Stroke Programs

Upper Extremity Motor Relearning: Comparative surface stimulation multi-site clinical trial

General Information on this clinical study

Principal Investigator: John Chae, M.D.

Clinical Coordinators: Cathy Corrigan, R.N. or Peggy Maloney, R.N.

Contact Number: 216-778-8903 or 216-778-8563

Contact Email: ccorrigan@metrohealth.org or mmaloney@metrohealth.org

Program Title: Electrostimulation for Hemiplegia

Purpose

Recovery of wrist and hand movement and use after a stroke is often difficult and incomplete. The use of surface neuromuscular electrical stimulation, or NMES, combined with repetitive and directed movement of the limb has shown promise in promoting motor relearning. "Motor relearning" is defined as the recovery of previously learned motor skills lost following brain injury from a stroke, and is thought to be a key component in promoting a sustained and more functional use of the affected limb.

Both cyclic NMES, in which muscles are stimulated to move in a regular pattern without conscious effort, and EMG-triggered NMES, in which successful stimulation requires conscious effort to "trigger" surface electrodes to move muscles, have the potential to aid limb motor recovery by at least encouraging movement repetition and possibly in promoting deeper cortical (brain) reorganization as would be shown in motor relearning.

Program Description

The goals of this large, multi-center clinical trial are to more definitively research the promise of surface stimulation for paretic wrist and hand muscles. It is also looking to help define if and how surface stimulation best promotes hand movement following a stroke. A total of 189 participants will be enrolled at two sites: MetroHealth Medical Center in Cleveland, Ohio and the University of Cincinnati in Cincinnati, Ohio over the course of a four (4) year trial.

Subjects enrolled will be stroke survivors between the ages of 55 and 80 who are within 3 months of their first clinical hemorrhagic or non-hemorrhagic stroke, and who further show mild to moderate upper limb paresis with good limb sensation. These individuals will be randomly selected into three types of surface stimulation to paretic wrist and hand muscles: sensory stimulation, cyclic NMES and EMG-triggered NMES. Each group will have a total of 8 weeks of stimulation (treatment) and follow-up assessments for an additional 6 months. Outcome measures will include clinically and functionally accepted tests including the Fugl-Meyer motor impairment test and the Arm Motor Ability Test.