Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke.
David A Cunningham, Jayme S Knutson, Vishwanath Sankarasubramanian and 3 others
PMID 31315515WHAT IT FOUND
One hour of bilateral stimulation driven by the strong hand reduced the non-lesioned side's braking of the lesioned side and kept lesioned-side output steady, unlike unilateral stimulation.
The same-side pathway did not differ between sessions. This is physiology, not hand recovery proof.
Key findings
01Bilateral CCFES reduced interhemispheric inhibition on the lesioned hemisphere more than unilateral cNMES.
02The measure of lesioned-hemisphere drive to the paretic finger extensor fell after cNMES and rose after CCFES.
03There was no significant difference in ipsilateral output to the paretic hand between CCFES and cNMES.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Fifteen participants is a small convenience sample, so the results cannot be generalized to all chronic stroke patients. The study tested only one hour of stimulation and measured physiology, not hand function or daily activities. The input/output measure was completed in only 7 of 15 participants because some could not produce usable motor-evoked potentials. Same-side MEP size had poor between-session reliability. The study could not measure how much volitional effort participants used during stimulation. The authors could not confirm whether effects depend on impairment severity because of limited sample size and power.
Declared interests
The paper was supported by NIH and non-U.S. government funding. An author is a co-inventor on a patent assigned to Case Western Reserve University for therapeutic neuromuscular electrical stimulation. Another author reports consulting for functional neuromodulation at St Jude, distribution rights at Enspire, ATI, and Cardionomics, and fellowship support from Medtronic. The other listed authors report no disclosures.
The easy way to misread this
Do not conclude that bilateral CCFES improves hand function. This study measured brain and nerve responses after one hour, not arm use, and maximal finger extension force did not change.