Article
A functional electric stimulation—assisted exercise therapy system for hemiplegic hand function1☆,

Presented in part at the Society for Neuroscience’s 31st Annual Meeting, November 11, 2001, San Diego, CA.
https://doi.org/10.1016/j.apmr.2003.08.094Get rights and content

Abstract

Gritsenko V, Prochazka A. A functional electric stimulation—assisted exercise therapy system for hemiplegic hand function. Arch Phys Med Rehabil 2004;85:881–5.

Objective

To test a functional electric stimulation (FES)–assisted exercise therapy system for improvement of motor function of the hemiplegic upper extremity.

Design

A before-after trial, with 2-month follow-up.

Setting

A university research laboratory.

Participants

A convenience sample of 6 subjects (3 men, 3 women). Main inclusion criteria were that stroke had occurred more than 1 year before the study (mean time poststroke, 5.6±4.4y) and had resulted in hemiplegia, and that FES produced adequate hand opening.

Intervention

A prototype workstation with instrumented objects was used by subjects to perform a set of tasks with their affected hand during 1-hour sessions for 12 consecutive workdays. A FES stimulator was used to assist hand opening.

Main outcome measures

Kinematic data, provided by the workstation sensors, and 3 clinical tests.

Results

Kinematic data indicated statistically significant improvement in subjects’ performance (pre-/posttreatment effect size [pre/post ES] of the mean performance scores=5.46; mean pretreatment/follow-up ES [pre/FU ES]=3.44). Two of 3 clinical tests showed improvement in hand function (mean pre/post ES=.51; mean pre/FU ES=.61).

Conclusions

Improvement in hemiplegic hand function because of FES-assisted therapy was documented in a small group of people with hemiplegia whose motor impairment would exclude them from participation in constraint-induced movement therapy. However, the long-term clinical relevance of such improvement needs further study.

Section snippets

System

The therapeutic system consisted of a workstation and an FES stimulator. The workstation included a desk with a number of instrumented objects (fig 1). The objects were chosen to represent household items, manipulation of which would require movements of the whole upper extremity in various configurations. A spring-loaded doorknob and a handle attached via a cord and pulley to an adjustable set of weights were instrumented with potentiometers, which allowed us to monitor their displacement and

Results

Figure 2 shows the FP scores of 6 subjects using the workstation for 12 days and the FP scores of 4 subjects using the workstation on a follow-up session (day 72). Figure 2A shows individual FP scores, whereas figure 2B shows the FP scores averaged over all subjects. The data show gradual improvement in subjects’ performance with continued use of the workstation. The maximum change in the mean FP scores between the first and the last day of exercises was 287% (pre-/posttreatment effect size

Discussion

This pilot study indicated that 12 hours of exercise on the workstation was associated with modest improvements in upper-extremity function in 6 subjects with chronic hemiplegia. Workstation sensors recorded statistically significant improvement in hand function in all 6 subjects. All subjects included in the study were more than a year poststroke, at which time no spontaneous recovery is expected.9 Therefore, we believe that the quantitative results represent genuine improvements in hemiplegic

Conclusions

Our study showed that the use of FES-assisted exercise therapy in conjunction with an instrumented workstation was associated with improvements in hand function in a group of hemiplegic people whose level of motor function would have excluded them from CIMT. The eventual goal of this research is to provide workstations for home use that will allow people with hemiplegia to engage in regular teletherapy sessions to improve upper-extremity function.

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Acknowledgements

We thank Dr. Anne Bellamy, Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, for her positive suggestions and critical comments. We thank Allen Denington, Michel Gauthier, and Sam Chhibber for their help with design of the workstation and Sergiy Yakovenko for his assistance with data analysis.

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☆

Supported by Canadian Institute of Health Research (grant no. G118160323) and Heart and Stroke Foundation of Canada (scholarship no. G513000065).

1

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

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Copyright © 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.