exercise for improving walking after stroke? A randomized controlled clinical trial. Clin Rehabil2009; 23: 1093–1103.
54.
YavuzerGOkenOAtayMB. Effect of sensory amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study. Arch Phys Med Rehabil2007; 88: 710–714.
55.
RosenkranzKRothwellJC. The effect of sensory input and attention on the sensorimotor organization of the hand area of the human motor cortex. J Physiol2004; 561: 307–320.
56.
WolfSLWinsteinCJMillerJP. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA2006; 296: 2095–2104.
57.
HunterSHammettLBallS. Dose-response study of mobilisation and tactile stimulation therapy for the upper extremety early after stroke: a phase I trial. Neurorehabil Neural Repair2011; 25: 314–322.
58.
KnutsonJSHarleyMYHiselTZ. Improving hand function in stroke survivors: a pilot study of contralaterally controlled functional electrical stimulation in chroic stroke. Arch Phys Med Rehabil2007; 88: 513–520.
59.
KnutsonJSHiselTZHarleyMY. A novel functional electrical stimulation treatment for recovery of hand function in hemiplegia: 12-week pilot study. Neurorehabil Neural Repair2009; 23: 17–25.
60.
PageSJLevinLHermannV. Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke. Arch Phys Med Rehabil2012; 93: 200–206.
61.
KunkelAKoppBMullerG. Constraint-induced movement therapy for motor recovery in chronic stroke patients. Arch Phys Med Rehabil1999; 80: 624–628.
62.
KimberleyTJLewisSMAuerbachEJ. Electrical stimulation driving functional improvements and cortical changes in subjects with stroke. Exp Brain Res2004; 154: 450–460.
