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Intramuscular Electrical Stimulation for Upper Limb Recovery in Chronic Hemiparesis: An Exploratory Randomized Clinical Trial

Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio,jchae{at}metrohealth.org

Mary Y. Harley, OTR/L

Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio

Terri Z. Hisel, OTR/L

Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio

Catherine M. Corrigan, RN

Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio

Jeffrey A. Demchak, MS

NeuroControl Corporation, North Ridgeville, Ohio, Life Line Screening, Cleveland, Ohio.

Yu-Tung Wong, MSE

Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio

Zi-Ping Fang, PhD

NeuroControl Corporation, North Ridgeville, Ohio, Nevro Corporation, Palo Alto, California

Background. Surface electrical stimulation (ES) has been shown to improve the motor impairment of stroke survivors. However, surface ES can be painful and motor activation can be inconsistent from session to session. Percutaneous intramuscular ES may be an effective alternative. Objective. Evaluate the effectiveness of percutaneous intramuscular ES in facilitating the recovery of the hemiparetic upper limb of chronic stroke survivors. Methods. A total of 26 chronic stroke survivors were randomly assigned to percutaneous intramuscular ES for hand opening (n = 13) or percutaneous ES for sensory stimulation only (n = 13). The intramuscular ES group received cyclic, electromyography (EMG)-triggered or EMG-controlled ES depending on baseline motor status. All participants received 1 hour of stimulation per day for 6 weeks. After completion of ES, participants received 18 hours of task-specific functional training. The primary outcome measure was the Fugl-Meyer Motor Assessment. Secondary measures included the Arm Motor Ability Test and delay and termination of EMG activity. Outcomes were assessed in a blinded manner at baseline, at the end of ES, at the end of functional training, and at 1, 3, and 6 months follow-up. Results. Repeated measure analysis of variance did not yield any significant treatment, or time by treatment interaction effects for any of the outcome measures. Conclusion. Percutaneous intramuscular ES does not appear to be any more effective than sensory ES in enhancing the recovery of the hemiparetic upper limb among chronic stroke survivors. However, because of the exploratory nature of the study and its inherent limitations, conclusions must be drawn with caution.

Key Words: Intramuscular electrical stimulation • Upper limb • Chronic hemiparesis • Stroke

This version was published on July 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 6, 569-578 (2009)
DOI: 10.1177/1545968308328729


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