Abstract
Persch AC, Page SJ, Murray C. Paretic upper extremity movement gains are retained
3 months after training with an electrical stimulation neuroprosthesis.
Objective
To determine retention of upper extremity (UE) motor changes 3 months after participation
in a regimen in which subjects with moderate UE hemiparesis engaged in repetitive
task-specific training using an electrical stimulation neuroprosthesis (ESN).
Design
Prospective, blinded, cohort, pre-post study.
Setting
Outpatient rehabilitation hospital.
Participants
Individuals (N=24) in the chronic stage of stroke exhibiting stable UE hemiparesis
(11 men; mean age, 57.9±9.5y; age range, 39–75y; mean time since stroke at time of
repetitive task-specific practice [RTP] using ESN intervention start, 36.7mo; range
of onset, 7–162mo).
Intervention
As part of a larger trial, subjects had been randomly assigned to receive an 8-week
regimen comprised of RTP on valued activities using the ESN. This observational study
assessed this single group's paretic UE motor levels immediately after, and 3 months
after, the intervention.
Main Outcome Measures
The Fugl-Meyer (FM) assessment of sensorimotor impairment, the Action Research Arm
Test (ARAT), the Arm Motor Ability Test (AMAT), and the Box and Block Test (BBT).
Results
None of the scores significantly changed from the period directly after intervention
to the test 3-months follow-up (FM: t=1.64; ARAT: t=2.17; AMAT: t=.76, .92, and 1.01 for the functional ability, quality of movement, and time scales,
respectively; BBT: t=.36; adjusted t critical value to reject the null [tcrit]=2.90, 2-tailed α=.008 to preserve experiment-wise error rate of .05).
Conclusions
Subjects exhibited no changes in the various functional tests, indicating that changes
in paretic UE movement realized through RTP using ESN appear to be retained 3 months
after the intervention has concluded. This was the first study to our knowledge to
examine the longer-term effects of RTP using an ESN in any population.
Key Words
List of Abbreviations:
AMAT (Arm Motor Ability Test), ARAT (Action Research Arm Test), ESN (electrical stimulation neuroprosthesis), FM (Fugl-Meyer), RTP (repetitive task-specific practice), UE (upper extremity)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The unchanging incidence and case-fatality of stroke in the 1990s: a population-based study.Stroke. 2006; 37: 2473-2478
- Heart disease and stroke statistics: 2011 update: A report from the American Heart Association.Circulation. 2011; 123: e18-e19
- Effects of Bobath-based therapy on depression, shoulder pain and health-related quality of life in patients after stroke.J Rehabil Med. 2007; 39: 627-632
- Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial.Clin Rehabil. 2005; 19: 714-724
- Rehabilitation effort to improve upper extremity function in post-stroke patients: a meta-analysis.J Phys Ther Sci. 2005; 13: 5-9
- Electromyography controlled exoskeletal upper-limb–powered orthosis for exercise training after stroke.Am J Phys Med Rehabil. 2007; 86: 255-261
- Task-specific, patient-driven neuroprosthesis training in chronic stroke: results of a 3-week clinical study.Am J Occup Ther. 2008; 62: 466-472
- Activity-based electrical stimulation training in a stroke patient with minimal movement in the paretic upper extremity.Neurorehabil Neural Repair. 2009; 23: 595-599
- Functional electrical stimulation (FES) may modify the poor prognosis of stroke survivors with severe motor loss of the upper extremity: a preliminary study.Am J Phys Med Rehabil. 2008; 87: 627-636
- Affected arm use, motor, and cortical change in stroke patients exhibiting minimal hand movement.Neurorehabil Neural Repair. 2010; 24: 195-203
- Longer versus shorter daily durations of electrical stimulation during task specific practice in moderately impaired stroke.Arch Phys Med Rehabil. 2012; 93: 200-206
- The post-stroke hemiplegic patient.Scand J Rehabil Med. 1975; 7: 13-31
- A performance test for assessment of upper limb function in physical rehabilitation treatment and research.Int J Rehabil Res. 1981; 4: 483-492
- Clinical scales for the assessment of spasticity, associated with phenomena, and function: a systematic review of the literature.Disabil Rehab. 2005; 27: 7-18
- The Arm Motor Ability Test: reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living.Arch Phys Med Rehabil. 1997; 78: 615-620
- What is the long-term benefit of constraint-induced movement therapy?.Clin Rehabil. 2009; 23: 418-423
- Forced use of the upper extremity in chronic stroke patients.Stroke. 1999; 30: 2369-2375
- Affected upper extremity movement ability is retained 3 months after modified constraint-induced therapy.Am J Occup Ther. 2011; 65: 589-593
- Plasticity.NeuroRx. 2006; 3: 420-427
Article info
Publication history
Published online: June 22, 2012
Footnotes
Supported by the American Heart Association.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
In-press corrected proof published online on Aug 9, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
