Contralaterally Controlled Functional Electrical Stimulation Plus Video Games for Hand Therapy After Stroke

Not yet recruiting

Phase 2 Results N/A

Eligibility Criteria

Inclusion Criteria

- 6 months since a first clinical cortical or subcortical, hemorrhagic or nonhemorrhagic stroke
- unilateral upper limb hemiparesis with finger extensor strength of grade 4/5 on the Medical Research Council (MRC) scale AND a score of 1 and 11/14 on the hand section of the upper extremity Fugl-Meyer Assessment
- adequate active movement of the shoulder and elbow to position the hand in the workspace for table-top task practice (necessary for the lab task practice sessions)
- Montreal Cognitive Assessment score 23 (cutoff set to allow some mild cognitive impairment)
- able to follow 3-stage commands
- able to remember 2 of 3 items after 30 minutes
- surface stimulation of the paretic finger and thumb extensors produces functional hand opening without pain (this will exclude those who have degree of flexor hypertonia that prevents stimulated hand opening)
- Functional passive range of motion (minimal resistance) at elbow, wrist, fingers, and thumb, i.e.,:
- there exists enough passive range of motion (PROM) to reach and acquire table-top objects
- intact vision and hearing
- medically stable
- full voluntary opening/closing of the contralateral (less affected) hand
- demonstrate ability to follow instructions for operating the stimulator or have a caregiver who will assist them

Exclusion Criteria

- co-existing neurologic diagnosis of peripheral nerve injury, Parkinson's disease, spinal cord injury, traumatic brain injury, or multiple sclerosis
- uncontrolled seizure disorder
- severely impaired cognition and communication
- uncompensated hemineglect
- arm or forearm skin breakdown or edema (to avoid edema-related shunting of current)
- insensate forearm (to avoid risk of electrical burns)
- history of potentially fatal cardiac arrhythmias
- implanted electronic systems (e.g. pacemaker)
- botulinum toxin injections to any upper extremity muscle within 3 months of enrolling
- pregnant women due to unknown risks of surface NMES during pregnancy
- participating in occupational therapy or other rehabilitation therapies to the upper extremity
- severe shoulder or hand pain