MODIFICATION OF MOTOR CONTROL OF WRIST EXTENSION BY MESH-GLOVE ELECTRICAL AFFERENT STIMULATION IN STROKE PATIENTS

Objective: To study the effect of mesh-glove afferent stimulation on m otor control of voluntary wrist movement in stroke patients who have c hronic neurological deficits. Design: Case series, Motor control was e valuated by surface EMG of the arm muscles and kinematics of voluntary wrist movements on 3 occasions: before and immediately after the init ial session of mesh-glove stimulation, and then after a daily mesh-glo ve stimulation program conducted over several months. Setting: Tertiar y care center. Patients: The inclusion criteria were: a history of str oke lasting longer than 6 months; completion of a rehabilitation progr am during early recovery; and preserved cognitive and communicative ab ility, Fourteen referred patients (age 63 +/- 9yr; time since stroke 3 1 +/- 22mo) fulfilled the criteria and completed the daily stimulation program. Intervention: A single initial and then daily mesh-glove ele ctrical afferent stimulation was applied to the hand of the involved u pper limb for 20 to 30min.Main Outcome Measures: Surface EMGs from the affected biceps brachii and wrist extensor muscles and amplitudes of wrist movements were analyzed. Results: The single, initial mesh-glove application had no effect on outcome measures. Following a daily mesh -glove stimulation program, however, both the amplitude of wrist exten sion movement and wrist extensor integrated EMG were significantly inc reased while coactivation of biceps brachii decreased. These findings were most prominent in subjects with partially preserved voluntary wri st movements. Conclusion: We conclude that daily mesh-glove stimulatio n can modify altered motor control and improve voluntary wrist extensi on movement in stroke subjects with chronic neurological deficits. (C) 1996 by the American Congress of Rehabilitation Medicine and the Amer ican Academy of Physical Medicine and Rehabilitation