Motor Improvement Induced by a Modified-Hybrid Assistive Neuromuscular Dynamic Stimulation (m-HANDS) Protocol of 3-hour EMG-controlled Neuromuscular Electrical Stimulation and Wrist Splint in Patients with Subacute Stroke: A Randomized Controlled Trial - Abstract
Abstract Background and objective: In the hybrid assistive neuromuscular dynamic stimulation (HANDS) protocol, patients use EMG-controlled neuromuscular electrical stimulation (NMES) with a wrist splint for 8 hours a day for three weeks. The HANDS protocol reportedly improves upper extremity motor function, but application of EMG-controlled NMES training for 8 hours might be difficult for many patients in many facilities. Therefore, we developed an upper extremity training protocol using 3-hours of EMG-controlled NMES with a wrist splint, called the modified-HANDS protocol. This randomized controlled trial aimed to evaluate the efficacy of our modified HANDS protocol in subacute stroke patients. Methods” The participants were 40 subacute hemiparetic patients in a rehabilitation hospital. Patients were randomly assigned to two groups. All patients in both groups received the same daily dose and duration of standard post-stroke multidisciplinary rehabilitation. Patients in the modified-HANDS group additionally used the the integrated volitional control electrical stimulator (IVES) combined with a wrist splint for 3 hours a day for 3 weeks. The primary outcome was the Fugl-Meyer Assessment upper extremity motor score (FMA) and the secondary outcome was the Motor Activity Log-14 amount of use score (MAL-14-AOU). Results: All 20 patients in each group completed the interventions. Compared with the control group, the modified-HANDS group showed significantly greater gains in FMA (P < .01) and MAL-14-AOU (P < .01). Conclusion: Our modified-HANDS protocol induced an improvement in upper limb motor function in subacute stroke patients. Further expansion of the use of the modified-HANDS protocol in rehabilitation hospitals would be beneficial.