Posts Tagged cNMES

[Abstract] Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke

Background. Upper-limb chronic stroke hemiplegia was once thought to persist because of disproportionate amounts of inhibition imposed from the contralesional on the ipsilesional hemisphere. Thus, one rehabilitation strategy involves discouraging engagement of the contralesional hemisphere by only engaging the impaired upper limb with intensive unilateral activities. However, this premise has recently been debated and has been shown to be task specific and/or apply only to a subset of the stroke population. Bilateral rehabilitation, conversely, engages both hemispheres and has been shown to benefit motor recovery. To determine what neurophysiological strategies bilateral therapies may engage, we compared the effects of a bilateral and unilateral based therapy using transcranial magnetic stimulation.

Methods. We adopted a peripheral electrical stimulation paradigm where participants received 1 session of bilateral contralaterally controlled functional electrical stimulation (CCFES) and 1 session of unilateral cyclic neuromuscular electrical stimulation (cNMES) in a repeated-measures design. In all, 15 chronic stroke participants with a wide range of motor impairments (upper extremity Fugl-Meyer score: 15 [severe] to 63 [mild]) underwent single 1-hour sessions of CCFES and cNMES. We measured whether CCFES and cNMES produced different effects on interhemispheric inhibition (IHI) to the ipsilesional hemisphere, ipsilesional corticospinal output, and ipsilateral corticospinal output originating from the contralesional hemisphere.

Results. CCFES reduced IHI and maintained ipsilesional output when compared with cNMES. We found no effect on ipsilateral output for either condition. Finally, the less-impaired participants demonstrated a greater increase in ipsilesional output following CCFES.

Conclusions. Our results suggest that bilateral therapies are capable of alleviating inhibition on the ipsilesional hemisphere and enhancing output to the paretic limb.

via Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke – David A. Cunningham, Jayme S. Knutson, Vishwanath Sankarasubramanian, Kelsey A. Potter-Baker, Andre G. Machado, Ela B. Plow,

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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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[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.

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

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