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Motor Improvement and Corticospinal Modulation Induced by Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) Therapy in Patients With Chronic Stroke

Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, tofuji{at}xc5.so-net.ne.jp

Yuko Kasashima, MD

Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo

Kaoru Honaga, MD

Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo

Yoshihiro Muraoka, PhD

Faculty of Rehabilitation School of Health Sciences, Fujita Health University, Aichi

Tetsuya Tsuji, MD, PhD

Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo

Rieko Osu, PhD

National Institute of Information and Communications Technology, Kyoto, ATR Computational Neuroscience Laboratories, Kyoto

Kimitaka Hase, MD, PhD

Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo

Yoshihisa Masakado, MD, PhD

Keio University Tsukigase Rehabilitation Center, Shizuoka Japan

Meigen Liu, MD, PhD

Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo

Background and objective . We devised a therapeutic approach to facilitate the use of the hemiparetic upper extremity (UE) in daily life by combining integrated volitional control electrical stimulation with a wrist splint, called hybrid assistive neuromuscular dynamic stimulation (HANDS). Methods. Twenty patients with chronic hemiparetic stroke (median 17.5 months) had moderate to severe UE weakness. Before and immediately after completing 3 weeks of training in 40-minute sessions, 5 days per week over 3 weeks and wearing the system for 8 hours each day, clinical measures of motor impairment, spasticity, and UE functional scores, as well as neurophysiological measures including electromyography activity, reciprocal inhibition, and intracortical inhibition were assessed. A follow-up clinical assessment was performed 3 months later. Results. UE motor function, spasticity, and functional scores improved after the intervention. Neurophysiologically, the intervention induced restoration of presynaptic and long loop inhibitory connections as well as disynaptic reciprocal inhibition. Paired pulse transcranial magnetic stimulation study indicated disinhibition of the short intracortical inhibition in the affected hemisphere. The follow-up assessment showed that improved UE functions were maintained at 3 months. Conclusion. The combination of hand splint and volitional and electrically induced muscle contraction can induce corticospinal plasticity and may offer a promising option for the management of the paretic UE in patients with stroke. A larger sample size with randomized controls is needed to demonstrate effectiveness.

Key Words: Stroke • Hemiparesis • Upper extremity function • Transcranial magnetic stimulation • Intracortical inhibition • Reciprocal inhibition • Electrical stimulation

This version was published on February 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 2, 125-132 (2009)
DOI: 10.1177/1545968308321777


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