HOME-BASED SENSORY AND MOTOR ELECTRICAL STIMULATION TO IMPROVE ARM FUNCTION POST STROKE
Lois Deming Hedman, Jane E. Sullivan, Kristin J. Krosschell · Neurology Report · 2006
Background & Purpose: Four years following stroke onset, 67% of individuals with arm hemiparesis report that non-use or disuse of their affected arm is a major problem in their lives. This study examined the effects of a home-based arm exercise program of sensory and motor amplitude electrical stimulation (SES and NMES) on impairment, function and quality of life for individuals with chronic stroke. Case Description: Ten adults with chronic arm hemiparesis following stroke participated in this non-concurrent, multiple-baseline, single-case design study. The subjects ranged in age from 27 to 81 years and were 6 months to 9 years post-stroke. Three participants had right-sided involvement; 7 had left. Subjects completed a 12-week, individualized, home-program of NMES and SES. All subjects participated in NMES-assisted, task-specific exercises for 15 minutes 2 to 3 times daily and engaged in an additional 15 minutes of SES to the tips of the fingers/thumb twice daily. The upper extremity subscale of the Fugl-Meyer Assessment (FMA) was used to examine movement quality and the Action Research Arm Test (ARAT) was used to examine arm function. These tests were administered weekly during the baseline phase and bi-weekly during the intervention. Three additional tests were administered once at the beginning of the baseline phase and again at the end of the intervention. The Nottingham Stereognosis Assessment (NSA) was used to examine sensory function; the Modified Ashworth Assessment of Spasticity (MASS) was used to examine muscle tone; and the Physical Performance Subscale of the Stroke Impact Scale (SIS) was used to examine quality of life. Outcomes: Clinically significant improvements on the FMA were seen for seven subjects (effect size 0.96 – 4.5). Three subjects demonstrated clinically significant improvements on the ARAT with effect sizes ranging from 0.35 – 2.61. A statistically significant difference was found between the group pre and post-intervention scores for the NSA (p= .03) and MASS (p = .04) but not for the SIS (p = .31). Discussion: This study demonstrates that individuals with arm paresis following stroke can successfully implement a home-based intervention of SES and NMES. Despite significant improvements in sensation, motor capacity, and muscle tone, changes in function and quality of life were less robust. These findings may be related to the limited amount of daily practice and should be further studied.