Stephen J. Page, Peter Levine, Valerie Hill; Mental Practice–Triggered Electrical Stimulation in Chronic, Moderate, Upper-Extremity Hemiparesis After Stroke. Am J Occup Ther 2014;69(1):6901290050. https://doi.org/10.5014/ajot.2015.014902
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© 2020 American Occupational Therapy Association
OBJECTIVE. To determine the feasibility and impact of home-based, mental practice–triggered electrical stimulation among stroke survivors exhibiting moderate upper-extremity (UE) impairment.
METHOD. Five participants with moderate, stable UE hemiparesis were administered the Fugl-Meyer Assessment, the Box and Block Test, and the Activities of Daily Living, Hand Function, and overall recovery domains of the Stroke Impact Scale (Version 3). They were then administered an 8-wk regimen consisting of 1 hr of mental practice–triggered electrical stimulation every weekday in their home. At the end of every 2 wk, participants attended supervised stimulation to progress therapeutic exercises and stimulation levels and monitor compliance.
RESULTS. Six instances of device noncompliance were reported. Participants exhibited reduced UE motor impairment and increased UE dexterity and participation in valued activities.
CONCLUSION. The regimen appears feasible and had a substantial impact on UE impairment, dexterity, and participation in valued activities as well as perceptions of recovery.
In the paretic UE, ≥20° of active shoulder flexion, ≥20° of active internal and external humeral rotation, ≥20° active elbow flexion, and ≥15° of passive wrist flexion and extension. The latter motor criterion was intended to ensure that participants exhibited sufficient passive range of motion without contractures or discomfort such that their fingers could be moved by the stimulation.
Manual muscle test of 1/5 in the paretic wrist flexors and extensors, indicative of a palpable muscle contraction. Minimal active joint movement could be exhibited in the paretic wrist or metacarpophalangeals but was not a requirement. The movement had to be <10°, which was a differentiating characteristic of this work from previous MP + RTP studies (e.g., Page, Szflarski, et al., 2009; Page et al., 2011).
One stroke (verified from each participant’s medical record) resulting in motor deficits, occurring ≥6 mo before study enrollment.
Score ≥24/30 on the Mini-Mental State Examination (Folstein, Folstein, & McHugh, 1975).
Discharged from all forms of physical rehabilitation.
Score ≥5 on a 10-point visual analog scale measuring pain in the paretic UE
Excessive spasticity in any of the paretic UE joints, defined as a score of ≥2 on the Modified Ashworth Scale (Bohannon & Smith, 1987)
Other conditions that, in the opinion of the investigative team, precluded safe or effective study participation.
MP-triggered electrical stimulation appears to reduce UE motor impairment and increase gross manual dexterity, participation, and performance of valued activities.
These effects were observed in people who were >6 mo poststroke and who exhibited moderately severe UE hemiparesis.
Although the MP-triggered electrical stimulation was mostly home based, participants displayed favorable compliance. Behavioral strategies were used to increase compliance and comprehension of the study protocol. These strategies included compliance visits, a 1-hr education session, and home use diaries.
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