Home-based electromyography-triggered stimulation in chronic stroke

Abstract

Objectives: (1) To determine the feasibility of a home-based electromyography triggered neuromuscular stimulation (ETMS) programme; and (2) to determine ETMS efficacy in increasing affected wrist extension and reducing affected arm impairment.

Design: Randomized, controlled, pre-lpost, cross-over design.

Setting: Outpatient rehabilitation hospital.

Patients: Twelve chronic stroke patients with palpable muscle contraction in their affected wrist extensors but no movement (7 males; mean age=59.75 years, age range 44-75 years; mean time since stroke=52.75 months, range 13-131 months).

Intervention: Subjects were randomly assigned to receive either: (a) ETMS use twice every weekday in 35-min increments during an eight-week period followed by an eight-week home exercise programme (ETMS/home exercise programme) (n=8); or (b) an eight-week home exercise programme followed by use of ETMS twice every weekday in 35-min increments during an eight-week period (home exercise programme) (n=4).

Main outcome measures: The Fugl-Meyer, Action Research Arm Test and goniometry.

Results: After home exercise programme participation, subjects showed nominal or no changes on any of the outcome measures. After ETMS, patients showed modest impairment reductions, as shown by the Fugl-Meyer, and no Action Research Arm Test changes. However, both groups showed a 218 increase in active affected wrist extension after ETMS use.

Conclusion: ETMS use is feasible in the home environment. Neither participation in a traditional home exercise programme nor ETMS use conveyed changes on the Fugl-Meyer or Action Research Arm Test. However, ETMS use increased active affected limb extension. This new movement may provide a potential pathway for subjects to participate in other interventions, such as modified constraint induced therapy.