Advertisement

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
    Search for articles by this author
  • 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
    Search for articles by this author
  • Andrea Maesani
    Affiliations
    Intento SA, Ecublens, Switzerland
    Search for articles by this author
  • 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
    Search for articles by this author
  • Julien Moncharmont
    Affiliations
    Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
    Search for articles by this author
  • Stephanie Clarke
    Affiliations
    Neuropsychology and Neurorehabilitation Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
    Search for articles by this author
  • 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
    Search for articles by this author
  • 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
    Search for articles by this author
  • Author Footnotes
    ∗ Carda and Biasiucci contributed equally to this work.
    ‡ Murray and Millán contributed equally to this work.

      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)
      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:

      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

      References

        • Mozaffarian D.
        • Benjamin E.J.
        • Go A.S.
        • et al.
        Heart disease and stroke statistics—2016 update: a report from the American Heart Association.
        Circulation. 2016; 133: e38-e360
        • 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
        • Powell J.
        • Pandyan A.D.
        • Granat M.
        • Cameron M.
        • Stott D.J.
        Electrical stimulation of wrist extensors in poststroke hemiplegia.
        Stroke. 1999; 30: 1384-1389
        • Thrasher T.A.
        • Zivanovic V.
        • McIlroy W.
        • Popovic M.R.
        Rehabilitation of reaching and grasping function in severe hemiplegic patients using functional electrical stimulation therapy.
        Neurorehabil Neural Repair. 2008; 22: 706-714
        • Peckham P.H.
        • Knutson J.S.
        Functional electrical stimulation for neuromuscular applications.
        Annu Rev Biomed Eng. 2005; 7: 327-360
        • Pomeroy V.M.
        • King L.
        • Pollock A.
        • Baily-Hallam A.
        • Langhorne P.
        Electrostimulation for promoting recovery of movement or functional ability after stroke.
        Cochrane Database Syst Rev. 2006; : CD003241
        • Wilson R.D.
        • Page S.J.
        • Delahanty M.
        • et al.
        Upper-limb recovery after stroke: a randomized controlled trial comparing EMG-triggered, cyclic, and sensory electrical stimulation.
        Neurorehabil Neural Repair. 2016; 30: 978-987
        • Hu X.L.
        • Tong R.K.
        • Ho N.S.
        • Xue J.J.
        • Rong W.
        • Li L.S.
        Wrist rehabilitation assisted by an electromyography-driven neuromuscular electrical stimulation robot after stroke.
        Neurorehabil Neural Repair. 2015; 29: 767-776
        • Popovic D.B.
        • Popovic M.B.
        • Sinkjaer T.
        • Stefanovic A.
        • Schwirtlich L.
        Therapy of paretic arm in hemiplegic subjects augmented with a neural prosthesis: a cross-over study.
        Can J Physiol Pharmacol. 2004; 82: 749-756
        • Dobkin B.H.
        Progressive staging of pilot studies to improve phase III trials for motor interventions.
        Neurorehabil Neural Repair. 2009; 23: 197-206
        • Sanford J.
        • Moreland J.
        • Swanson L.R.
        • Stratford P.W.
        • Gowland C.
        Reliability of the Fugl-Meyer Assessment for testing motor performance in patients following stroke.
        Phys Ther. 1993; 73: 447-454
        • Uswatte G.
        • Taub E.
        • Morris D.
        • Light K.
        • Thompson P.A.
        The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke.
        Neurology. 2006; 67: 1189-1194
        • Morris D.M.
        • Taub E.
        • Mark V.W.
        Constraint-induced movement therapy: characterizing the intervention protocol.
        Eura Medicophys. 2006; 42: 257-268
        • Taub E.
        • Uswatte G.
        • Mark V.W.
        • et al.
        Method for enhancing real-world use of a more affected arm in chronic stroke: transfer package of constraint-induced movement therapy.
        Stroke. 2013; 44: 1383-1388
        • Page S.J.
        • Fulk G.D.
        • Boyne P.
        Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke.
        Phys Ther. 2012; 92: 791-798
        • Lin J.H.
        • Hsu M.J.
        • Sheu C.F.
        • et al.
        Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke.
        Phys Ther. 2009; 89: 840-850
        • Wagner J.M.
        • Rhodes J.A.
        • Patten C.
        Reproducibility and minimal detectable change of three-dimensional kinematic analysis of reaching tasks in people with hemiparesis after stroke.
        Phys Ther. 2008; 88: 652-663
        • Morris D.M.
        • Uswatte G.
        • Crago J.E.
        • Cook III, E.W.
        • Taub E.
        The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke.
        Arch Phys Med Rehabil. 2001; 82: 750-755
        • Platz T.
        • Vuadens P.
        • Eickhof C.
        • Arnold P.
        • Van Kaick S.
        • Heise K.
        REPAS, a summary rating scale for resistance to passive movement: item selection, reliability and validity.
        Disabil Rehabil. 2008; 30: 44-53
        • Bamford J.
        • Sandercock P.
        • Dennis M.
        • Burn J.
        • Warlow C.
        Classification and natural history of clinically identifiable subtypes of cerebral infarction.
        Lancet. 1991; 337: 1521-1526
        • Klamroth-Marganska V.
        • Blanco J.
        • Campen K.
        • et al.
        Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial.
        Lancet Neurol. 2014; 13: 159-166
        • Díaz-Uriarte R.
        Incorrect analysis of crossover trials in animal behaviour research.
        Anim Behav. 2002; 63: 815-822
        • Knutson J.S.
        • Harley M.Y.
        • Hisel T.Z.
        • Chae J.
        Improving hand function in stroke survivors: a pilot study of contralaterally controlled functional electric stimulation in chronic hemiplegia.
        Arch Phys Med Rehabil. 2007; 88: 513-520
        • Knutson J.S.
        • Gunzler D.D.
        • Wilson R.D.
        • Chae J.
        Contralaterally controlled functional electrical stimulation improves hand dexterity in chronic hemiparesis: a randomized trial.
        Stroke. 2016; 47: 2596-2602
        • Barsi G.I.
        • Popovic D.B.
        • Tarkka I.M.
        • Sinkjaer T.
        • Grey M.J.
        Cortical excitability changes following grasping exercise augmented with electrical stimulation.
        Exp Brain Res. 2008; 191: 57-66
        • Carrico C.
        • Chelette II, K.C.
        • Westgate P.M.
        • et al.
        Nerve stimulation enhances task-oriented training in chronic, severe motor deficit after stroke: a randomized trial.
        Stroke. 2016; 47: 1879-1884
        • Kwakkel G.
        • Winters C.
        • van Wegen E.E.
        • et al.
        Effects of unilateral upper limb training in two distinct prognostic groups early after stroke: the EXPLICIT-Stroke Randomized Clinical Trial.
        Neurorehabil Neural Repair. 2016; 30: 804-816
        • Stinear C.M.
        • Barber P.A.
        • Petoe M.
        • Anwar S.
        • Byblow W.D.
        The PREP algorithm predicts potential for upper limb recovery after stroke.
        Brain. 2012; 135: 2527-2535