The effectiveness of combined bilateral upper limb training and functional electrical stimulation for the rehabilitation of upper limb function of patient with stroke : randomized controlled trial

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The effectiveness of combined bilateral upper limb training and functional electrical stimulation for the rehabilitation of upper limb function of patient with stroke : randomized controlled trial

 

Author: Chan, Ka-leung Marko
Title: The effectiveness of combined bilateral upper limb training and functional electrical stimulation for the rehabilitation of upper limb function of patient with stroke : randomized controlled trial
Degree: M.Sc.
Year: 2008
Subject: Hong Kong Polytechnic University -- Dissertations.
Electric stimulation.
Cerebrovascular disease -- Patients -- Rehabilitation.
Cerebrovascular disease -- Physical therapy.
Department: Dept. of Health Technology and Informatics
Pages: xiii, 100 leaves : ill. (chiefly col.) ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2240462
URI: http://theses.lib.polyu.edu.hk/handle/200/4304
Abstract: Stroke was a major disease which causes mortality and disability. Rehabilitation of upper limb function always showed poor outcome when compare with the lower limb recovery. Besides more clinical evidence showed using of functional electrical stimulation was effective for the upper limb rehabilitation of stroke. However, those studies had not clearly illustrated their training activities and some of them did not include placebo group. The purpose of this study was to investigate the effectiveness of functional electrical stimulation with bilateral activities training on upper limb function for the patient with chronic stroke. This was a double blinded randomized controlled trial design. Forty five stroke patients after 6 weeks of onset were recruited from Out-patient Occupational Therapy Department of Kowloon Hospital and all of them completed 15 training sessions. The participants were randomly assigned to experimental (FES) group, placebo group or control group. The experimental intervention was a 15 sessions training consisted of 10 minutes stretching activities, 20-minute functional electrical stimulation and 60 minutes conventional occupational therapy treatment in each session. The participant used the self trigger mechanism of the FES system to synchronize the bilateral upper limb activities during the training. The participants in placebo group would receive similar training except they just received placebo stimulation (the participants only had slight sensation of the stimulation but the intensity of the electrical stimulation would not elicit any muscle movement). The control group would receive conventional Occupational Therapy training without any electrical stimulation. The outcome measures included Fugl-Meyer Assessment, Functional Test for the hemiplegic upper extremity- Hong Kong Version (FTHUE-HK), forward reaching distance, active range of extension of the wrist, forward reaching distance, Modified Ashworth Scale (MAS) and self reported visual analogue scale (VAS) of perceived motor control, sensation and time of participation of the affected side in daily activities outside the training session. Those tests were done before and after the treatment. Kruskal-Wallis Test was adopted to compare the baseline data and the difference score before and after treatment. Post-Hoc Mann Whitney U test would be done if there was statistically significant difference in the Kruskal-Wallis Test. After 15 sessions training, FES group had significant better improvement in the FMA (Kruskal-Wallis Test P < .001), FTHUE-HK (Kruskal-Wallis Test P =.038), forward reaching distance (Kruskal-Wallis Test P =.005) and active range of motion of wrist extension (Kruskal-Wallis Test P =.035) when compared with other two groups. In conclusion, the bilateral upper limb training with FES could be an effective method for the upper limb rehabilitation for stroke patient. A larger scale randomized control trial with the long term generalization effect is indicated for further study to provide more evidence of this approach.

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