Synergy effects of combined multichannel EMG-triggered electrical stimulation and mirror therapy in subacute stroke patients with severe or very severe arm/hand paresis
Affiliations: [a] Department of Neurology and Neurological Rehabilitation, Rehab Center Wilhelmshaven, Wilhelmshaven, Germany
| [b] MED-EL Medical Electronics, Business Unit Neurorehabilitation STIWELL, Innsbruck, Austria
| [c] Physiotherapist, Wilhelmshaven, Germany
| [d] Department of Empirical Educational Research, FernUniversität in Hagen, Hagen, Germany
| [e] Department of Neurology and Neurological Rehabilitation, Asklepios Neurological Hospital Falkenstein, Königstein/Taunus, Germany
| [f] Department of Clinical Neurosciences and Preventive Medicine, Center for Neurorehabilitation, Danube University Krems, Krems, Austria
| [g] MEDIAN Klinik Berlin-Kladow, Berlin, Germany
| [h] Center for Stroke Research Berlin, Charité-University Medicine Berlin, Berlin, Germany
Correspondence:
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Corresponding author: Thomas Schick, MED-EL Medical Electronics, Business Unit Neurorehabilitation STIWELL, Fürstenweg 77a, 6020 Innsbruck, Austria. Tel.: +43 577881299; Fax: +43 5 77 88 56 95; E-mail: thomas.schick@medel.com.
Abstract: Background: Neurorehabilitation requires the development of severity-dependent and successful therapies for arm/hand rehabilitation in stroke patients. Objective: To evaluate the effectiveness of adding mirror therapy to bilateral EMG-triggered multi-channel electrostimulation for the treatment of severe arm/hand paresis in stroke patients. Methods: The subjects of this randomized, controlled, multicentre study were stroke patients who had suffered their first insult between 1 and 6 months before study start and had severe or very severe arm/hand paresis, as classified by Fugl-Meyer-Assessment. Subjects were randomly allocated to an intervention group (n = 16) or control group (n = 17). Both groups were treated for 3 weeks (5x week, 30 minutes) with bilateral EMG-triggered multi-channel electrostimulation. The intervention group additionally received mirror feedback of the unaffected limb. The primary outcome measure was motor recovery of the upper extremities, as measured by the Fugl-Meyer Assessment. Results: The Intervention Group with very severe paresis had significantly better motor recovery in total Fugl-Meyer Assessment (p = 0.017) at a medium effect size (Cohen) of d = 0.7, due to a significant recovery of shoulder and elbow function (p = 0.003) in the Fugl-Meyer Assessment Part A subtest. For subjects with severe paresis, additional mirror therapy did not significantly influence outcome. Conclusion: Additional mirror therapy in combination with EMG-triggered multi-channel electrostimulation is therapeutically beneficial for post-acute stroke patients with very severe arm/hand paresis.
