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Original research| Volume 98, ISSUE 8, P1628-1635.e2, August 01, 2017

Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study

  • Author Footnotes
    ∗ Carda and Biasiucci contributed equally to this work.
    Stefano Carda
    Correspondence
    Corresponding author Stefano Carda, MD, PhD, Service de neuropsychologie et de neuroréhabilitation, CHUV, Av. Pierre-Decker 5, CH-1011 Lausanne, Switzerland.
    Footnotes
    ∗ Carda and Biasiucci contributed equally to this work.
    Affiliations
    Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
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  • Author Footnotes
    ∗ Carda and Biasiucci contributed equally to this work.
    Andrea Biasiucci
    Footnotes
    ∗ Carda and Biasiucci contributed equally to this work.
    Affiliations
    Intento SA, Ecublens, Switzerland
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  • Andrea Maesani
    Affiliations
    Intento SA, Ecublens, Switzerland
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  • Silvio Ionta
    Affiliations
    Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland

    The Laboratory for Investigative Neurophysiology, Department of Radiology and Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland

    Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
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  • Julien Moncharmont
    Affiliations
    Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
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  • Stephanie Clarke
    Affiliations
    Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
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  • Author Footnotes
    ‡ Murray and Millán contributed equally to this work.
    Micah M. Murray
    Footnotes
    ‡ Murray and Millán contributed equally to this work.
    Affiliations
    Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland

    The Laboratory for Investigative Neurophysiology, Department of Radiology and Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland

    EEG Brain Mapping Core, Center for Biomedical Imaging, Lausanne, Switzerland

    Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN

    Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
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  • Author Footnotes
    ‡ Murray and Millán contributed equally to this work.
    José del R. Millán
    Footnotes
    ‡ Murray and Millán contributed equally to this work.
    Affiliations
    Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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  • Author Footnotes
    ∗ Carda and Biasiucci contributed equally to this work.
    ‡ Murray and Millán contributed equally to this work.
Published:May 09, 2017DOI:https://doi.org/10.1016/j.apmr.2017.02.020
Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study
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      Abstract

      Objective

      To evaluate the effects of electrically assisted movement therapy (EAMT) in which patients use functional electrical stimulation, modulated by a custom device controlled through the patient's unaffected hand, to produce or assist task-specific upper limb movements, which enables them to engage in intensive goal-oriented training.

      Design

      Randomized, crossover, assessor-blinded, 5-week trial with follow-up at 18 weeks.

      Setting

      Rehabilitation university hospital.

      Participants

      Patients with chronic, severe stroke (N=11; mean age, 47.9y) more than 6 months poststroke (mean time since event, 46.3mo).

      Interventions

      Both EAMT and the control intervention (dose-matched, goal-oriented standard care) consisted of 10 sessions of 90 minutes per day, 5 sessions per week, for 2 weeks. After the first 10 sessions, group allocation was crossed over, and patients received a 1-week therapy break before receiving the new treatment.

      Main Outcome Measures

      Fugl-Meyer Motor Assessment for the Upper Extremity, Wolf Motor Function Test, spasticity, and 28-item Motor Activity Log.

      Results

      Forty-four individuals were recruited, of whom 11 were eligible and participated. Five patients received the experimental treatment before standard care, and 6 received standard care before the experimental treatment. EAMT produced higher improvements in the Fugl-Meyer scale than standard care (P<.05). Median improvements were 6.5 Fugl-Meyer points and 1 Fugl-Meyer point after the experimental treatment and standard care, respectively. The improvement was also significant in subjective reports of quality of movement and amount of use of the affected limb during activities of daily living (P<.05).

      Conclusions

      EAMT produces a clinically important impairment reduction in stroke patients with chronic, severe upper limb paresis.

      Keywords

      List of abbreviations:

      ADL (activities of daily living), EAMT (electrically assisted movement therapy), FES (functional electrical stimulation), FMA-UE (Fugl-Meyer Assessment of the Upper Extremity), MAL (Motor Activity Log), MCID (minimal clinically important difference), MDC (minimum detectable change), SC (standard care)
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      Article Info

      Publication History

      Published online: May 09, 2017

      Footnotes

      Supported by the Commission for Technology and Innovation of the Swiss Confederation, by Swiss National Science Foundation and International Foundation for Research in Paraplegia grants, and by the Swiss National Science Foundation (grant no. 320030-149982 and Ambizione founding program PZ00P1_148186) and Carigest SA. The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

      Clinical Trial Registration No.: NCT02563886.

      Disclosures: A.B. and A.M. are shareholders of Intento SA. The other authors have nothing to disclose.

      Identification

      DOI: https://doi.org/10.1016/j.apmr.2017.02.020

      Copyright

      © 2016 by the American Congress of Rehabilitation Medicine

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