Hemiplegia contributes significantly to the physical disability and impaired quality of life of stroke survivors. However, there are no rehabilitation techniques that have been shown to influence the motor neuroplasticity of a healing brain after stroke. Present rehabilitation strategies emphasize compensatory training of the unimpaired extremities to maximize function, and prevention of complications of immobility. The broad goal of this project is to develop strategies to facilitate the motor recovery of stroke survivors, and thereby maximize their function and quality of life Previous studies have suggested that repetitive exercises facilitated by electromyograph (EMG)-controlled neuromuscular stimulation enhance the motor recovery of stroke survivors. However, those studies were poorly controlled, and mechanisms of action were not addressed.
The aims of this project are to 1) assess the efficacy of EMG-controlled, neuromuscular stimulation in enhancing the upper-extremity motor recovery of chronic stroke survivors, and 2) determine whether EMG-controlled neuromuscular stimulation mediates its effect on motor recovery via central mechanisms. Phase I of the study will identify neurophysiologic measures of brain function that correlate with objective measures of motor impairment. Phase II will consist of a single-blinded, randomized clinical trial to assess the effects of EMG-controlled neuromuscular stimulation on objective measures of motor impairment and measures of central motor function identified in phase I. This study will demonstrate that EMG-controlled neuromuscular stimulation enhances the motor recovery of chronic stroke survivors, and that the motor recovery is mediated by central mechanisms. The proposed intervention may be effective for acute stroke survivors and persons with other forms of cerebral motor dysfunction such as traumatic brain injury, cerebral palsy and multiple sclerosis. EMG-controlled neuromuscular stimulation may also be effective for lower extremity motor recovery. Finally, techniques developed for assessing central motor function may be useful for evaluating other interventions directed at stroke rehabilitation.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
First Independent Research Support & Transition (FIRST) Awards (R29)
Project #
5R29HD035616-03
Application #
6182670
Study Section
Special Emphasis Panel (ZRG4-GRM (01))
Program Officer
Quatrano, Louis A
Project Start
1998-07-01
Project End
2003-06-30
Budget Start
2000-07-01
Budget End
2001-06-30
Support Year
3
Fiscal Year
2000
Total Cost
$99,227
Indirect Cost
Name
Case Western Reserve University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
077758407
City
Cleveland
State
OH
Country
United States
Zip Code
44106
Chae, John; Labatia, Ihab; Yang, Guang (2003) Upper limb motor function in hemiparesis: concurrent validity of the Arm Motor Ability test. Am J Phys Med Rehabil 82:1-8
Park, B K; Chae, J; Lee, Y Hee et al. (2003) Median nerve somatosensory evoked potentials and upper limb motor function in hemiparesis. Electromyogr Clin Neurophysiol 43:169-79
Chae, John; Yang, Guang; Park, Byung Kyu et al. (2002) Delay in initiation and termination of muscle contraction, motor impairment, and physical disability in upper limb hemiparesis. Muscle Nerve 25:568-75
Chae, John; Yang, Guang; Park, Byung Kyu et al. (2002) Muscle weakness and cocontraction in upper limb hemiparesis: relationship to motor impairment and physical disability. Neurorehabil Neural Repair 16:241-8
Chae, J; Fang, Z P; Walker, M et al. (2001) Intramuscular electromyographically controlled neuromuscular electrical stimulation for upper limb recovery in chronic hemiplegia. Am J Phys Med Rehabil 80:935-41
Chae, J; Yu, D (2000) A critical review of neuromuscular electrical stimulation for treatment of motor dysfunction in hemiplegia. Assist Technol 12:33-49