Clinical note| Volume 93, ISSUE 11, P2122-2125, November 2012

Paretic Upper Extremity Movement Gains Are Retained 3 Months After Training With an Electrical Stimulation Neuroprosthesis


      Persch AC, Page SJ, Murray C. Paretic upper extremity movement gains are retained 3 months after training with an electrical stimulation neuroprosthesis.


      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).


      Prospective, blinded, cohort, pre-post study.


      Outpatient rehabilitation hospital.


      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).


      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).


      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).


      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 access
      One-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 to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kleindorfer D.
        • Broderick J.
        • Khoury J.
        • et al.
        The unchanging incidence and case-fatality of stroke in the 1990s: a population-based study.
        Stroke. 2006; 37: 2473-2478
        • Roger V.L.
        • Go A.S.
        • Lloyd-Jones D.M.
        • et al.
        • American Heart Association
        Heart disease and stroke statistics: 2011 update: A report from the American Heart Association.
        Circulation. 2011; 123: e18-e19
        • Hafsteinsdottir T.B.
        • Kappelle J.
        • Grypdonck M.H.
        • Algra A.
        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
        • Platz T.
        • Eickhof C.
        • van Kaick S.
        • et al.
        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
        • Hiraoka K.
        Rehabilitation effort to improve upper extremity function in post-stroke patients: a meta-analysis.
        J Phys Ther Sci. 2005; 13: 5-9
        • Stein J.
        • Narendran K.
        • McBean J.
        • Krebs K.
        • Hughes R.
        Electromyography controlled exoskeletal upper-limb–powered orthosis for exercise training after stroke.
        Am J Phys Med Rehabil. 2007; 86: 255-261
        • Hill-Hermann V.
        • Strasser A.
        • Albers B.
        • et al.
        Task-specific, patient-driven neuroprosthesis training in chronic stroke: results of a 3-week clinical study.
        Am J Occup Ther. 2008; 62: 466-472
        • Page S.J.
        • Maslyn S.
        • Hermann V.H.
        • Wu A.
        • Dunning K.
        • Levine P.G.
        Activity-based electrical stimulation training in a stroke patient with minimal movement in the paretic upper extremity.
        Neurorehabil Neural Repair. 2009; 23: 595-599
        • Alon G.
        • Levitt A.F.
        • McCarthy P.A.
        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
        • Page S.J.
        • Harnish S.
        • Lamy M.
        • Eliassen J.
        • Szaflarski J.
        Affected arm use, motor, and cortical change in stroke patients exhibiting minimal hand movement.
        Neurorehabil Neural Repair. 2010; 24: 195-203
        • Page S.J.
        • Levin L.
        • Hermann V.
        • Dunning K.
        • Levine P.
        Longer versus shorter daily durations of electrical stimulation during task specific practice in moderately impaired stroke.
        Arch Phys Med Rehabil. 2012; 93: 200-206
        • Fugl-Meyer A.R.
        • Jaasko L.
        • Leyman I.
        • Olsson S.
        • Steglind S.
        The post-stroke hemiplegic patient.
        Scand J Rehabil Med. 1975; 7: 13-31
        • Lyle R.C.
        A performance test for assessment of upper limb function in physical rehabilitation treatment and research.
        Int J Rehabil Res. 1981; 4: 483-492
        • Platz T.
        • Eichhof C.
        • Nuyens G.
        • Vuadens P.
        Clinical scales for the assessment of spasticity, associated with phenomena, and function: a systematic review of the literature.
        Disabil Rehab. 2005; 27: 7-18
        • Kopp B.
        • Kunkel A.
        • Flor H.
        • et al.
        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
        • Brogårdh C.
        • Flansbjer U.B.
        • Lexell J.
        What is the long-term benefit of constraint-induced movement therapy?.
        Clin Rehabil. 2009; 23: 418-423
        • van der Lee J.H.
        • Wagenaar R.C.
        • Lankhorst G.J.
        • Vogelaar T.W.
        • Deville W.L.
        • Bouter L.M.
        Forced use of the upper extremity in chronic stroke patients.
        Stroke. 1999; 30: 2369-2375
        • Page S.J.
        • Murray C.
        • Hermann V.
        Affected upper extremity movement ability is retained 3 months after modified constraint-induced therapy.
        Am J Occup Ther. 2011; 65: 589-593
        • Nudo R.J.
        NeuroRx. 2006; 3: 420-427