Upper-Extremity Functional Electric Stimulation–Assisted Exercises on a Workstation in the Subacute Phase of Stroke Recovery

Abstract 

Kowalczewski J, Gritsenko V, Ashworth N, Ellaway P, Prochazka A. Upper-extremity functional electric stimulation−assisted exercises on a workstation in the subacute phase of stroke recovery.

Objective

To test the efficacy of functional electric stimulation (FES)−assisted exercise therapy (FES-ET) on a workstation in the subacute phase of recovery from a stroke.

Design

Single-blind, randomly controlled comparison of high- and low-intensity treatment.

Setting

Laboratory in a rehabilitation hospital.

Participants

Nineteen stroke survivors (10 men, 9 women; mean age ± standard deviation, 60.6±5.8y), with upper-extremity hemiplegia (mean poststroke time, 48±17d). The main inclusion criteria were: stroke occurred within 3 months of onset of trial and resulted in severe upper-limb dysfunction, and FES produced adequate hand opening.

Intervention

An FES stimulator and an exercise workstation with instrumented objects were used by 2 groups to perform specific motor tasks with their affected upper extremity. Ten subjects in the high-intensity FES-ET group received FES-ET for 1 hour a day on 15 to 20 consecutive workdays. Nine subjects in the low-intensity FES-ET group received 15 minutes of sensory electric stimulation 4 days a week and on the fifth day they received 1 hour of FES-ET.

Main Outcome Measures

Primary outcome measure included the Wolf Motor Function Test (WMFT). Secondary outcome measures included the Motor Activity Log (MAL), the upper-extremity portion of the Fugl-Meyer Assessment (FMA), and the combined kinematic score (CKS) derived from workstation measurements. The WMFT, MAL, and FMA were used to assess function in the absence of FES whereas CKS was used to evaluate function assisted by FES.

Results

Improvements in the WMFT and CKS were significantly greater in the high-intensity group (post-treatment effect size, .95) than the low-intensity group (post-treatment effect size, 1.3). The differences in MAL and FMA were not statistically significant.

Conclusions

Subjects performing high-intensity FES-ET showed significantly greater improvements on the WMFT than those performing low-intensity FES-ET. However, this was not reflected in subjects’ self-assessments (MAL) or in their FMA scores, so the clinical significance of the result is open to debate. The CKS data suggest that high-intensity FES-ET may be advantageous in neuroprosthetic applications.

Key Words: Electric stimulation therapy, Hemiplegia, Rehabilitation, Stroke