Motor Improvement and Corticospinal Modulation Induced by Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) Therapy in Patients With Chronic Stroke

Abstract

The combination of hand splint and volitional and electrically induced muscle contraction can induce corticospinal plasticity and may offer a promising option for the management of the paretic UE in patients with stroke. A larger sample size with randomized controls is needed to demonstrate effectiveness.

Effects of Integrated Volitional Control Electrical Stimulation (IVES) on Upper Extremity Function in Chronic Stroke

“…In fact, once the clinician has set up the portable stimulator device, the patient can exercise on their own with the IVES system, and the individual settings need to be reset only with respect to the recovery of voluntary movements. These aspects, together with the proven therapeutic efficacy of IVES on the paretic upper limb, [7][8][9] suggest that the device can be effectively used in stroke rehabilitation programs.…”

“…Furthermore, the improvement of abnormal coactivation of the wrist muscles suggests that the continuous sensory input by IVES may have an important effect on the improvement of voluntary movements, facilitation of reciprocal inhibition 18 and recurrent inhibition, 19 and intensive sensory fiber activation. 20 Fujiwara et al 9 reported that treatment with IVES combined with a wrist-hand splint induced restoration of presynaptic and long loop inhibitory connections as well as disynaptic reciprocal inhibition. Previous studies 3,5,7,8 have demonstrated that electrical stimulation combined with volitional efforts or additional therapy is more effective than electrical stimulation alone in the recovery process.…”

Effects of Functional Electrical Stimulation with and without a Wrist-Hand Orthosis on Hand Opening in Individuals with Chronic Hemiparetic Stroke: A Pilot Study

“…This additional assistance for wrist extension may or may not improve purposeful use of the paretic arm, depending on how such device will interfere with the hand opening ability. Previous reports showed the combined use of a WHO with wrist/finger extension FES enhanced hand function [11,12]. However, post-stroke stiffness or shortening in the long finger flexor muscles/tendons may result in finger flexion during wrist extension.…”

Improvements in Quality of Life in Individuals with Friedreich’s Ataxia after Participation in a 5-Year Program of Physical Activity: An observational Study Pre-Post Test Design, and Two Years Follow-Up

“…One of the things we know about neural plasticity is that it is enhanced by new behavioral learning, rather than just repetition of exercises/activities in the absence of learning [36], supporting the hypothesis that's implemotor activity is insufficient to produce long-term plasticity in cortical representations. In turn, this would explain the clinical improvement observed following participation in physical programs, the improvement being attributable to the plasticity of the central nervous system, which ensures that when certain neurons lose their function, others take over their role [37][38][39][40]. Further, voluntary learning and re-learning of lost or impaired skills, by the continuous repetition of tasks requiring neurological functions affected by the disease and retraining of functional patterns, could also improve the quality of life of these patients [37][38][39][40].…”

“…In turn, this would explain the clinical improvement observed following participation in physical programs, the improvement being attributable to the plasticity of the central nervous system, which ensures that when certain neurons lose their function, others take over their role [37][38][39][40]. Further, voluntary learning and re-learning of lost or impaired skills, by the continuous repetition of tasks requiring neurological functions affected by the disease and retraining of functional patterns, could also improve the quality of life of these patients [37][38][39][40]. In particular, stimulation of proprioceptive pathways could improve balance.…”