Upper Limb Outcomes in Stroke Subjects following Neuroprosthetic Functional Electrical Therapy versus a Graded Arm Exercise Program

Purpose: A study was undertaken to assess the utility of neuroprosthetic functional electrical therapy (NPFET) to enhance arm function in chronic stroke subjects. Method: Randomized controlled study in which subjects were allocated to a program of NPFET or a program of customized arm exercises known as GRASP (Graded Repetitive Arm Supplementary Program). The NPFET group underwent an average of 25 sessions of treatment over a 10 week period. NPFET was provided by a physiotherapist in a rehabilitation hospital setting. The control group received 1:1 instruction on the GRASP exercises, were encouraged to practise exercises at home on a daily basis for 3 months, keep a daily exercise activity log and were followed up by phone interviews to monitor compliance. Only subjects with Chedoke McMaster Stage of Motor Recovery (CMSMR) 1,2 and 3 (indicating no functional motor recovery in the arm) were admitted to the study. Average time since stroke onset: 5 years. Average age of subjects: 57 years Outcome measures: FuglMyer Assessment (FMA), Ashworth Assessment and Motor Activity Log (MAL). [It was not possible to apply other planned testing measures: Action Research Arm Test (ARAT), Box and Block Test (BBT) and Rehabilitation Engineering Laboratory Hand Function Test (REL Test), due to the severe motor impairment of the subjects]. Subject assessments were completed at baseline, on completion of intervention and 2-3 months post intervention. Results: By study completion 10 subjects will have received NPFET training and 7, the GRASP protocol. Post intervention assessments have yet to be completed to ascertain long term outcomes. To date no significant change in functional use of the arm observed at immediate post intervention follow up in the treatment group although 4 subjects group improved FMA scores by 2 to 6 points. A few subjects reported reduced spasticity in the forearm flexor muscles immediately following stimulation but no long term change in Ashworth Scale was observed. Conclusion: In this group of severe chronic stroke CMSMR 1, 2 & 3 subjects, NPFET did not produce functional arm change in spite of an intensive upper limb stimulation program. All subjects were significantly constrained by loss of shoulder rotator cuff muscles as well as middle/anterior deltoid muscles to abduct and control the arm in space. This aspect of motor impairment proved problematic, limiting the usefulness of the NPFET for forward reaching with the arm.