Few patients with severe upper extremity (UE) paresis after stroke achieved full recovery, because of the lack of a definitive approach to improve severe UE paresis immediately after onset.
OBJECTIVE:
to investigate the effects of coupled EMG-triggered and cyclic neuromuscular electrical stimulation (NMES) on UE paresis during early acute phase of stroke.
METHODS:
Seventeen participants with severe UE disability met the criteria. 8 subjects received 20 minutes of NMES prior to standard care per session, while 9 age- and severity-matched subjects received two times 20 minutes of standard care. Outcome measures included UE motor section of the Fugl-Meyer Motor Assessment Scale (FMA-UE), Wolf motor function test (WMFT), and box and block test (BBT).
RESULTS:
The NMES group received treatment (average session: 10.87) after a median 7 days from stroke (16.5 sessions after 5 days for control). To adjust the different treatment durations, we defined “progress rate” as the gains of UE function scores divided by treatment duration. The progress rate was significantly different in FMA-UE, but not in WMFT and BBT.
CONCLUSIONS:
The present study suggested beneficial effects of coupled NMES on UE paresis during early acute phase of stroke.
Blickenstorfer,A., Kleiser,R., Keller,T., Keisker,B., Meyer,M., Riener,R., & Kollias,S. (2009). Cortical and subcortical correlates of functional electrical stimulation of wrist extensor and flexor muscles revealed by fMRI. Hum Brain Mapp, 30(3), 963–975. doi: 10.1002/hbm.20559
2.
Boyaci,A., Topuz,O., Alkan,H., Ozgen,M., Sarsan,A., Yildiz,N., & Ardic,F. (2013). Comparison of the effectiveness of active and passive neuromuscular electrical stimulation of hemiplegic upper extremities: a randomized, controlled trial. Int J Rehabil Res, 36(4), 315–322. doi: 10.1097/MRR.0b013e328360e541.
3.
Burnett,M. G., Shimazu,T., Szabados,T., Muramatsu,H., Detre,J. A., & Greenberg,J. H. (2006). Electrical forepaw stimulation during reversible forebrain ischemia decreases infarct volume. Stroke, 37(5), 1327–1331. doi: 10.1161/01.STR.0000217305.82123.d8
4.
Carda,S., Biasiucci,A., Maesani,A., Ionta,S., Moncharmont,J., Clarke,S.,. . . Millan,J. D. R. (2017). Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study. Arch Phys Med Rehabil, 37(5), 1628–1635 e1622. doi: 10.1016/j.apmr.2017.02.020
5.
Cauraugh,J., Light,K., Kim,S., Thigpen,M., & Behrman,A. (2000). Chronic motor dysfunction after stroke: recovering wrist and finger extension by electromyography-triggered neuromuscular stimulation. Stroke, 31(6), 1360–1364. doi: 10.1161/01.str.31.6.1360
6.
Chae,J., Bethoux,F., Bohine,T., Dobos,L., Davis,T., & Friedl,A. (1998). Neuromuscular stimulation for upper extremity motor and functional recovery in acute hemiplegia. Stroke, 29(5), 975–979. doi: 10.1161/01.str.29.5.975
7.
Chae,J., & Zorowitz,R. (1998). Functional status of cortical and subcortical nonhemorrhagic stroke survivors and the effect of lesion laterality. Am J Phys Med Rehabil, 77(5), 415–420. doi: 10.1097/00002060-199809000-00011
8.
Conforto,A. B., Cohen,L. G., dos Santos,R. L., Scaff,M., & Marie,S. K. (2007). Effects of somatosensory stimulation on motor function in chronic cortico-subcortical strokes. J Neurol, 254(3), 333–339. doi: 10.1007/s00415-006-0364-z
9.
Desrosiers,J., Bravo,G., Hebert,R., Dutil,E., & Mercier,L. (1994). Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Arch Phys Med Rehabil, 75(7), 751–755.
10.
Francisco,G., Chae,J., Chawla,H., Kirshblum,S., Zorowitz,R., Lewis,G., & Pang,S. (1998). Electromyogram-triggered neuromuscular stimulation for improving the arm function of acute stroke survivors: a randomized pilot study. Arch Phys Med Rehabil, 79(5), 570–575. doi: 10.1016/s0003-9993(98)90074-0
11.
Fugl-Meyer,A. R., Jaasko,L., Leyman,I., Olsson,S., & Steglind,S. (1975). The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med, 7(1), 13–31.
12.
Grefkes,C., & Fink,G. R. (2014). Connectivity-based approaches in stroke and recovery of function. Lancet Neurol, 13(2), 206–216. doi: 10.1016/S1474-4422(13)70264-3
13.
Hara,Y., Obayashi,S., Tsujiuchi,K., & Muraoka,Y. (2013). The effects of electromyography-controlled functional electrical stimulation on upper extremity function and cortical perfusion in stroke patients. Clin Neurophysiol, 124(10), 2008–2015. doi: 10.1016/j.clinph.2013.03.030
14.
Hsu,S. S., Hu,M. H., Wang,Y. H., Yip,P. K., Chiu,J. W., & Hsieh,C. L. (2010). Dose-response relation between neuromuscular electrical stimulation and upper-extremity function in patients with stroke. Stroke, 41(4), 821–824. doi: 10.1161/STROKEAHA.109.574160
15.
Kwakkel,G., Kollen,B., & Twisk,J. (2006). Impact of time on improvement of outcome after stroke. Stroke, 37(9), 2348–2353. doi: 10.1161/01.STR.0000238594.91938.1e
16.
Kwakkel,G., Kollen,B. J., van der Grond,J., & Prevo,A. J. (2003). Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke, 34(9), 2181–2186. doi: 10.1161/01.STR.0000087172.16305.CD
17.
Morizawa,Y. M., Hirayama,Y., Ohno,N., Shibata,S., Shigetomi,E., Sui,Y.,. . . Koizumi,S. (2017). Reactive astrocytes function as phagocytes after brain ischemia via ABCA-1-mediated pathway. Nat Commun, 8(1), 28–10.1038/s41467-017-00037-1
18.
Nudo,R. J., Wise,B. M., SiFuentes,F., & Milliken,G. W. (1996). Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct. Science, 272(5269), 1791–1794. doi: 10.1126/science.272.5269.1791
19.
Powell,J., Pandyan,A. D., Granat,M., Cameron,M., & Stott,D. J. (1999). Electrical stimulation of wrist extensors in poststroke hemiplegia. Stroke, 30(7), 1384–1389. doi: 10.1161/01.str.30.7.1384
20.
Whitall,J. (2004). Stroke rehabilitation research: time to answer more specific questions?Neurorehabil Neural Repair, 18(1), 3–8; author reply 9-11. doi: 10.1177/0888439003262876
21.
Wilson,R. D., Page,S. J., Delahanty,M., Knutson,J. S., Gunzler,D. D., Sheffler,L. R., & Chae,J. (2016). Upper-Limb Recovery After Stroke: A Randomized Controlled Trial Comparing EMG-Triggered, Cyclic, and Sensory Electrical Stimulation. Neurorehabil Neural Repair, 30(10), 978–987. doi: 10.1177/1545968316650278
22.
Wolf,S. L., Catlin,P. A., Ellis,M., Archer,A. L., Morgan,B., & Piacentino,A. (2001). Assessing Wolf motor function test as outcome measure for research in patients after stroke. Stroke, 32(7), 1635–1639. doi: 10.1161/01.str.32.7.1635
