Electrical stimulation therapy improves manual dexterity among stroke patients

Adults with chronic hand impairment after suffering a stroke improved their manual dexterity when they received 12 weeks of contralaterally controlled functional electrical stimulation (CCFES).

The benefits of CCFES were superior to equivalent doses of cyclic neuromuscular electrical stimulation (cNMES), although the researchers said the differences fell short of the minimum detectable change threshold and were not clinically relevant.

Lead researcher Jayme S. Knutson, PhD, of Case Western Reserve University in Cleveland, and colleagues published their results online in Stroke on Sept. 8.

With cNMES, the researchers noted that therapists set the cycle timing, repetitions and intensity of stimulation, so patients do not need to actively participate. Meanwhile, with CCFES, patients open their paretic hand and perform functional tasks. They control the stimulation to their paretic hand by opening and closing their strong hand.

For this study, the researchers enrolled 80 patients from March 2009 to October 2014 at an academic medical center in Cleveland and randomized them to receive 12 weeks of treatment with cNMES or CCFES. All of the patients had a stroke and had moderate to severe upper extremity hemiparesis.

Of the 80 participants, 72 completed the treatment. The other eight withdrew within the first three weeks of the treatment period. All eight participants were from the CCFES group.

The treatments lasted 12 weeks and consisted of 20 sessions of therapist-guided functional task practice in the laboratory and 10 sessions per week of self-administered repetitive hand opening exercise at home.

Six months after the treatment, participants in the CCFES group had greater improvement on the Box and Block Test (BBT), a measure of manual dexterity in which participants pick up one block at a time, move it over a partition and release it in a target area within 60 seconds. The researchers mentioned that participants who had the largest improvements on the BBT had their strokes within two years and had moderate hand impairment at baseline.

There were no differences between the CCFES and cNMES groups on the upper extremity Fugl-Meyer and Arm Motor Abilities Test (AMAT). The Fugl-Meyer assesses functional ability, while the AMAT measures upper limb impairment.

“Future trials should include validated patient reported outcomes and outcomes that are sensitive to participation and quality of life,” the researchers wrote. “Also, the translatability of CCFES therapy to other research sites and to clinical practice still needs to be established. A future multisite study is needed to confirm the findings of this study and to demonstrate generalizability across different rehabilitation centers.”