Chronic Motor Dysfunction After Stroke

Abstract

Background and Purpose-After stroke, many individuals have chronic unilateral motor dysfunction in the upper extremity that severely limits their functional movement control. The purpose of this study was to determine the effect of electromyography-triggered neuromuscular electrical stimulation on the wrist and finger extension muscles in individuals who had a stroke Ն1 year earlier. Methods-Eleven individuals volunteered to participate and were randomly assigned to either the electromyographytriggered neuromuscular stimulation experimental group (7 subjects) or the control group (4 subjects). After completing a pretest involving 5 motor capability tests, the poststroke subjects completed 12 treatment sessions (30 minutes each) according to group assignments. Once the control subjects completed 12 sessions attempting wrist and finger extension without any external assistance and were posttested, they were then given 12 sessions of the rehabilitation treatment. Results-The Box and Block test and the force-generation task (sustained muscular contraction) revealed significant findings (PϽ0.05). The experimental group moved significantly more blocks and displayed a higher isometric force impulse after the rehabilitation treatment. Conclusions-Two lines of evidence clearly support the use of the electromyography-triggered neuromuscular electrical stimulation treatment to rehabilitate wrist and finger extension movements of hemiparetic individuals Ն1 year after stroke. The treatment program decreased motor dysfunction and improved the motor capabilities in this group of poststroke individuals.

Efeitos da estimulação elétrica funcional nos músculos do punho e dedos em indivíduos hemiparéticos: uma revisão sistemática da literatura

“…there were no gains for the group that received FES with 5 seconds of electrical activation. Cauraugh et al 17 , using the same test, reported a gain of 129% in the FES group, significantly higher than the control group. Kimberley et al 18 found a significant gain in the performance of the Box and Block Test and in subtests of the Jebsen Taylor Hand Function Test only for the FES group.…”

“…Four studies 7,[17][18][19] had a sample with chronic stroke diagnosis, with post-lesion peri- ods varying from 1 17 to 4 ½ years 18 . Sample size varied from 9 11 to 48 10 subjects divided between treatment and control groups.…”

“…Session duration varied from 10 minutes 7 to 6 hours 18 . Current parameters varied, with frequency ranging from 20 to 100 hz 11 , amplitude from 14 17 to 60 ma 9 and pulse width from 200 to 300µs 9,10 . In most studies, FES was applied to extensor muscles [9][10][11][17][18][19] ; in one study it was applied to wrist and finger flexors 7 and in another, to both muscle groups 4 .…”

“…of the four RCts [9][10][11]17 that assessed motor function, three [9][10][11] showed positive effects after FES. powell et al 10 found significant gains in the grip and grasp subscores of the Action Research Arm Test when compared to a control group.…”

“…outcomes related to adverse effects were not measured directly in seven of the eight studies 4,7,9,11,[17][18][19] . Francisco et al 11 and Chae et al 9 only suggested that some participant drop out might be linked to the pain and discomfort caused by FES.…”