Longer Versus Shorter Daily Durations of Electrical Stimulation During Task-Specific Practice in Moderately Impaired Stroke

• Published in: Archives of physical medicine and rehabilitation Vol. 93; no. 2; pp. 200 - 206
• Main Authors: Page, Stephen J., PhD, MS, S/OT, Levin, Linda, PhD, Hermann, Valerie, MS, OTR/L, Dunning, Kari, PhD, PT, Levine, Peter, BA, PTA
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-02-2012; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Disability Evaluation; Diseases of the osteoarticular system; Electric stimulation; Electric Stimulation Therapy - methods; Female; Hemiplegia; Hemiplegia - physiopathology; Hemiplegia - rehabilitation; Humans; Male; Medical sciences; Middle Aged; Motor Skills Disorders - physiopathology; Motor Skills Disorders - rehabilitation; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Neuropsychological Tests; Occupational therapy; Physical Medicine and Rehabilitation; Physical Therapy Modalities; Prospective Studies; Rehabilitation; Single-Blind Method; Stroke; Stroke - physiopathology; Stroke Rehabilitation; Time Factors; Upper Extremity - physiopathology; Vascular diseases and vascular malformations of the nervous system; AMAT; PRE; POST; FM; home exercise program; Canadian Occupational Performance Measure; RTP; Action Research Arm Test; Fugl-Meyer Assessment of Sensorimotor Impairment; UE; Box and Block; electrical stimulation neuroprosthesis; Hemiplegia; Occupational therapy; Electric stimulation; B&B; upper extremity; ESN; Stroke; repetitive task-specific practice; Arm Motor Ability Test; HEP; mean score obtained during pretesting period; COPM; mean score obtained during posttest; ARAT; Rehabilitation; Nervous system diseases; Motor system disorder; Electric; Cardiovascular disease; Duration; Cerebral disorder; Vascular disease; Reeducation; Treatment; Orthopedics; Central nervous system disease; Neurological disorder; Cerebrovascular disease; Comparative study
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2011.09.016

Abstract Page SJ, Levin L, Hermann V, Dunning K, Levine P. Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke. Objective To examine and compare efficacy of 30-, 60-, and 120-minute repetitive task-specific practice (RTP) sessions incorporating use of an electrical stimulation neuroprosthesis (ESN) on affected upper-extremity (UE) movement. Design Prospective, single-blinded, randomized controlled trial. Setting Outpatient rehabilitation hospital. Participants Chronic stroke subjects (N=32) exhibiting moderate, stable affected UE motor deficits. Interventions Subjects participated in 30-, 60-, or 120-minute therapy sessions involving RTP incorporating the ESN, occurring every weekday for 8 weeks. During sessions, they wore the ESNs to enable performance of valued activities that they had identified. A fourth group participated in a 30-minute per weekday home exercise program. Main Outcome Measures Outcomes were evaluated using the UE section of the Fugl-Meyer Assessment of Sensorimotor Impairment (FM), the Arm Motor Ability Test (AMAT), the Action Research Arm Test (ARAT), and Box and Block (B&B) 1 week before and 1 week after intervention. Results After intervention, subjects in the 120-minute condition were the only ones to exhibit significant score increases on the FM ( P =.0007), AMAT functional ability scale ( P =.002), AMAT quality of movement scale ( P =.0002), and ARAT ( P =.02). They also exhibited the largest changes in time to perform AMAT tasks and in B&B score, but these changes were nonsignificant, ( P =.15 and P =.10, respectively). Conclusions One hundred and twenty minutes a day of RTP augmented by ESN use elicits the largest and most consistent UE motor changes in moderately impaired stroke subjects.