A. Stefanovic

Clinical evaluation of Functional Electrical Therapy in acute hemiplegic subjects

This paper describes a clinical randomized single-blinded study of the effects of Functional Electrical Therapy (FET) on the paretic arms of subjects with acute hemiplegia caused by strokes. FET is an exercise program that comprises voluntary arm movements and opening, closing, holding, and releasing of objects that are assisted by a neural prosthesis (electrical stimulation). FET consisted of a 30 min everyday exercise for 3 consecutive weeks in addition to conventional therapy. Twenty-eight acute hemiplegic subjects participated in a 6 mo study. The subjects were divided into lower functioning groups (LFGs) and higher functioning groups (HFGs) based on their capacity to voluntarily extend the wrist and fingers against the gravity, and were randomly assigned to controls or FET groups. The outcomes included the Upper Extremity Function Test, the coordination of elbow and shoulder movements, spasticity of key muscles of the paretic arm, and Reduced Upper Extremity Motor Activity Log. FET and control groups showed a recovery trend in all outcome measures. The gains in FET groups were much larger compared with the gains in control groups. The speed of recovery in FET groups was substantially faster compared with the recovery rate in control groups during the first 3 weeks (treatment). The LFG subjects showed less improvement than the HFG in both the FET and control groups.

Efekti funkcionalne električne terapije na oporavak motorne funkcije gornjeg ekstremiteta kod pacijenata nakon moždanog udara: iskustva i smernice za dalje

INTRODUCTION New neurorehabilitation together with conventional techniques provide methods and technologies for maximizing what is preserved from the sensory motor system after cerebrovascular insult. The rehabilitation technique named functional electrical therapy was investigated in more than 60 patients in acute, subacute and chronic phase after cerebrovascular insult. The functional sensory information generated by functional electrical therapy was hypothesized to result in the intensive functional brain training of the activities performed. FUNCTIONAL ELECTRICAL THERAPY Functional electrical therapy is a combination of functional exercise and electrical therapy. The functional electrical therapy protocol comprises voluntary movement of the paretic arm in synchrony with the electrically assisted hand functions in order to perform typical daily activities. The daily treatment of 30 minutes lasts three weeks. The outcome measures include several tests for the evaluation of arm/hand functionality: upper extremity function test, drawing test, modified Aschworth scale, motor activity log and passive range of movement. RESULTS OF FUNCTIONAL ELECTRICAL THERAPY STUDIES Results from our several clinical studies showed that functional electrical therapy, if applied in acute and subacute stroke patients, leads to faster and greater improvement of functioning of the hemiplegic arm/hand compared to the control group. The outcomes were significantly superior at all times after the treatment for the higher functioning group. DISCUSSION Additional well-planned clinical studies are needed to determine the adequate dose of treatment (timing, duration, intensity) with functional electrical therapy regarding the patients status. A combination with other techniques should be further investigated.Sažetak – Funkcionalna elektricna terapija predstavlja kombinaciju elektricne terapije i funkcionalnih vežbi posle cerebrovaskularnog insulta. Ona je pokretacki sistem onoga sto osoba stice preko novih iskustava nakon lezije, dajuci joj mogucnost da uvežbava funkcije. Sastoji se od 30-minutnog vežbanja uobicajenih dnevnih aktivnosti asistirano elektricnom stimulacijom sake, a izvodi se tokom tri nedelje. Klinicka ispitivanja dosad su obuhvatila vise od 60 ispitanika u akutnoj, subakutnoj i hronicnoj fazi posle moždanog udara. Opsti zakljucak je da statisticki znacajan pozitivan efekat primene funkcionalne elektricne terapije na funkcionalnost sake i ruke postoji kod pacijenata u akutnoj i subakutnih fazi koji inicijalno imaju male pokrete u rucnom zglobu, kao i prstima i da se taj oporavak održava i posle sest meseci. Unapređenje razumevanja neurofizioloskog uticaja funkcionalne elektricne terapije na osobe koje su imale moždani udar, kao i bolje razumevanje neuroplasticnih efekata ove terapije može da omoguci optimizaciju funkcionalne elektricne terapije, posebno kod evaluacije neurofizioloskih mehanizama pri sprovođenju ove terapije i evaluacije posledica modifikovanog upravljanja usled tog vežbanja na voljno i automatsko upravljanje hvatanja i manipulaciju rukom. Kljucne reci: Elektro terapija; Funkcionalna terapija; Oporavak funkcije; Motorna aktivnost; Moždani udar; Saka; Snaga sake; Rehabilitacija; Neurofiziologija