Posts Tagged CCFES

[Abstract] Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis

Abstract

Background and Purpose—It is unknown whether one method of neuromuscular electrical stimulation for poststroke upper limb rehabilitation is more effective than another. Our aim was to compare the effects of contralaterally controlled functional electrical stimulation (CCFES) with cyclic neuromuscular electrical stimulation (cNMES).

Methods—Stroke patients with chronic (>6 months) moderate to severe upper extremity hemiparesis (n=80) were randomized to receive 10 sessions/wk of CCFES- or cNMES-assisted hand opening exercise at home plus 20 sessions of functional task practice in the laboratory for 12 weeks. The task practice for the CCFES group was stimulation assisted. The primary outcome was change in Box and Block Test (BBT) score at 6 months post treatment. Upper extremity Fugl–Meyer and Arm Motor Abilities Test were also measured.

Results—At 6 months post treatment, the CCFES group had greater improvement on the BBT, 4.6 (95% confidence interval [CI], 2.2–7.0), than the cNMES group, 1.8 (95% CI, 0.6–3.0), between-group difference of 2.8 (95% CI, 0.1–5.5), P=0.045. No significant between-group difference was found for the upper extremity Fugl–Meyer (P=0.888) or Arm Motor Abilities Test (P=0.096). Participants who had the largest improvements on BBT were <2 years post stroke with moderate (ie, not severe) hand impairment at baseline. Among these, the 6-month post-treatment BBT gains of the CCFES group, 9.6 (95% CI, 5.6–13.6), were greater than those of the cNMES group, 4.1 (95% CI, 1.7–6.5), between-group difference of 5.5 (95% CI, 0.8–10.2), P=0.023.

Conclusions—CCFES improved hand dexterity more than cNMES in chronic stroke survivors.

Source: Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis | Stroke

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[WEB PAGE] Chronic stroke survivors may benefit from electrical stimulation

After a stroke, patients often lose muscle strength and require upper limb rehabilitation. Still, the best way to help patients recover depends on how long ago they had their stroke and on other factors.

A recent study suggests that contralaterally controlled functional electrical stimulation (CCFES) may be the preferable option for patients with finger, thumb and wrist issues who suffered a stroke less than two years ago. The researchers added that patients would likely not see improvement with cyclic neuromuscular electrical stimulation (cNMES) or CCFES if they suffered their strokes more than two years ago. Results were published in Stroke on Sept. 8.

The researchers enrolled 80 patients who had a stroke and had moderate to severe upper extremity hemiparesis for at least six months. Patients were randomized to receive 10 sessions per week of CCFES- or cNMES-assisted hand opening exercise at home as well as 20 sessions of functional task practice in the laboratory for 12 weeks.

After six months, the CCFES group had a greater improvement on the Box and Block Test (BBT), a measure of manual dexterity in which participants pick up one block at a time, move it over a partition and release it in a target area within 60 seconds.

“The finding of a statistically significant between-group difference on the BBT in a chronic population is encouraging and may point to a true mechanistic advantage underlying the CCFES method of electrical stimulation therapy,” the researchers wrote. “One or more of the elements that distinguish CCFES from cNMES may be important in facilitating motor recovery, namely, (1) real-time patient-controlled intensity of stimulation to the paretic hand (ie, intention-driven movement), (2) synchronized opening of both hands, and (3) stimulation-assisted task practice with the paretic hand. Thus, the method of NMES may matter.

”Still, the researchers mentioned that the average magnitudes of change on the BBT and the average between-group difference were lower than the minimum detectable change threshold. Thus, the results were not clinically relevant.

The study had some limitations, including that patients were aware of their treatment assignment and that the trial took place at one academic medical center in Cleveland, Ohio. The trial was also conducted at least six months after patients suffered their strokes, a period during which healthcare professionals do not typically prescribe rehabilitation. More work is needed to compare CCFES and cNMES, according to the researchers.

“Future trials should include validated patient reported outcomes and outcomes that are sensitive to participation and quality of life,” the researchers wrote. “Also, the translatability of CCFES therapy to other research sites and to clinical practice still needs to be established. A future multisite study is needed to confirm the findings of this study and to demonstrate generalizability across different rehabilitation centers.”

Source: Chronic stroke survivors may benefit from electrical stimulation | Cardiovascular Business

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[WEB SITE] One Hand Controls Another: A New Electrical Stimulation Therapy for Stroke Rehab

post-stroke-rehabElectrical stimulation of the arms and hands affected by a stroke is one rehab technique that can provide a lot of benefits if done right. One major problem is having a reliable method of activating stimulation at just the right time so that the patient feels in control and gets the most out of the therapy.

Researchers in Ohio at the MetroHealth System, Case Western Reserve University, and the Cleveland Functional Electrical Stimulation Center developed an electrical stimulation system that uses the strong hand to control the grip of the weakened one. An electronic sensing glove is worn by the hand on the stronger side of the body. Every time the person squeezes the hand with the glove, it sends an appropriate signal to an electrical stimulator connected to electrodes on the other arm that in turn make that hand create a grip. The same happens when the grip is opened, just that different muscles are stimulated as a result.

To test the new system in comparison to the existing stimulation method, the research team enrolled 80 patients post stroke for a three month program. Half of the people received the traditional stimulation therapy, while the other half used the new system. Most of it was performed by patients on their own at home in addition to three hours spent with a therapist at the rehab lab.

Here are the promising findings shown in the study:

  • Patients who received the new therapy had greater improvement on the dexterity test (4.6 blocks) than the common group (1.8 blocks).
  • Patients who had the greatest improvements in hand dexterity following the new therapy were less than two years post-stroke and had at least some finger movement when they started the study. These patients saw an improvement of 9.6 blocks on the dexterity test, compared to 4.1 blocks in the common group.
  • Patients with no finger movement also saw improvements in arm movement after the new therapy.
  • At treatment end, 97 percent of the participants who received the new therapy agreed that they could use their hand better than at the start of the study.

 

Study in journal Stroke: Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis…

Via: American Heart Association…

Source: One Hand Controls Another: A New Electrical Stimulation Therapy for Stroke Rehab | Medgadget

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[Abstract] Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis – Stroke

Abstract

Background and Purpose—It is unknown whether one method of neuromuscular electrical stimulation for poststroke upper limb rehabilitation is more effective than another. Our aim was to compare the effects of contralaterally controlled functional electrical stimulation (CCFES) with cyclic neuromuscular electrical stimulation (cNMES).

Methods—Stroke patients with chronic (>6 months) moderate to severe upper extremity hemiparesis (n=80) were randomized to receive 10 sessions/wk of CCFES- or cNMES-assisted hand opening exercise at home plus 20 sessions of functional task practice in the laboratory for 12 weeks. The task practice for the CCFES group was stimulation assisted. The primary outcome was change in Box and Block Test (BBT) score at 6 months post treatment. Upper extremity Fugl–Meyer and Arm Motor Abilities Test were also measured.

Results—At 6 months post treatment, the CCFES group had greater improvement on the BBT, 4.6 (95% confidence interval [CI], 2.2–7.0), than the cNMES group, 1.8 (95% CI, 0.6–3.0), between-group difference of 2.8 (95% CI, 0.1–5.5), P=0.045. No significant between-group difference was found for the upper extremity Fugl–Meyer (P=0.888) or Arm Motor Abilities Test (P=0.096). Participants who had the largest improvements on BBT were <2 years post stroke with moderate (ie, not severe) hand impairment at baseline. Among these, the 6-month post-treatment BBT gains of the CCFES group, 9.6 (95% CI, 5.6–13.6), were greater than those of the cNMES group, 4.1 (95% CI, 1.7–6.5), between-group difference of 5.5 (95% CI, 0.8–10.2), P=0.023.

Conclusions—CCFES improved hand dexterity more than cNMES in chronic stroke survivors.

Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00891319.

Source: Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis | Stroke

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[WEB SITE] New Device Improves Hand Dexterity for Some Stroke Survivors – Neurology Now

CCFES-Chess-02.jpg
Credit: Cleveland FES Center (http://fescenter.org)

BY SARAH OWENS

For patients whose stroke affected their ability to use their hand, a new electrical stimulation device may help. The device allows patients to control their impaired hand using their unaffected hand, and to control the timing and intensity of electrical stimulation. In a study published online on September 8 in Stroke, the new method led to improvements in hand dexterity.

Patient-Controlled Electrical Stimulation

Electrical stimulation is already widely available and used in stroke rehabilitation to help patients recover the use of their limbs. Traditional electrical stimulation, known as cyclic neuromuscular electric stimulation (cNMES), is controlled by a therapist and requires no active participation from the patient. By contrast, the new method, called contralaterally controlled functional electrical stimulation or CCFES, allows patients to exercise an impaired hand by controlling electrical stimulation to the impaired hand using their strong hand (or contralateral hand) and performing tasks.

The researchers hypothesized that because CCFES allows patients to use both hands, is done in real time, and involves tasks, it may result in better, faster rehabilitation compared to cNMES.

Improving Dexterity

Researchers at MetroHealth Medical Center in Cleveland, Ohio enrolled 80 patients who had had a stroke and were partially paralyzed in one of their upper limbs for at least six weeks. Half the patients received 10 sessions per week of the new stimulation method, and half received 10 sessions of the traditional stimulation, for six months.

After the six months, the researchers administered the Box and Block Test (BBT) to gauge improvements in hand dexterity. The test counts how many times a person can pick up a block, move it over a partition, and release it in a target area within 60 seconds.

Patients who received CCFES had greater improvement in dexterity as measured by the Box and Block Test than patients who underwent cNMES. Patients who’d had a stroke less than two years prior to the study and had moderate, not severe, hand impairment at the start of the study had the biggest improvements.

A New Option for Stroke Rehabilitation

For recent stroke patients with moderate hand impairment, CCFES is a better option than cNMES, the study authors say, possibly because CCFES happens in real time, requires patients to open both hands at once, and/or allows patients to practice tasks with the impaired hand. They added that with CCFES—unlike with cNMES—patients can control the timing and intensity of tasks.

Watch a video showing the new stimulation device in action here:

Source: Neurology Now

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[WEB SITE] Electrical stimulation therapy improves manual dexterity among stroke patients

Adults with chronic hand impairment after suffering a stroke improved their manual dexterity when they received 12 weeks of contralaterally controlled functional electrical stimulation (CCFES).

The benefits of CCFES were superior to equivalent doses of cyclic neuromuscular electrical stimulation (cNMES), although the researchers said the differences fell short of the minimum detectable change threshold and were not clinically relevant.

Lead researcher Jayme S. Knutson, PhD, of Case Western Reserve University in Cleveland, and colleagues published their results online in Stroke on Sept. 8.

With cNMES, the researchers noted that therapists set the cycle timing, repetitions and intensity of stimulation, so patients do not need to actively participate. Meanwhile, with CCFES, patients open their paretic hand and perform functional tasks. They control the stimulation to their paretic hand by opening and closing their strong hand.

For this study, the researchers enrolled 80 patients from March 2009 to October 2014 at an academic medical center in Cleveland and randomized them to receive 12 weeks of treatment with cNMES or CCFES. All of the patients had a stroke and had moderate to severe upper extremity hemiparesis.

Of the 80 participants, 72 completed the treatment. The other eight withdrew within the first three weeks of the treatment period. All eight participants were from the CCFES group.The treatments lasted 12 weeks and consisted of 20 sessions of therapist-guided functional task practice in the laboratory and 10 sessions per week of self-administered repetitive hand opening exercise at home.Six months after the treatment, participants in the CCFES group had greater improvement on the Box and Block Test (BBT), a measure of manual dexterity in which participants pick up one block at a time, move it over a partition and release it in a target area within 60 seconds. The researchers mentioned that participants who had the largest improvements on the BBT had their strokes within two years and had moderate hand impairment at baseline.

There were no differences between the CCFES and cNMES groups on the upper extremity Fugl-Meyer and Arm Motor Abilities Test (AMAT). The Fugl-Meyer assesses functional ability, while the AMAT measures upper limb impairment.

“Future trials should include validated patient reported outcomes and outcomes that are sensitive to participation and quality of life,” the researchers wrote. “Also, the translatability of CCFES therapy to other research sites and to clinical practice still needs to be established. A future multisite study is needed to confirm the findings of this study and to demonstrate generalizability across different rehabilitation centers.”

Source: Electrical stimulation therapy improves manual dexterity among stroke patients | Cardiovascular Business

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[ARTICLE] Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis – Full Text PDF

Abstract

Background and Purpose—It is unknown whether one method of neuromuscular electrical stimulation for poststroke upper limb rehabilitation is more effective than another. Our aim was to compare the effects of contralaterally controlled functional electrical stimulation (CCFES) with cyclic neuromuscular electrical stimulation (cNMES).

Methods—Stroke patients with chronic (>6 months) moderate to severe upper extremity hemiparesis (n=80) were randomized to receive 10 sessions/wk of CCFES- or cNMES-assisted hand opening exercise at home plus 20 sessions of functional task practice in the laboratory for 12 weeks. The task practice for the CCFES group was stimulation assisted. The primary outcome was change in Box and Block Test (BBT) score at 6 months post treatment. Upper extremity Fugl–Meyer and Arm Motor Abilities Test were also measured.

Results—At 6 months post treatment, the CCFES group had greater improvement on the BBT, 4.6 (95% confidence interval [CI], 2.2–7.0), than the cNMES group, 1.8 (95% CI, 0.6–3.0), between-group difference of 2.8 (95% CI, 0.1–5.5), P=0.045. No significant between-group difference was found for the upper extremity Fugl–Meyer (P=0.888) or Arm Motor Abilities Test (P=0.096). Participants who had the largest improvements on BBT were <2 years post stroke with moderate (ie, not severe) hand impairment at baseline. Among these, the 6-month post-treatment BBT gains of the CCFES group, 9.6 (95% CI, 5.6–13.6), were greater than those of the cNMES group, 4.1 (95% CI, 1.7–6.5), between-group difference of 5.5 (95% CI, 0.8–10.2), P=0.023.

Conclusions—CCFES improved hand dexterity more than cNMES in chronic stroke survivors.

Download Full Text PDF

 

Source: Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis

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[Abstract] On the use of wearable sensors to enhance motion intention detection for a contralaterally controlled FES system.

During the last years, there has been a relevant progress in motor learning and functional recovery after the occurrence of a brain lesion. Rehabilitation of motor function has been associated to motor learning that occurs during repetitive, frequent and intensive training.

Contralaterally controlled functional electrical stimulation (CCFES) is a new therapy designed to improve the recovery of paretic limbs after stroke, that could provide repetitive training-based therapies and has been developed to control the upper and lower limbs movements in response to user’s intentionality.

Electromyography (EMG) signals reflect directly the human motion intention, so it can be used as input information to control a CCFES system. Implementation of the EMG-based pattern recognition is not easy to be accomplished due to some difficulties, among them that the activity level of each muscle for a certain motion is different between each person. Inertial Measurement Units (IMU) is a kind of wearable sensors that are used to gather movement data. IMUs could provide valuable kinematic information in an EMG-based pattern recognition process to improve classification.

This work describes the use of IMUS to improve detecting motion intention from EMG data. Results shows that myoelectric algorithm using information from IMUs was better in classification of seven movements at the upper-limb level that algorithm using only EMG data.

Source: IEEE Xplore Abstract (Abstract) – On the use of wearable sensors to enhance motion intention detection for a contralaterally controlle…

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