For decades, rehabilitation clinicians have known that electrical stimulation provided after stroke can bring about new movement changes in the impaired arm or leg.
But how much stimulation should patients get daily?
Stephen Page, PhD, and colleagues at the Neuromotor Recovery and Rehab Lab, building on promising preliminary data, tested and evaluated subjects in therapy sessions of varying times over an eight-week period. The results, Page says, constitute the first data that determines the optimal dosing of electrical stimulation in stroke, or in any neurologic population.
"Electrical stimulation is a modality that has been used for over 30 years to help with rehabilitation of stroke patients, but there was no information on optimal dosing,” says Page, an associate professor in the College of Allied Health Science’s department of rehabilitation sciences. "It’s an amazing thing, but many of the most commonly used rehabilitative treatments lack data on their optimal dosing, the window after injury that we have to use them and whether the treatment effect is retained over time.”
Page presented the findings in a poster session at the 2010 Joint Educational Conference of the American Congress of Rehabilitation Medicine (ACRM) and American Society of Neurorehabilitation (ASNR) Oct. 20-23 in Montreal. The corresponding article is in press for Neurorehabilitation and Neural Repair, the No. 1-ranked journal in rehabilitation.
Based on promising pilot data published over the past few years by his team, Page studied chronic stroke patients exhibiting upper extremity motor deficits as they participated in 30-, 60- or 120-minute training sessions. They wore a special electrical stimulation neuroprosthesis (ESN) every weekday for eight weeks that provided stimulation while they performed activities that they valued, such as reaching for a cup or grasping and opening a jar. A fourth "control” group participated in a 30-minute home exercise program each weekday.
Subjects in the 120-minute sessions exhibited significant, consistent score increases on all of the measures that Page and his team administered. More importantly, the subjects exhibited functional changes, including new ability to reach, grasp and release objects, bring a piece of food to their mouths and wipe a towel across a table.
"This has major implications for stroke patients and their care partners, particularly as the overall population ages and the incidence of stroke remains stable,” says Page. "We hope that these data will become the standard for providing electrical stimulation for patients.
"Plus, the folks in this study were moderately impaired; by most accounts, these individuals tend not to respond to conventional therapies. The kinds of changes that we saw were not necessarily expected.”
Page’s team presented three additional papers at the meeting, the world’s largest interdisciplinary rehabilitation research conference. In addition, Page assumed leadership of the Clinical Practice Committee for ACRM and is continuing his role as a member of the ASNR Board of Directors.