Category: Stroke; Neuroplasticity (includes neuroscience); Cross-Cutting
Objective : To determine the effect of cyclic neuromuscular electrical stimulation (NMES), electromyographically (EMG)-triggered NMES, and sensory stimulation on motor impairment and activity limitations in patients with upper-limb hemiplegia.
Design : This was a multicenter, single-blind, multiarm parallel-group study of nonhospitalized hemiplegic stroke survivors within 6 months of stroke
Setting : Three outpatient rehabilitation hospitals in the United States.
Participants (or Animals, Specimens, Cadavers) : The nurse coordinator and the blinded assessor at each site determined eligibility using the above screening criteria. Participants who satisfied study criteria underwent baseline assessment prior to randomization. Once the candidate enrolled and completed baseline assessment, the treating therapist, who was not blinded, assigned participants to treatment groups via a computer generated random permuted blocked randomization sequence (in blocks of 6) for each of the sites.
Out of a total of 1,197 stroke survivors that were pre-screened for eligibility, 122 met study criteria, agreed to participate and were randomized. Time from stroke at enrollment ranged from 12 days to 6.0 months. 109 (89.3%) participants completed the treatment interventions as assigned, and 83 (68.0%) completed all outcomes assessments. The demographic characteristics were similar among the treatment groups
Interventions : Subjectswere randomized to receive either cyclic NMES, EMG-triggered NMES, or sensory stimulation twice every weekday in 40-minute sessions, over an 8 week-period. Patients were followed for 6 months after treatment concluded.
Main Outcome Measure(s) : Fugl-Meyer Assessment (FMA), modified Arm Motor Ability Test.
Results : There were significant increases in the Fugl-Meyer Assessment [F(1, 111) = 92.6, P < .001], FMA Wrist and Hand [F(1, 111) = 66.7, P < .001], and modified Arm Motor Ability Test [mAMAT; time effect: F(1, 111) = 91.0, P < .001] for all 3 groups. There was no significant difference in the improvement among groups in the FMA [F(2, 384) = 0.2, P = .83], FMA Wrist and Hand [F(2, 384) = 0.4, P = .70], or the mAMAT [F(2, 379) = 1.2, P = .31]
Conclusions : All groups exhibited significant improvement of impairment and functional limitation with electrical stimulation therapy. Improvements were likely a result of spontaneous recovery. There was no difference based on the type of electrical stimulation that was administered
Richard Wilson– ASSISTANT PROFESSOR, METROHEALTH, Cleveland, Ohio
John Chae– PROFESSOR, METROHEALTH, CLEVELAND, Ohio
Stephen Page– Professor, The Ohio State University College of Medicine, Columbus, Ohio
STEPHEN Page– Professor, OHIO STATE UNIVERSITY, COLUMBUS, Ohio