Modification of motor control of wrist extension by mesh-glove electrical afferent stimulation in stroke patients

Abstract Objective: To study the effect of mesh-glove afferent stimulation on motor control of voluntary wrist movement in stroke patients who have chronic neurological deficits. Design: Case series. Motor control was evaluated by surface EMG of the arm muscles and kinematics of voluntary wrist movements on 3 occasions: before and immediately after the initial session of mesh-glove stimulation, and then after a daily mesh-glove stimulation program conducted over several months. Setting: Tertiary care center. Patients: The inclusion criteria were: a history of stroke lasting longer than 6 months; completion of a rehabilitation program during early recovery; and preserved cognitive and communicative ability. Fourteen referred patients (age 63 ± 9yr; time since stroke 31 ± 22 mo) fulfilled the criteria and completed the daily stimulation program. Intervention: A single initial and then daily mesh-glove electrical afferent stimulation was applied to the hand of the involved upper 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 extension movement and wrist extensor integrated EMG were significantly increased while coactivation of biceps brachii decreased. These findings were most prominent in subjects with partially preserved voluntary wrist movements. Conclusion: We conclude that daily mesh-glove stimulation can modify altered motor control and improve voluntary wrist extension movement in stroke subjects with chronic neurological deficits.