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Efficacy of a Hybrid Upper Limb Neuromuscular Electrical Stimulation System in Lessening Selected Impairments and Dysfunctions Consequent to Cerebral Damage

Associate Professor, University of Maryland, School of Medicine

Amit Dar, PT

NESS Ltd., 19 Ha'haroshet Street, Ra'anana 43654, Israel

Deganit Katz-Behiri, OT

NESS Ltd., Ra'anana 43654, Israel

Harold Weingarden, MD

Sheba Medical Center, Department of Neurological Rehabilitation, Tel Hashomer, Israel

Roger Nathan, PhD

Senior Vice President, NESS Ltd., Associate Professor, Department of Mechanical Engineering, Ben-Gurion University, Beer-Sheba, Israel

Objective: The purpose of this study was to test the efficacy of a new computerized neu romuscular electric stimulation system (Handmaster^TM) in improving selected im pairments and functional measures of patients who survived stroke and traumatic brain injury (TBI).

Methods: Survivors of stroke (n = 13) and TBI (n = 7) with chronic paralysis lasting 6.8 ± 7.8 years (range 1 to 29 years) participated in a home program of elec trical stimulation. The device is a hybrid of a hand-forearm splint that incorporates five surface electrodes and a computerized electrical stimulator. The patterned stimu lation elicits finger flexion and extension, lateral pinch, and grasp of the paralyzed hand. Patients practiced daily for 3.4 ± 0.5 hours over a mean duration of 13.1 ± 6.6 weeks. Assessment included goniometric measurements of wrist and elbow rest ing posture, passive and active joints motion, linear distance of fingers to palm, Ash worth scale, and the ability to hold a 1 kg load in the affected hand. The Frenchay arm test represented hand function.

Results : ANOVA tests and Wilcoxon signed rank test were employed. There were significant improvements (p = 0.01) in elbow, wrist, and fingers posture; Ash worth scale; volitional active elbow flexion (32.5 ± 12.7°); wrist extension (12.7 ± 11.1°) and flexion (9.03 ± 4.5°). Passive wrist extension improved 13.7 ± 3.6°. Thir teen patients (65 percent) had active wrist extension post stimulation compared with only three (15 percent) before study commencement. Partial completion of the Fren chay tasks were observed before stimulation in only three patients compared with partial completion of tasks by nine patients at study conclusion. Post stimulation, 16 of 20 patients were able to hold a 1 kg weight with the NESS system active, com pared with only three patients without it.

Conclusions: Application of the NESS system for three to four hours daily im proves selected impairments and may help to restore partial hand functions of patients with chronic stroke or head injury. Key Words: Chronic—Stroke—Brain injury— Electrical stimulation—Motor recovery.

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