Effect of intensive functional electrical stimulation therapy on the upper limb motor recovery after stroke: Single case study of a chronic stroke patient

This case report describes a stroke patient who participated in an intensive functional electrical stimulation (FES) therapy that consisted of task-specific upper arm movements with a combination of pre-programmed electrical stimulation and manually assisted motion. The patient was a 22-year-old woman who had suffered a hemorrhagic stroke 2 years earlier. Motor function of the upper extremity was severely impaired and showed the typical flexor synergy pattern. The FES therapy was carried out for 12 weeks, two times per day, one hour in each session (108 training sessions in total). The patient showed remarkable improvement in the the coordination of the shoulder and elbow joints during the kinematic test. While the motor recovery (measured using the Chedoke McMaster Stroke Assessment (CMSA) scale and maximal voluntary contraction level of upper arm muscles) did not show any remarkable changes, there was remarkable reduction of the arm spasticity and muscle tone; observed was a decrease in the Modified Ashworth Scale (MAS) and a reduction of the H-reflex in the wrist flexor muscle. The present results suggest that intensive FES therapy has the capability of improving upper limb function in chronic stroke patients. The improvement of the upper limb motion can be attributed to the enhancement of coordinated muscle activation patterns and the reduction of spasticity and muscle tone.