Electromyography-triggered Neuromuscular Stimulation Research Articles

Effects of Home-based Telesupervising Rehabilitation on Physical Function for Stroke Survivors with Hemiplegia: A Randomized Controlled Trial.

The aims of this work were to evaluate the effects of home-based telesupervising rehabilitation on physical function for stroke survivors with hemiplegia and to determine if the rehabilitation therapy can relieve the burden on caregivers. This study is a randomized, controlled, assessor-blinded trial. Stroke survivors were randomly assigned to either home-based telesupervising rehabilitation group or conventional rehabilitation group to receive physical exercise and electromyography-triggered neuromuscular stimulation. Modified Barthel Index, Berg Balance Scale, modified Rankin Scale, Caregiver Strain Index, root mean square of extensor carpi radialis longus and tibialis anterior muscle were measured at 3 time points: baseline, postintervention (12 weeks), and 12-week follow-up (24 weeks). Both the home-based telerehabilitation and conventional rehabilitation groups demonstrated significant effects within groups over the 3 time points in increasing Modified Barthel Index, Berg Balance Scale, and root mean square value of extensor carpi radialis longus and tibialis anterior, as well as decreasing Caregiver Strain Index (P < 0.001), but none of the between-group differences was significant. For modified Rankin Scale, the percentage of participants of grades 0 and 1 in 2 groups increased over time without significant difference between the groups. Home-based telesupervising rehabilitation is most likely as effective as the conventional outpatient rehabilitation for improving functional recovery in stroke survivors and could ease the burden of caregivers as conventional rehabilitation.

Duration of ETMS Is Not Associated With Upper-Extremity Motor Outcomes in Subacute Stroke

Abstract Date Presented 4/9/2016 This study determined that electromyography-triggered neuromuscular stimulation duration was not significantly associated with paretic upper-extremity impairment and functional limitation in stroke survivors. Primary Author and Speaker: Stephen Page Additional Author and Speaker: Andrew Persch Contributing Authors: Kelsey Schaub, Richard Wilson, Jayme Knutson, John Chae

Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke

Background and Objective. Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered neuromuscular stimulation (EMG-NMS) on upper limb capacity early poststroke. Methods. A total of 159 ischemic stroke patients were included: 58 patients with a favorable prognosis (>10° of FE) were randomly allocated to 3 weeks of mCIMT or usual care only; 101 patients with an unfavorable prognosis were allocated to 3-week EMG-NMS or usual care only. Both interventions started within 14 days poststroke, lasted up until 5 weeks, focused at preservation or return of FE. Results. Upper limb capacity was measured with the Action Research Arm Test (ARAT), assessed weekly within the first 5 weeks poststroke and at postassessments at 8, 12, and 26 weeks. Clinically relevant differences in ARAT in favor of mCIMT were found after 5, 8, and 12 weeks poststroke (respectively, 6, 7, and 7 points; P < .05), but not after 26 weeks. We did not find statistically significant differences between mCIMT and usual care on impairment measures, such as the Fugl-Meyer assessment of the arm (FMA-UE). EMG-NMS did not result in significant differences. Conclusions. Three weeks of early mCIMT is superior to usual care in terms of regaining upper limb capacity in patients with a favorable prognosis; 3 weeks of EMG-NMS in patients with an unfavorable prognosis is not beneficial. Despite meaningful improvements in upper limb capacity, no evidence was found that the time-dependent neurological improvements early poststroke are significantly influenced by either mCIMT or EMG-NMS.

Feasibility study of a combined treatment of electromyography-triggered neuromuscular stimulation and mirror therapy in stroke patients: A randomized crossover trial

Mirror therapy (MT) and electromyography-triggered neuromuscular stimulation (ETMS) are both effective treatments for impaired upper limbs following stroke. A combination of these two treatments (ETMS-MT) may result in greater gain than either treatment alone. The feasibility and possible effects of ETMS-MT upon upper extremity function were investigated in stroke patients. Thirteen post-acute stroke patients were randomly assigned to an immediate ETMS-MT group or a delayed ETMS-MT group and then underwent an 8-week training program. The immediate ETMS-MT group received ETMS-MT in addition to physical and occupational therapy (PT+OT) for 4 weeks. They then received only PT+OT for the next 4 weeks. In the delayed ETMS-MT group, interventions were provided in the reverse order. The main outcome measure was the Fugl-Meyer Assessment (FMA). The immediate ETMS-MT group showed significantly greater gain in FMA in the first 4 weeks. The delayed ETMS-MT group showed significantly greater gain in active range of motion during the latter 4 weeks. No adverse effects were reported following ETMS-MT. ETMS-MT might be as effective as independent MT or ETMS without causing any side effects. Future research should focus upon the direct comparisons between independent and combined interventions.

Clinical Feasibility of Mirror Therapy Combined with Electromyography-Triggered Neuromuscular Stimulation for the Paretic Hand after Stroke: a Pilot Study

Clinical Feasibility of Mirror Therapy Combined with Electromyography-Triggered Neuromuscular Stimulation for the Paretic Hand after Stroke: a Pilot Study

Low-Dose, EMG-Triggered Electrical Stimulation for Balance and Gait in Chronic Stroke

Background: Although promising for the affected arm, evidence supporting efficacy of surface electromyographytriggered neuromuscular stimulation (ETMS) is equivocal. Furthermore, the optimal ETMS dosing for any impairment remains unknown. Objective: To determine the impact of a low-dose (20 min/day) ETMS regimen on affected ankle movement, balance, and ambulation in a chronic stroke patient (>12 months post stroke) exhibiting no active, affected ankle movement. Method: Goniometry, the Berg Balance Scale (Berg), and an automated measure of ambulation (the GAITRite) were administered. The subject then used ETMS once every weekday in 20-minute increments during a 4-week period. One week after completing the ETMS regimen, the outcome measures were again administered. Results: After intervention, the subject exhibited 25° of active ankle flexion and 17° active ankle extension. He also exhibited a 6-point increase on the Berg, indicative of score increases on 5 of the 14 Berg items: standing unsupported (3 to 4), standing to sitting (2 to 3), retrieving an object from floor (3 to 4), turning to look behind (1 to 3), and turning 360° (1 to 2). He also exhibited increased gait velocity, cadence, step length, and stride length. Functionally, the subject reported safer and more rapid walking and improved transfers. Discussion: Even though the maximum ETMS dosing remains unknown, it appears that 20 minutes/day is a minimum amount that produces functionally relevant motor, balance, and ambulation changes. A larger ETMS dosing and efficacy trial is now planned.

Cortical effect and functional recovery by the electromyography-triggered neuromuscular stimulation in chronic stroke patients

We investigated the effect of electromyography (EMG)-triggered neuromuscular electrical stimulation (NMES; EMG-stim) on functional recovery of the hemiparetic hand and the related cortical activation pattern in chronic stroke patients. We enrolled 14 stroke patients, who were randomly assigned to the EMG-stim (n=7) or the control groups (n=7). The EMG-stim was applied to the wrist extensor of the EMG-stim group for two sessions (30 min/session) a day, five times per week for 10 weeks. Four functional tests (box and block, strength, the accuracy index, and the on/offset time of muscle contraction) and functional MRI (fMRI) were performed before and after treatment. fMRI was measured at 1.5 T in parallel with timed finger flexion-extension movements at a fixed rate. Following treatment, the EMG-stim group showed a significant improvement in all functional tests. The main cortical activation change with such functional improvement was shifted from the ipsilateral sensorimotor cortex (SMC) to the contralateral SMC. We demonstrated that 10-week EMG-stim can induce functional recovery and change of cortical activation pattern in the hemiparetic hand of chronic stroke patients.

Back From the Brink: Electromyography-Triggered Stimulation Combined With Modified Constraint-Induced Movement Therapy in Chronic Stroke

Page SJ, Levine P. Back from the brink: electromyography-triggered stimulation combined with modified constraint-induced movement therapy in chronic stroke. Objective To determine the efficacy of a regimen that combines electromyography-triggered neuromuscular stimulation (ETMS) with modified constraint-induced movement therapy (mCIMT) in patients with chronic stroke. Design Pre-post, case series. Setting Outpatient rehabilitation hospital. Participants Six subjects who had had a stroke less than 1 year before the study and who had upper-limb hemiparesis. All subjects were only able to activate the affected wrist extensors. Intervention Subjects underwent ETMS twice every weekday in 35-minute increments during an 8-week period. One week after they completed the ETMS regimen, and after the outcome measures were readministered, subjects participated in mCIMT, which consisted of structured therapy sessions that emphasized use of the more affected arm in valued activities. The sessions were held 3 times a week for 10 weeks. The less affected arms were also restrained 5 days a week for 5 hours. Main Outcome Measures The Fugl-Meyer Assessment (FMA) of motor recovery, Action Research Arm Test (ARAT), and goniometry. Results Subjects had nominal changes on the ARAT (mean change, 0.3), and no functional changes after ETMS. However, they had a mean increase of 21.5° in affected wrist extension and an improved ability to perform the wrist items of the FMA (reflected by a mean increase of 4.1 points on the FMA), which qualified them for mCIMT. After mCIMT, subjects had a 15.5-point change on the FMA, an 11.4-point change on the ARAT, and a new ability to perform valued activities. Conclusions ETMS alone does not result in functional changes. However, it may elicit sufficient active affected wrist and finger extension increases to permit possible participation in mCIMT, which can result in marked functional gains. This study is among the first to show improved function in stroke patients who initially had little hand motor control, and it is among the first to effectively combine 2 singularly efficacious regimens.

Home-based electromyography-triggered stimulation in chronic stroke

(1) To determine the feasibility of a home-based electromyography-triggered neuromuscular stimulation (ETMS) programme; and (2) to determine ETMS efficacy in increasing affected wrist extension and reducing affected arm impairment. Randomized, controlled, pre-post, cross-over design. Outpatient rehabilitation hospital. Twelve chronic stroke patients with palpable muscle contraction in their affected wrist extensors but no movement (7 males; mean age = 59.75 years, age range 44-75 years; mean time since stroke = 52.75 months, range 13-131 months). Subjects were randomly assigned to receive either: (a) ETMS use twice every weekday in 35-min increments during an eight-week period followed by an eight-week home exercise programme (ETMS/home exercise programme) (n=8); or (b) an eight-week home exercise programme followed by use of ETMS twice every weekday in 35-min increments during an eight-week period (home exercise programme) (n=4). The Fugl-Meyer, Action Research Arm Test and goniometry. After home exercise programme participation, subjects showed nominal or no changes on any of the outcome measures. After ETMS, patients showed modest impairment reductions, as shown by the Fugl-Meyer, and no Action Research Arm Test changes. However, both groups showed a 21 degree increase in active affected wrist extension after ETMS use. ETMS use is feasible in the home environment. Neither participation in a traditional home exercise programme nor ETMS use conveyed changes on the Fugl-Meyer or Action Research Arm Test. However, ETMS use increased active affected limb extension. This new movement may provide a potential pathway for subjects to participate in other interventions, such as modified constraint induced therapy.

Feasibility of Electromyography-Triggered Neuromuscular Stimulation as an Adjunct to Constraint-Induced Movement Therapy

The purpose of this case report is to explore the feasibility of electromyography-triggered neuromuscular stimulation (EMG-stim) as an adjunct to constraint-induced movement therapy (CIMT). The patient was a 72-year-old man, 10 years poststroke, who did not meet traditional CIMT criteria. The EMG-stim was applied to the wrist extensors of the patient's weaker arm for one half of the CIMT training hours. The intervention was feasible for this individual. Improvements were observed in motor behavior, quality and amount of use, muscle activity, wrist range of motion, and reaction time of the more-affected extremity. These improvements were paralleled by a change in the size and location of the extensor digitorum communis muscle representation in the primary motor cortex, as measured by transcranial magnetic stimulation mapping. These changes suggest that using EMG-stim as an adjunct to CIMT should be further investigated in individuals who have low functional abilities following stroke.

Poster 265 Feasibility, compliance, and efficacy of home-based electromyography-triggered neuromuscular stimulation in chronic stroke: a case series Usama Gabr MD; Peter Levine BA, PTA; Stephen Page, PhD, FAHA (Univ Cincinnati Coll Med, Cincinnati, OH), Stephen.Page@uc.edu

Poster 265 Feasibility, compliance, and efficacy of home-based electromyography-triggered neuromuscular stimulation in chronic stroke: a case series Usama Gabr MD; Peter Levine BA, PTA; Stephen Page, PhD, FAHA (Univ Cincinnati Coll Med, Cincinnati, OH), Stephen.Page@uc.edu