Restoration of upper-extremity function after task-oriented, intention-driven functional electrical stimulation therapy using a wearable sleeve in adults with chronic stroke: a case series.

BackgroundFunctional electrical stimulation (FES) has been recognized for decades as a method to retrain the motor system after stroke. Benefits of FES rehabilitation can be enhanced by combining task-oriented therapy, dubbed FES therapy (FEST). Furthermore, by synchronizing FES with the users volitional motor intention and incorporating multiple trained tasks FES can be better integrated into common task-oriented rehabilitation practice. Using wearable FES technology, we tested therapy incorporating these elements in two chronic stroke survivors. MethodsOur group has developed the NeuroLife(R) Sleeve, a wearable forearm sleeve that contains a high-density grid of embedded FES electrodes, that may be controlled by an operator or by the wearers own electromyographic (EMG) signals. During eight weeks of FEST, intention-driven FES enabling multiple movements was delivered via operator control twice weekly and EMG control once weekly. ResultsAt the end of the therapy period, subjects A and B had both improved their scores: Box and Blocks Test (A: +5, B: +7), the Action Arm Research Test (A: +7, B: +12), the Fugl Meyer Upper Extremity section (A: +11, B: +9), and the 9-Hole Peg Test (A: 158 sec, B: 54 sec, both previously unable). All score improvements persisted over the 10-week follow-up period despite greatly reduced (>80%) effective dose of FES. ConclusionsThis case series provides additional evidence that intention-driven FEST drives long-lasting motor recovery in chronic stroke survivors. The NeuroLife Sleeve enabled this therapy through the easily donned wearable sleeve interface, control schemes for pairing FES with motor intention, and efficient transitions between tasks with programmable FES placement and parameters.