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Influence of Functional Electric Stimulation on the Hand Motoric after Cerebrovasvascular Event (stroke) a Preclinical Study


Authors: Z. Pilsová;  J. Uhlířová;  O. Švestková
Authors‘ workplace: Klinika rehabilitačního lékařství, 1. lékařská fakulta, Univerzita Karlova a Všeobecná fakultní nemocnice v Praze, přednostka kliniky doc. MUDr. O. Švestková, Ph. D.
Published in: Rehabil. fyz. Lék., 24, 2017, No. 4, pp. 195-201.
Category: Original Papers

Overview

Introduction:
Spastic paresis if a frequent symptom of cerebral vascular event as well as other kinds of acquired brain damage. It is a sensorimotor complication, which is increasingly discussed in the field of neurorehabilitation. In connection with these problems and present trends of modern time, increasingly novel robotic systems, which are components of ergotherapy intervention, come to the rehabilitation technique market. Functional electric stimulation employs the deep penetration of the electric signal to relevant nervous filaments which mediates contractions of the required muscular groups of upper extremity including fingers and wrist. Due to the high amplitude of electric signal, which is used by functional electric stimulation, there are multiple repetitive movements of the hand, which contribute to sensorimotor restoration of the paretic extremity. Functional neuromuscular electric stimulation can make it easier to return to original functional abilities of the patient and to perform independent activities of daily living.

Methodology:
the objective of the study was to evaluate effects of the system Ness H200, which uses electric stimulation on the motor and functional abilities of the paretic upper extremity after cerebral vascular event (8 to 36 months since the event). The preclinical study monitors immediate effect of functional electric stimulation (FES) on the increase of active range of the wrist dorsal flexion in six cases for the period of three weeks by means of goniometric measurement, always before and after the treatment (60 observations in 6 patients). Moreover, it monitors improving functional performance of the paretic extremity in the final examination compared with the entry examination by an objective standardized method of the Modified Frenchay scale. Ergotherapeutic intervention by means of Ness H200 was performed for 5 days a week, 3 weeks for the period of 30min with the use of the neuromodulation program evoking repetitive passive movements and a functional program stimulating the hand grip function.

Hypotheses:
“Functional electric stimulation produces an immediate effect on the increase of active range of the wrist dorsal flexion movements in patient after cerebral vascular event”.

In patients having been applied functional electric stimulation of the paretic upper extremity there is an improvement of Modified Frenchay scale in the final examination as compared with the entry examination”.

Results:
According to goniometric examination, FES significantly influences immediate increase of active range of the hand wrist flexion at the 5% level of significance (P=0.043). The mean improvement represented 9.64°, which is an improvement of 0.08 in the 95% interval estimate improvement. The results of the Modified Frenchay scale were not significant at the 5% level of significance. (P=0.06).

Conclusion:
Functional electric stimulation is a new therapeutic procedure, which significantly improves the grip function of acral paretic upper extremity in patients after cerebral vascular event. This study revealed that it is a suitable therapeutic procedure, which can be employed by ergotherapy specialists in their practice.

Keywords:
functional electric stimulation, ergotherapy, cerebral vascular event, upper extremity, active locomotion, paresis


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Labels
Physiotherapist, university degree Rehabilitation Sports medicine
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