Activity-Based Electrical Stimulation Training in a Stroke Patient With Minimal Movement in the Paretic Upper Extremity

Abstract

Background. Existing task-specific practice interventions do not increase movement in stroke patients exhibiting minimal distal movement in the paretic upper extremity. Although often used, an important limitation of conventional electrical stimulation is that it does not involve task-specific practice. Objective. To determine the impact of an activity-specific electrical stimulation program on paretic limb impairment, functional limitation, and ability to perform valued activities in a subacute stroke patient exhibiting minimal paretic wrist and hand movement. Method. A female subject exhibiting trace paretic hand and finger movement was administered, 9 months after stroke, the upper extremity section of the Fugl-Meyer Impairment Scale (FM), the Action Research Arm Test (ARAT), and the Arm Motor Ability Test (AMAT). She then engaged in paretic upper extremity, task-specific training incorporating an electrical stimulation neuroprosthesis. Training occurred 3 hours per day, 5 days per week for 3 weeks. The FM, ARAT, and AMAT were again administered. Results. After intervention, she exhibited reduced impairment (evidenced by an FM score change of 22 to 29), decreased functional limitation (evidenced by an ARAT score change of 4 to 10), and increased ability and speed in performing valued AMAT activities. She also reported using the paretic hand and fingers more and new abilities to perform valued activities such as playing piano. Conclusion. Although conventional paretic upper extremity training strategies are ineffective in patients at this level, electrical stimulation training incorporating a neuroprosthesis appears promising.