OBJECTIVE. We investigated the effect of a combined neuromuscular electrical stimulation (ES) and dynamic hand orthosis (DHO) regimen with a group of people with chronic stroke to improve performance on specific daily tasks. METHOD. Four people with chronic stroke participated in an ES–DHO regimen using the affected upper extremity 5×/wk for 6 wk. Outcome measures included grip strength, range of motion (ROM), and analysis of muscle activation–deactivation during release of grasp through electromyography. Ability to perform specific daily living tasks was assessed using the Assessment of Motor and Process Skills (AMPS). RESULTS. Results suggested that improvements in strength, ROM, and grasp deactivation are possible with the combined ES–DHO regimen. All participants’ AMPS motor scores improved. CONCLUSIONS. An ES–DHO regimen may improve motor skills needed for functional task performance in people with chronic stroke. Results should be interpreted cautiously because of the pilot nature of the study and the small sample size.

OBJECTIVE. We examined the efficacy of a remotely based arm rehabilitation regimen. A 62-year-old man participated in occupation-based, task-specific practice of activities of daily living (ADLs) >3 years after stroke. The entire regimen was administered over the Internet using personal computer–based cameras and free network meeting software. METHOD. Fugl-Meyer Assessment (FM), Action Research Arm Test (ARA), and Canadian Occupational Performance Measure (COPM) were administered before intervention. One week after treatment, FM, ARA, and COPM were readministered. RESULTS. The participant exhibited reduced impairment and reduced functional limitation. He also expressed enhanced satisfaction with his ability to perform ADLs and rated his ADL performance better after intervention. The participant could now drive using both hands, use eating utensils, and catch and throw a ball. CONCLUSION. Data suggest feasibility and efficacy of a remotely based, inexpensive approach using functional electrical stimulation for affected arm rehabilitation after stroke.

OBJECTIVE. We examined the efficacy of a clinically based regimen in which a woman 16 months’ post-stroke participated in daily practice sessions of valued activities of daily living (ADLs). A unique aspect of this intervention was that it was largely patient driven, with the patient practicing ADLs while wearing an electrical stimulation neuroprosthesis. METHOD. The Fugl-Meyer Assessment (FM), Action Research Arm Test (ARA), Arm Motor Activity Test (AMAT), and Canadian Occupational Performance Measure (COPM) were administered before intervention. Therapy consisted of 3-hr ADL training sessions every weekday during a 3-week period using a neuroprosthesis featuring functional electrical stimulation during treatment sessions. One week after the end of the treatment phase, the FM, ARA, AMAT, and COPM were again administered. RESULTS. The patient exhibited reduced impairment (FM score change from 31 to 35), decreased time needed to complete AMAT tasks (from 998 s to 558 s), and increased ARA score (from 27 to 31). CONCLUSION. Clinically meaningful changes were realized with distant or minimal therapist supervision, making this regimen a practical and efficacious alternative.

Purposeful and nonpurposeful tasks were performed by 30 normal college-age students (15 male, 15 female) in a study examining the effectiveness of the two types of activity in prolonging tolerance to electrically induced pain. The subjects acted as their own controls, indicated their own threshold for stimulation, and were monitored for peripheral skin temperature and heart rate. Duration of tolerance was measured in seconds from attainment of threshold until the request by the subject that stimulation be stopped. Results indicated that the subjects tolerated pain significantly longer (p = .02) while performing the activity designated as purposeful. No significant differences in peripheral skin temperature or heart rate were found under the two conditions.