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Home-based electromyography-triggered stimulation in chronic stroke

Physical Medicine and Rehabilitation Residency Program, The University of Cincinnati College of Medicine (UCCOM), UCCOM, Cincinnati, Ohio, USA

Peter Levine

UCCOM and Neuromotor Recovery and Rehabilitation Laboratory (NMRRL) at Drake Rehabilitation Center, The Institute for the Study of Health and Neurosciences Graduate Program, UCCOM, Cincinnati, Ohio, USA

Stephen J Page

Department of Physical Medicine and Rehabilitation, The Institute for the Study of Health and Neurosciences Graduate Program, UCCOM, Cincinnati, Ohio, USA

Objectives: (1) To determine the feasibility of a home-based electromyography triggered neuromuscular stimulation (ETMS) programme; and (2) to determine ETMS efficacy in increasing affected wrist extension and reducing affected arm impairment.

Design: Randomized, controlled, pre-lpost, cross-over design.

Setting: Outpatient rehabilitation hospital.

Patients: Twelve chronic stroke patients with palpable muscle contraction in their affected wrist extensors but no movement (7 males; mean age=59.75 years, age range 44-75 years; mean time since stroke=52.75 months, range 13-131 months).

Intervention: Subjects were randomly assigned to receive either: (a) ETMS use twice every weekday in 35-min increments during an eight-week period followed by an eight-week home exercise programme (ETMS/home exercise programme) (n=8); or (b) an eight-week home exercise programme followed by use of ETMS twice every weekday in 35-min increments during an eight-week period (home exercise programme) (n=4).

Main outcome measures: The Fugl-Meyer, Action Research Arm Test and goniometry.

Results: After home exercise programme participation, subjects showed nominal or no changes on any of the outcome measures. After ETMS, patients showed modest impairment reductions, as shown by the Fugl-Meyer, and no Action Research Arm Test changes. However, both groups showed a 218 increase in active affected wrist extension after ETMS use.

Conclusion: ETMS use is feasible in the home environment. Neither participation in a traditional home exercise programme nor ETMS use conveyed changes on the Fugl-Meyer or Action Research Arm Test. However, ETMS use increased active affected limb extension. This new movement may provide a potential pathway for subjects to participate in other interventions, such as modified constraint induced therapy.

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