FES therapy with upper extremity training may be an efficacious intervention in the rehabilitation of reaching and grasping function during acute stroke rehabilitation.
Objective: To determine the clinical efficacy of functional electrical therapy in the rehabilitation of grasping function for quadriplegics. Study design: Randomized intervention-versus-control trial. Setting: Rehabilitation hospital for spinal cord injury in Toronto, Canada. Methods: A total of 21 people with new spinal cord injuries ranging from C3 to C7 were randomly assigned to two groups: Control (N ¼ 9) and Intervention (N ¼ 12). The intervention was functional electrical therapy, which consisted of repetitive grasping exercises using a neuroprosthesis that applied surface electrical stimulation to the arm to generate and/or assist grasping movements. It was applied by registered Occupational Therapists in a clinical setting. Main outcome measures were: Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM), and the Rehabilitation Engineering Laboratory Hand Function Test. Consumer perceptions of functional electrical therapy were assessed via qualitative interviews. Results: Differences between the Control and Intervention groups could be observed although they are not significant due to an insufficient number of participants. Consumer perceptions were positive, including improved Activities of Daily Living and self-satisfaction. Conclusion: Functional electrical therapy has the potential to be an effective treatment modality to restore grasping function in quadriplegia. It can be implemented by occupational therapists in a clinical setting. Further research is required to establish suitable indications for participant selection. In addition, a larger number of participants is needed to demonstrate statistical significance of the Functional Electrical Therapy.
Study design: Case series, and repeated assessments of the same individuals. Objective: To demonstrate the feasibility and efficacy of a multiweek intervention on walking function in people with chronic, incomplete spinal cord injuries. Setting: Rehabilitation hospital for spinal cord injury (SCI) in Toronto, Canada. Methods: A convenience sample of five subjects with chronic, incomplete SCI trained for 12-18 weeks using a new multichannel neuroprosthesis for walking. The following outcome measures were recorded throughout the training period: walking speed, step frequency and average stride length based on a 2-min walk test. Also identified were which walking aids and orthoses subjects preferred to use, and whether they employed a step-to or step-through gait strategy. Follow-up measurements of three subjects were made up to 10 weeks after treatment. Results: All subjects demonstrated significant improvements in walking function over the training period. Four of the subjects achieved significantly increased walking speeds, which were due to increases in both stride length and step frequency. The fifth subject experienced a significant reduction in preferred assistive devices. Follow-up measurements revealed that two subjects walked slightly slower several weeks after treatment, but they still walked significantly faster than at the start of treatment. Conclusion: The gait training regimen was effective for improving voluntary walking function in a population for whom significant functional changes are not expected. This application of functional electrical therapy is viable for rehabilitation of gait in incomplete SCI.
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