[Development of newer rehabilitative measures for hemiparetic upper limb after stroke]

Because recovery of upper extremity (UE) function to a practical level has been difficult in many stroke patients, compensatory approaches have been emphasized. Based on researches indicating greater potential for brain plasticity, newer approaches targeting at functional restoration have been attempted. However, no intervention has been shown to be effective to improve hand function. We therefore devised a therapeutic approach to facilitate the use of the hemiparetic hand in daily life by combining EMG triggered electrical stimulation with a wrist splint, called hybrid assistive neuromuscular dynamic stimulation (HANDS). With HANDS, we demonstrated improved motor function, spasticity, functional scores and neurophysiological parameters in chronic stroke. With a RCT, we also demonstrated its effectiveness in subacute stroke. However, to be its candidates, electromyogram must be recorded from finger extensors, and it cannot be applied to patients with complete paralysis. For them, we recently developed a Brain Machine Interface (BMI) neurorehabilitation system. Based on analysis of volitionally decreased amplitudes of sensory motor rhythm during motor imagery involving extending the affected fingers, real-time visual feedback is provided. In patients with severe hemiparesis, we demonstrated its effectiveness with clinical scales, neuroimaging and electrophysiological studies. These newer interventions might offer useful neurorehabilitative tools for hemiparetic UE.