Date Presented 4/18/2015
This study suggests that mental-practice-triggered stimulation markedly increases movement and dexterity in moderately impaired upper extremities following stroke. These changes caused increased ability to use the limb functionally for occupations such as opening a door and using a fishing rod.
RATIONALE/BACKGROUND: Stroke remains a leading cause of disability. Upper-extremity (UE) motor impairments are common and profoundly undermine occupational performance and independence. Yet, most conventional therapies are only efficacious in clients exhibiting active distal UE movement. For example, this laboratory was the first to show that repetitive use of mental practice (MP) reduces UE impairment, causes cortical reorganizations, and significantly increases paretic UE use and function. However, MP is also limited in that survivors must exhibit active paretic wrist and finger flexion to be eligible. An innovative electrical stimulation device called the Mentamove was developed that is triggered by the minute muscle activations occurring during MP. The stimulation is only activated when the client’s electromyographic (EMG) activity during MP attains a preset threshold level displayed on the device’s screen. The primary study objective was to estimate the impact of Mentamove use on UE motor impairment in stroke survivors exhibiting trace movement in the distal areas of their paretic UEs. Given that the regimen was mostly home based and that this was the first application of MP-triggered stimulation to the paretic UE following stroke, we also monitored compliance and adverse events—important information for a pilot study that would inform, in part, whether the intervention should move forward to subsequent Phase 1b work.
METHOD: The primary goal of this Phase 1 work was to determine whether a positive treatment effect was associated with Mentamove use in a well-defined, small, stable cohort of stroke survivors exhibiting moderate UE impairment. Thus, we used a prospective, pre–post, case-series design, and we analyzed data using descriptive statistics. The setting took place in an outpatient rehabilitation clinic. The study included 5 participants (1 man, 4 women; mean age = 43.7 + 6.43 yr; mean time poststroke = 56.5 mo + 42.2 mo; 4 Caucasians; 4 with left-sided strokes; 5 with ischemic strokes; all strokes occurred in participants’ dominant limbs). Measures included (1) UE motor impairment (as measured by the Fugl-Meyer Scale [FM]; primary study endpoint), (2) paretic UE dexterity (as measured by the Box and Block test [B&B]), and (3) integration of the paretic UE into valued activities (as measured by the Stroke Impact Scale [SIS]).
RESULTS: Only six instances of noncompliance were reported, due to forgetting to use the device as scheduled, and all occurred during the first 2 wk of the intervention. No difficulties with electrode placement were reported. No adverse events or discomforts were reported. Participants uniformly displayed positive changes on the FM and the B&B (+4.0 and +3.75, respectively). These new movements translated to consistently positive increases in perception of UE recovery and ability to integrate the paretic UE into valued activities as measured by the SIS.
CONCLUSION: MP-triggered stimulation markedly increases UE movement and dexterity in moderately impaired UEs following stroke. These changes conspire to cause increased ability to use the paretic UE functionally for occupations such as opening a door or even using a fishing rod. Although the regimen was home based, high compliance with no adverse events was reported. There is sufficient rationale to move to controlled efficacy trials of this promising approach.
