Motor Training of Upper Extremity With Functional Electrical Stimulation in Early Stroke Rehabilitation

Abstract

Background. Functional electrical stimulation (FES) allows active exercises in stroke patients with upper extremity paralysis. Objective. To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and/or hand paralysis. Methods. For this pilot study, 23 acute and subacute stroke patients were randomly assigned to the intervention (n = 12) and control group (n = 11). Distributed over 4 weeks, FES training replaced 12 conventional training sessions in the intervention group. An Extended Barthel Index (EBI) subscore assessed the performance of activities of daily living (ADL). The Chedoke McMaster Stroke Assessment (CMSA) measured hand and arm function and shoulder pain. The Modified Ashworth Scale (MAS) assessed resistance to passive movement. Unblinded assessments were performed prior to and following the end of the training period. Results. The EBI subscore and CMSA arm score improved significantly in both groups. The CMSA hand function improved significantly in the FES group. Resistance to passive movement of finger and wrist flexors increased significantly in the FES group. Shoulder pain did not change significantly. None of the outcome measures, however, demonstrated significant gain differences between the groups. Conclusions. We did not find clear evidence for superiority or inferiority of FES. Our findings, and those of similar trials, suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences.

Keywords

Electric stimulation Stroke Hemiplegia Upper extremity Rehabilitation

References

Parker VM , Wade DT , Langton Hewer R. Loss of arm function after stroke: measurement, frequency, and recovery. Int Rehabil Med. 1986;8 (2):69-73.

Kwakkel G. , Kollen BJ , van der Grond J. , Prevo AJ Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke. 2003;34(9):2181-2186.

Bobath B. Adult hemiplegia: evaluation and treatment. London, England: Heinemann Medical Books; 1990.

Langhammer B. , Stanghelle JK Bobath or motor relearning program? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. Clin Rehabil. 2000;14(4): 361-369.

Woldag H. , Hummelsheim H. Evidence-based physiotherapeutic concepts for improving arm and hand function in stroke patients: a review. J Neurol. 2002 ;249(5):518-528.

Berner YN , Lif Kimchi O. , Spokoiny V. , Finkeltov B. The effect of electric stimulation treatment on the functional rehabilitation of acute geriatric patients with stroke-a preliminary study. Arch Gerontol Geriatr. 2004;39(2):125-132.

Popovic MB , Popovic DB , Sinkjaer T. , Stefanovic A. , Schwirtlich L. Clinical evaluation of functional electrical therapy in acute hemiplegic subjects . J Rehabil Res Dev. 2003;40(5):443-453.

Alon G. , Levitt A. , McCarthy PA Functional electrical stimulation enhancement of upper extremity functional recovery during stroke rehabilitation: a pilot study. Neurorehabil Neural Repair. 2007;21:207-215.

Popovic MR , Thrasher TA , Zivanovic V. , Takaki J. , Hajek V. Neuroprosthesis for retraining reaching and grasping functions in severe hemiplegic patients. Neuromodulation. 2005;8(1):60-74.

10.

Popovic DB , Popovic MB , Sinkjaer T. , Stefanovic A. , Schwirtlich L. Therapy of paretic arm in hemiplegic subjects augmented with a neural prosthesis: a cross-over study. Can J Physiol Pharmacol. 2004;82(8-9): 749-756.

11.

Chae J. , Ng A. , Yu DT , et al. Intramuscular electrical stimulation for shoulder pain in hemiplegia: does time from stroke onset predict treatment success? Neurorehabil Neural Repair. 2007;21:561-567.

12.

Ring H. , Rosenthal N. Controlled study of neuroprosthetic functional electrical stimulation in sub-acute post-stroke rehabilitation. J Rehabil Med. 2005;37(1):32-36.

13.

Popovic MR , Keller T. Modular transcutaneous functional electrical stimulation system. Med Eng Phys. 2005;27(1):81-92.

14.

Gowland C. , Stratford P. , Ward M. , et al. Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke. 1993;24(1):58-63.

15.

Jansa J. , Pogacnik T. , Gompertz P. An evaluation of the Extended Barthel Index with acute ischemic stroke patients . Neurorehabil Neural Repair. 2004;18(1):37-41.

16.

Gregson JM , Leathley M. , Moore AP , Sharma AK , Smith TL , Watkins CL Reliability of the Tone Assessment Scale and the Modified Ashworth Scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehabil. 1999;80(9):1013-1016.

17.

Pandyan AD , Johnson GR , Price CI , Curless RH , Barnes MP , Rodgers H. A review of the properties and limitations of the Ashworth and Modified Ashworth Scales as measures of spasticity. Clin Rehabil. 1999;13(5): 373-383.

18.

Hsieh YW , Wang CH , Wu SC , Chen PC , Sheu CF , Hsieh CL Establishing the minimal clinically important difference of the Barthel Index in stroke patients. Neurorehabil Neural Repair. 2007;21(3):233-238.

19.

Bortz J. , Lienert GA Kurzgefasste Statistik für die klinische Forschung. Leitfaden für die verteilungsfreie Analyse kleiner Stichproben. Berlin, Germany: Springer-Verlag; 2003.

20.

Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Earlbaum Associates; 1988.

21.

Yozbatiran N. , Donmez B. , Kayak N. , Bozan O. Electrical stimulation of wrist and fingers for sensory and functional recovery in acute hemiplegia. Clin Rehabil. 2006;20(1):4-11.

22.

Houlden H. , Edwards M. , McNeil J. , Greenwood R. Use of the Barthel Index and the Functional Independence Measure during early inpatient rehabilitation after single incident brain injury. Clin Rehabil. 2006;20(2):153-159.

23.

Chae J. , Bethoux F. , Bohine T. , Dobos L. , Davis T. , Friedl A. Neuromuscular stimulation for upper extremity motor and functional recovery in acute hemiplegia. Stroke. 1998;29(5):975-979.

24.

Powell J. , Pandyan AD , Granat M. , Cameron M. , Stott DJ Electrical stimulation of wrist extensors in poststroke hemiplegia. Stroke. 1999;30(7):1384-1389.

25.

Siekierka-Kleiser EM , Kleiser R. , Wohlschläger AM , Freund HJ , Seitz RJ Quantitative assessment of recovery from motor hemineglect in acute stroke patients. Cerebrovasc Dis. 2006;21(5-6):307-314.

26.

Daprati E. , Sirigu A. Laterality effects on motor awareness. Neuropsychologia. 2002;40(8):1379-1386.

27.

Ratnasabapathy Y. , Broad J. , Baskett J. , Pledger M. , Marshall J. , Bonita R. Shoulder pain in people with a stroke: a population-based study. Clin Rehabil. 2003;17(3):304-311.

28.

Church C. , Price C. , Pandyan AD , Huntley S. , Curless R. , Rodgers H. Randomized controlled trial to evaluate the effect of surface neuromuscular electrical stimulation to the shoulder after acute stroke. Stroke. 2006;37(12):2995-3001.

29.

Chantraine A. , Baribeault A. , Uebelhart D. , Gremion G. Shoulder pain and dysfunction in hemiplegia: effects of functional electrical stimulation. Arch Phys Med Rehabil. 1999;80(3):328-331.

30.

Renzenbrink GJ , Ijzerman MJ Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life. Clin Rehabil. 2004;18(4):359-365.