Contralaterally Controlled Functional Electrical Stimulation for Recovery of Elbow Extension and Hand Opening After Stroke

Abstract

Objective The aims of this study were to determine whether patients with moderate-to-severe upper limb hemiplegia could use contralaterally controlled functional electrical stimulation at the arm and the hand (Arm+Hand CCFES) at home and to evaluate the feasibility of the Arm+Hand CCFES to reduce arm and hand motor impairment. Design With the Arm+Hand CCFES, the paretic elbow and hand extensors were stimulated with intensities proportional to the degree of elbow extension and hand opening, respectively, of the contralateral unimpaired side. For 1 2 wks, four participants with chronic (≥6 mos) upper limb hemiplegia received ∼7 hrs per week of self-administered home-based stimulation-mediated elbow extension and hand opening exercise plus ∼2.5 hrs per week of therapist-supervised laboratory-based stimulation-assisted functional task practice. Assessments of upper limb impairment were made at pretreatment, posttreatment, and 1 mo after treatment. Results All four participants were able to use the Arm+Hand CCFES system at home either independently or with very minimal assistance from a caregiver. All four participants had increases in the Fugl-Meyer score (1–9 points) and the Wolf Motor Function Test (0.2–0.8 points) and varying degrees of improvement in maximum hand opening, maximum elbow extension, and simultaneous elbow extension and hand opening. Conclusions The Arm+Hand CCFES can be successfully administered in stroke patients with moderate-to-severe impairment and can reduce various aspects of upper limb impairment. A larger efficacy study is warranted.

An EMG-Controlled Robotic Hand Exoskeleton for Bilateral Rehabilitation

“…So EMG captured on the impaired hand can act both as a mean to guide the impaired limb by robotic assistance during manipulation tasks, where the control of grasping force is essential, and as an intrinsic measure of the interaction force with the environment during manipulation. This approach has been recently successfully evaluated within [27] in a stroke case study, where it has been shown how contralaterally controlled functional electrical stimulation can be used to reduce arm and hand motor impairment. In this study, paretic elbow and hand extensors of four stroke patients were stimulated with intensities proportional to the degree of elbow extension and hand opening, respectively, of the contralateral unimpaired side.…”

Comments to: ”Contralaterally controlled functional electrical stimulation improves wrist dorsiflexion un upper limb function in patients with early-phase stroke: A randomized controlled trial?”

“…Hospital of Nanjing Medical University, Nanjing, China E-mail: zhengyu8710@163.com it was safe for patients' skin (6). Knutson et al applied a pulse amplitude of 40 mA for all patients and 60 mA for one participant (7)(8)(9). Regarding the third point, the target population of the current study was early-phase stroke patients, most of whom were in the flaccid paralysis stage and therefore no patient with high muscular tension was observed.…”

Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke

“…Several groups, including our own (for a review, please refer to Cunningham et al 14 ), have suggested that bilateral therapies may be a useful/feasible alternative for such patients who suffer from extensive ipsilesional damage. For example, some bilateral therapies, such as active passive bilateral training 15,16 and contralaterally controlled functional electrical stimulation (CCFES) [17][18][19][20] use movement of the nonparetic limb to drive/assist in the movement of the paretic limb. Movement of the nonparetic limb may help recruit viable, uncrossed pathways projecting from the contralesional hemisphere to the paretic limb, and this may support recovery of the paretic limb.…”