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Contralaterally Controlled Functional Electrical Stimulation for Recovery of Elbow Extension and Hand Opening After Stroke: A Pilot Case Series Study

Knutson, Jayme S. PhD; Harley, Mary Y. OT/L; Hisel, Terri Z. OTR/L; Makowski, Nathaniel S. PhD; Chae, John MD

American Journal of Physical Medicine & Rehabilitation: June 2014 - Volume 93 - Issue 6 - p 528–539
doi: 10.1097/PHM.0000000000000066
Case Series

Objective The aims of this study were to determine whether patients with moderate-to-severe upper limb hemiplegia could use contralaterally controlled functional electrical stimulation at the arm and hand (Arm+Hand CCFES) at home and to evaluate the feasibility of Arm+Hand CCFES to reduce arm and hand motor impairment.

Design With Arm+Hand CCFES, the paretic elbow and hand extensors were stimulated with intensities proportional to the degree of elbow extension and hand opening, respectively, of the contralateral unimpaired side. For 12 wks, four participants with chronic (≥6 mos) upper limb hemiplegia received ∼7 hrs per week of self-administered home-based stimulation-mediated elbow extension and hand opening exercise plus ∼2.5 hrs per week of therapist-supervised laboratory-based stimulation-assisted functional task practice. Assessments of upper limb impairment were made at pretreatment, posttreatment, and 1 mo after treatment.

Results All four participants were able to use the Arm+Hand CCFES system at home either independently or with very minimal assistance from a caregiver. All four participants had increases in the Fugl-Meyer score (1–9 points) and the Wolf Motor Function Test (0.2–0.8 points) and varying degrees of improvement in maximum hand opening, maximum elbow extension, and simultaneous elbow extension and hand opening.

Conclusions Arm+Hand CCFES can be successfully administered in stroke patients with moderate-to-severe impairment and can reduce various aspects of upper limb impairment. A larger efficacy study is warranted.

From the Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio (JSK, JC); Cleveland Functional Electrical Stimulation Center, Cleveland, Ohio (JSK, NSM, JC); Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute of Ohio, MetroHealth Medical Center, Cleveland, Ohio (JSK, MYH, TZH, JC); and Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio (NSM).

All correspondence and requests for reprints should be addressed to Jayme S. Knutson, PhD, Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute of Ohio, 4229 Pearl Rd, Suite N527, Cleveland, OH 44109.

Supported by the National Institutes of Health (NIH) National Institute of Child Health and Human Development (NICHD) grant number R01HD059814. The stimulators used in this study were developed and provided by the Technical Development Laboratory of the Cleveland FES Center and are limited by federal law to investigational use.

Portions of this work were published as part of an abstract at the 34th Annual International Conference of the IEEE EMBS, San Diego, CA, August 28 to September 1, 2012.

Jayme S. Knutson, PhD, and John Chae, MD, are coinventors on the CCFES patent assigned to Case Western Reserve University, Patent 8,165,685: System and Method for Therapeutic Neuromuscular Electrical Stimulation.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2014 by Lippincott Williams & Wilkins