Electrical Stimulation and a Dynamic Orthosis for Stroke Recovery
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Objective: To explore the effectiveness of a combined neuromuscular electrical stimulation
      (ES) and dynamic hand orthosis (DHO) regimen used with a small group of persons with chronic
      stroke in improving ability to perform daily tasks. Method: Four participants with chronic
      stroke participated in the combined ES-DHO regimen using the affected upper extremity (UE)
      five times (5X) per week for 6 weeks. Outcome measures included grip strength, range of
      motion (ROM), and analysis of muscle activation/deactivation during release of grasp through
      electromyography (EMG). Ability to perform daily functional tasks was assessed using the
      Assessment of Motor and Process Skills (AMPS). Results: Preliminary results suggest that
      improvements in strength, ROM and grasp deactivation are possible with the combined ES-DHO
      regimen. Ability to perform daily functional tasks improved in all participants. Conclusion:
      Results should be interpreted cautiously due to the pilot nature of the study and small
      participant number. Further research in this area is warranted.
    

Detailed description: 
      The purpose of this pilot study was to explore the outcomes on performance of functional
      daily living tasks following a six-week combined regimen using ES and the SaeboFlex orthosis
      with repetitive task training (RTT) in four persons with chronic stroke. Functional outcomes
      were assessed before and after (pre-post design) a six-week combined treatment regimen using
      the DHO during RTT followed by a regimen of ES. Feasibility and logistics for translation of
      these preliminary results to a larger, more comprehensive controlled trial were explored.
      Participants donned the orthosis on the affected upper extremity with therapist assistance
      and performed the RTT grasp/release practice daily for 30 minutes, 5X/week for 6 weeks (30
      sessions).Following completion of the grasp/release practice, ES to the finger extensor
      muscles was provided for 15 minutes. Goniometry to measure range of motion (ROM) at wrist and
      fingers, dynamometry to measure hand strength, electromyography (EMG) collection to measure
      muscle activation/deactivation, and AMPS testing to measure functional activity performance
      were performed before starting the intervention (baseline) and one day after the final
      training session. Gains in grip strength, 3rd metacarpophalangeal (MP) flexion, AMPS motor
      score, and improved deactivation of grasp were observed in all participants. Wrist extension,
      3rd MP extension, AMPS process score, EMG root mean square (RMS) and time to release grasp
      improved in three of the four participants.These preliminary pilot results begin to suggest
      that gains can be made in impairment areas of strength, ROM, and the functional movement
      pattern of grasp release with a combined ES-DHO program in individuals with chronic stroke.
      Perhaps most importantly, the results may indicate that this type of training may translate
      to improvement in performance of daily living tasks. Completion of this work suggests that a
      larger trial is feasible and logistically able to be performed. The preliminary data are
      limited in that only four volunteers with chronic stroke were studied, so the small numbers
      involved restrict generalizations of effectiveness and comprehensive analysis of outcomes.
    

Intervention name(s): Electrical stimulation-dynamic hand orthosis
Intervention type(s): Other
Intervention description(s): Each participant participated in the electrical stimulation-dynamic hand orthosis regimen. Repetitive grasp/release motions were performed for 30 minutes while wearing the dynamic hand orthosis. This was followed by 15 minutes of electrical stimulation applied to forearm extensor muscles. This regimen was performed daily, 5X/week for 6 weeks.
Other intervention name(s): Empi 300PV neuromuscular electrical stimulation unit; SaeboFlex dynamic hand orthosis
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: stroke; upper extremity function; rehabilitation