UPPER LIMB FUNCTIONAL RESPONSE TO MOTOR LEARNING ALONE and MOTOR LEARNING WITH FUNCTIONAL NEUROMUS-CULAR STIMULATION FOR STROKE SURVIVORS.

Abstract

Purpose/Hypothesis: The purpose of the study was to test two interventions in chronic stroke survivors (>12 months) with moderate to severe upper limb functional deficits. The two interventions were: 1) motor learning (ML-alone); and 2) functional neuromuscular stimulation along with motor learning (FNSML). Number of Subjects: Eighteen. Materials/ Methods: Eighteen subjects were stratified according to the Fugl-Meyer Upper Limb Coordination Scale and randomized to: FNSML or ML-alone. Subjects had a Trace wrist extensor grade. Many had 0 grade finger flexors/extensors. Treatment was: 5 times/wk for 12 weeks. The therapist patient ratio was 1: 3. Subjects practiced task components and full task performance (60-tasks array). For 1.5 hrs of each daily session, FNS was provided for the subjects in the FNSML group. A two-channel, surface stimulator, the EMS+2 (Staodyne, Inc., Longmont, Colorado) was used for finger/wrist flexors/extensors and lower/middle trapezius. The waveform was biphasic, symmetric, and rectangular. Stimulus parameters were: 300microsecs phase duration; 30Hz; amplitude, 1mA to the highest comfortable stimulus; and 10secs on/10secs off duty cycle (1sec ramp up, 10secs on, 1 sec ramp down, 10secs off). Subjects practiced single and multiple joint movements using FNS, including the following movements: alternating wrist flexion/extension;and simultaneous wrist extension and finger flexion. FNS was used in conjunction with task component movements like preparation before grasping an object. Outcome measures were: 1) the Arm Motor Ability Test (AMAT); 2) the AMAT wrist/hand components (AMATW/H); and 3) the Functional Independence Measure. The AMAT is comprised of 13 functional tasks (using knife/fork; grasping mug handle and drinking from cup). Pre-treatment baseline comparisons between the two groups were made using t-test. Within-group, pre-/post-treatment comparisons were made using t-test. Group comparisons in response to treatment were made using an ordinal regression model (PLUM Ordinal Model, SPSS) for the FIM. Post-treatment FIM score was the dependent variable, pre-treatment was a co-variate, and group assignment was the independent variable. Results: At baseline, there was no significant difference between the two groups for the outcome measures (p>.05). In response to treatment, there were significantly greater gains for FNSML group versus ML-alone, according to the FIM (p=.003). In response to treatment, FNSML had significant improvement in the AMAT, AMATW/H, and FIM (p= .042, .036, and .007, respectively); whereas the ML-alone group did not (p=.167; .242; .068, respectively). Conclusions: Results suggested that FNSML could be functionally beneficial for moderately to severely involved stroke survivors with chronic deficits. Clinical Relevance: The treatment was successfully offered with a therapist: patient ratio of 1: 3.Moderately to severely involved stroke survivors with chronic deficits can benefit from intervention.