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Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis: A
Jayme S Knutson1, Douglas D Gunzler2, Richard D Wilson2
1From the Department of Physical Medicine and Rehabilitation (J.S.K., R.D.W., J.C.), Department of Medicine (D.D.G.), and Department of Biomedical Engineering (J.C.), Case Western Reserve University, Cleveland, OH; Cleveland Functional Electrical Stimulation Center, OH (J.S.K., R.D.W., J.C.); and Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute of Ohio (J.S.K., R.D.W., J.C.) and the Center for Health Care Research and Policy (D.D.G.), MetroHealth Medical Center, Cleveland. jayme.knutson@case.edu.
Background And Purpose:
It is unknown whether one method of neuromuscular electrical stimulation for poststroke upper limb rehabilitation is more effective than another. Our aim was to compare the effects of contralaterally controlled functional electrical stimulation (CCFES) with cyclic neuromuscular electrical stimulation (cNMES).
Methods:
Stroke patients with chronic (>6 months) moderate to severe upper extremity hemiparesis (n=80) were randomized to receive 10 sessions/wk of CCFES- or cNMES-assisted hand opening exercise at home plus 20 sessions of functional task practice in the laboratory for 12 weeks. The task practice for the CCFES group was stimulation assisted. The primary outcome was change in Box and Block Test (BBT) score at 6 months post treatment. Upper extremity Fugl-Meyer and Arm Motor Abilities Test were also measured.
Results:
At 6 months post treatment, the CCFES group had greater improvement on the BBT, 4.6 (95% confidence interval [CI], 2.2-7.0), than the cNMES group, 1.8 (95% CI, 0.6-3.0), between-group difference of 2.8 (95% CI, 0.1-5.5), P=0.045. No significant between-group difference was found for the upper extremity Fugl-Meyer (P=0.888) or Arm Motor Abilities Test (P=0.096). Participants who had the largest improvements on BBT were <2 years post stroke with moderate (ie, not severe) hand impairment at baseline. Among these, the 6-month post-treatment BBT gains of the CCFES group, 9.6 (95% CI, 5.6-13.6), were greater than those of the cNMES group, 4.1 (95% CI, 1.7-6.5), between-group difference of 5.5 (95% CI, 0.8-10.2), P=0.023.
Conclusions:
CCFES improved hand dexterity more than cNMES in chronic stroke survivors.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00891319.
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