Reps Aren't Enough: Augmenting Functional Electrical Stimulation With Behavioral Supports Significantly Reduces Impairment in Moderately Impaired Stroke

Objective: To determine the impact of repetitive task-specific practice (RTP) integrating electrical stimulation and behavioral supports on upper extremity (UE) impairment, gross manual dexterity, and paretic UE amount and quality of use in chronic stroke survivors exhibiting moderate, stable UE deficits. Design: Case series with 3-month follow-up. Setting: Outpatient rehabilitation hospital. Participants: Persons (N=9) who experienced a stroke >12 months before enrollment and exhibiting chronic, moderate, stable UE impairment. Interventions: After administering outcome measures, RTP was administered 3d/wk for 120 minutes with an electrical stimulation neuroprosthesis (60min in a supervised clinical setting; 60min at home) over 8 weeks. Behavioral supports (eg, behavior contract; weekly reviews of UE use) were provided during clinical sessions and integrated into home exercise sessions to increase paretic UE use and maximize carryover to subjects' community environments. Main Outcome Measures: The UE section of the Fugl-Meyer Impairment Scale, the Box and Block Test, and the Motor Activity Log. Results: Subjects exhibited statistically significant (P<.01) increases on all measures at both time-point comparisons (ie, preintervention to postintervention; preintervention to 3mo postintervention). Subjects reported a new ability to perform valued activities they had not performed in months. Conclusions: Addition of behavioral supports to RTP augmented by electrical stimulation significantly increased paretic UE use and function. Significant motor changes were exhibited across ages and etiologies, and no other intervention was administered to this stable population, making it likely that results were not due to chance and suggests a larger trial is justified. (C) 2016 by the American Congress of Rehabilitation Medicine