Post Stroke Hand Functions: Bilateral Movements and Electrical Stimulation Treatments
Post Stroke Hand Functions: Bilateral Movements and Electrical Stimulation Treatments
The purpose of this study was to determine the effect of two amounts of treatment therapy on
 post stroke motor recovery in the arms. The therapy is bilateral movement training combined
 with electrical stimulation on the impaired limb.
Intense movement training (practice) with the affected arm after stroke has the potential to
 improve upper extremity (UE) function resulting from neuroplasticity changes in the motor
 cortex. However, the necessary and sufficient parameters of this therapy in humans have not
 been fully investigated. Delineation of the most efficacious and efficient therapy for
 promoting UE recovery post-stroke is necessary before effective clinical implementation of
 this therapy. The current compared the effects on motor function impairments for three
 bilateral movement groups involving two doses of treatment (i.e., bilateral training coupled
 with neuromuscular electrical stimulation) and a sham control. During the subacute recovery
 phase (3 - 6 months), patients who meet motor capabilities criteria will be randomly assigned
 to one of three groups: (a) low intensity: 90 minutes/session, 2 sessions/week 2 weeks;
 bilateral movement training coupled with active neuromuscular stimulation on the impaired
 wrist/fingers; (b) high intensity: 90 minutes/session, 4 sessions/week for 2 weeks; bilateral
 movement training coupled with active stimulation on the impaired wrist/finger extensors; and
 (c) control group (sham active stimulation). Patients' UE motor capabilities were assessed
 before treatment therapy began (pretest) and within the first week after the treatment
 therapy ended (posttest).
Inclusion Criteria:

 -  an ability to complete 10º of wrist or finger extension from a 60 - 65 º flexed
 position

 -  score less than a 56 on the UE subscale of the Fugl-Meyer Assessment

 -  an ability to voluntarily activate slight movements in the wrist and fingers so that
 the EMG activity reaches a minimal level on the microprocessor for electrical
 stimulation to be activated

 -  unilateral, first stroke of ischemic or hemorrhagic origin in the carotid artery
 distribution

 -  free of major post stroke complications

 -  able to attend therapy 2 days/week or 4 days/week for 2 weeks

 -  score at least a 16 on the Mini Mental Status Examination

 -  able to discriminate sharp from dull and light touch using traditional sensation
 tests.

 Exclusion Criteria:

 -  hemiparetic arm is insensate

 -  motor impairments from stroke on opposite side of body

 -  pre-existing neurological disorders such as Parkinson's disease, Multiple Sclerosis,
 or dementia

 -  Legal blindness or severe visual impairment; 5) Life expectancy less than one year

 -  Severe arthritis or orthopedic problems that limit passive ranges of motion of upper
 extremity (passive finger extension < 40º; passive wrist extension < 40º; passive
 elbow extension <40º; shoulder flexion/abduction < 80º)

 -  History of sustained alcoholism or drug abuse in the last six months

 -  Has pacemaker or other implanted device

 -  pregnant