Using Electrical Stimulation to Improve Performance of Functional Bimanual Tasks in Individuals with Moderate to Severe Stroke.

Research Report
Population: Adult

Carolina Carmona, PT, DPT, NCS, Physical Therapist 2, Northwestern Univeristy–Department of Physical Therapy & Human Movement Sciences ccarmona@northwestern.edu

Julius Dewald, PT, PhD, Professor and Chair Physical Therapy & Human Movement Sciences, Northwestern University- Department of Physical Therapy & Human Movement Sciences j-dewald@northwestern.edu

Jane Sullivan, PT, DHS, MS, Assistant Department Chair – Recruiting & Admissions, Northwestern University- Department of Physical Therapy & Human Movement Sciences j-sullivan@northwestern.edu

Jun Yao, PhD, Assistant Professor, Northwestern University- Department of Physical Therapy & Human Movement Sciences j-yao4@northwestern.edu

Keywords: Plasticity, Stroke, Electrical Stimulation, Bimanual Task

Purpose/Hypothesis: Following stroke, only 50% will regain some hand use. Although, the literature supports the use of EMG-triggered electrical stimulation (ES) in the treatment of the hemiplegic wrist and forearm (Level 1 evidence), further research is needed to determine if bilateral functional hand training with ES is more effective than conventional care. The aim of this pilot study is, therefore, to demonstrate that ES with smart control, which allows for the usage of the paretic hand during functional bimanual tasks, may deliver effective interventions for hand’s function recovery. We hypothesize that ES with smart control will decrease task completion time, as well as create a carry-over effect in time during post-ES trials.

Subjects: A total of 9 participants were recruited for this pilot study. All participants had chronic stroke (>12 months), a moderate to severe arm impairment (Fugl-Meyer scores <37, Chedoke-McMaster scores 2, 3), and were able to achieve some hand opening with ES.

Materials/Methods: All participants performed 4 functional tasks (opening a jar, picking up a telephone, applying toothpaste onto a toothbrush, and using a fork and knife to cut a piece of Play-Doh®) in random order. For each task, subjects were trained to perform the functional tasks with minimal time in 3 sessions: pre-ES (4 trials), with ES (3 trials), followed by a post-ES condition (2 trials without ES). During the ES session, a researcher triggered the ES to assist hand opening, when s/he saw the need to open the paretic hand. We measured the time to perform these functional tasks with and without ES to the finger extensors. The time used during the first trial of a task was removed, and subsequent trails averaged for each condition.

Results: Two-factor repeated measures ANOVA with repeated measures of 4 functional tasks during 3 sessions (pre-ES, ES and post-ES) showed that the session has a significant effect on within-subject task completion time (p=.011). Post-hoc paired t-test showed a significant reduction in time required to complete the tasks in post-ES trials as compared to pre-ES trials (p<0.01, time reduction = 14.83%), and a clear trend in reduced time in ES trials as compared to pre-ES trials (p<0.1, time reduction = 7.16%).

Conclusion: Results of our study demonstrated that individuals with moderate to severe chronic stroke were still able to reduce the time to perform a functional bimanual task, with the assistance of an ES with smart control.

Recovery of finger extension is crucial for improvement of hand function after stroke. Recent evidence suggests that individuals with moderate to severe stroke may benefit from interventions such that include Functional Electrical Stimulation to improve the hemiparetic hand function. The use of EMG-triggered electrical stimulation (ES) as an intervention in this population, should continue to be investigated as a potential means of rehabilitation.

KEYWORDS: Stroke, Electrical Stimulation, Bimanual Tasks.

Citation:
Carmona, Carolina , PT, DPT, NCS; Dewald, Julius P.A., PT, PhD; Sullivan, Jane E, PT, DHS, MS; Yao, Jun , PhD. Using Electrical Stimulation to Improve Performance of Functional Bimanual Tasks in Individuals with Moderate to Severe Stroke.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/032_carmona-et-al/

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