Therapies for Recovery of Hand Function After Stroke

Prior treatment

• concurrent enrollment in another investigational study

Other illness

• co-existing neurologic diagnosis of peripheral nerve injury, Parkinson's disease, spinal cord injury, traumatic brain injury, or multiple sclerosis
• uncontrolled seizure disorder
• brainstem stroke
• history of potentially fatal cardiac arrhythmias with hemodynamic instability
• diagnosis (apart from stroke) that substantially affects paretic arm and hand function

Other

• uncompensated hemineglect
• severe shoulder or hand pain
• insensate forearm or hand
• 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
• lack of functional passive range of motion of the wrist or fingers of affected side
• deficits in communication that interfere with reasonable study participation
• lacking sufficient visual acuity to see the stimulator's display

• 6 to 24 months since a first clinical cortical or subcortical, hemorrhagic or nonhemorrhagic stroke
• unilateral upper limb hemiparesis with finger extensor strength of grade no more than 4 out of 5 on the Medical Research Council (MRC) scale
• score of at least 1 and no more than 11 out of 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)
• able to follow 3-stage commands
• able to recall at least 2 of a list of 3 items after 30 minutes
• skin intact on the hemiparetic arm
• surface stimulation of the paretic finger and thumb extensors produces functional hand opening without pain (this will exclude those who have too much flexor spasticity)
• able to hear and respond to cues from stimulator
• not receiving occupational therapy (no concomitant OT)
• full voluntary opening/closing of the contralateral (less affected) hand
• demonstrates ability to follow instructions for operating the stimulator or have a caregiver who will assist them