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Feasibility of Electromyography-Triggered Neuromuscular Stimulation as an Adjunct to Constraint-Induced Movement Therapy

SL Fritz, PT, PhD, MSPT, is Clinical Assistant Professor, Department of Exercise Science, University of South Carolina, 1300 Wheat St, Blatt PE Bldg, Columbia, SC 29208 (USA) (sfritz{at}gwm.sc.edu). At the time the work was completed, she was Pre-Doctoral Fellow, Brain Rehabilitation Research Center, North Florida/South Georgia VA Medical Center, Gainesville, Fla, and a graduate student in the Department of Physical Therapy, University of Florida, Gainesville, Fla
YP Chiu, PT, MHS, is a graduate student in rehabilitation science, Department of Physical Therapy, University of Florida
MP Malcolm, OT, PhD, is Assistant Professor, Department of Occupational Therapy, Colorado State University, Fort Collins, Colo. He was Pre-Doctoral Fellow, Brain Rehabilitation Research Center, North Florida/South Georgia VA Medical Center, and a graduate student in the Department of Occupational Therapy, University of Florida, at the time the work was completed
TS Patterson, MEd, is a graduate student in rehabilitation sciences in the Department of Physical Therapy, University of Florida
KE Light, PT, PhD, is Associate Professor, Department of Physical Therapy, University of Florida
Dr Fritz, Mr Chiu, and Dr Light provided concept/idea/protocol design. Dr Fritz, Mr Chiu, Dr Malcolm, and Dr Light provided writing. Dr Fritz, Mr Chiu, Dr Malcolm, and Ms Patterson provided data collection, and Dr Fritz, Mr Chiu, and Dr Malcolm provided data analysis. Dr Fritz provided project management and the patient. Dr Light provided fund procurement, facilities/equipment, and institutional liaisons. Ms Patterson and Dr Light provided consultation (including review of manuscript before submission)

Address all correspondence to Dr Fritz

Background and Purpose. The purpose of this case report is to explore the feasibility of electromyography-triggered neuromuscular stimulation (EMG-stim) as an adjunct to constraint-induced movement therapy (CIMT). Case Description. The patient was a 72-year-old man, 10 years poststroke, who did not meet traditional CIMT criteria. The EMG-stim was applied to the wrist extensors of the patient's weaker arm for one half of the CIMT training hours. Outcomes. The intervention was feasible for this individual. Improvements were observed in motor behavior, quality and amount of use, muscle activity, wrist range of motion, and reaction time of the more-affected extremity. These improvements were paralleled by a change in the size and location of the extensor digitorum communis muscle representation in the primary motor cortex, as measured by transcranial magnetic stimulation mapping. Discussion. These changes suggest that using EMG-stim as an adjunct to CIMT should be further investigated in individuals who have low functional abilities following stroke.

Key Words: Cerebrovascular accident • Electrical stimulation • Hemiplegia • Muscle performance

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