Here's a great piece of clinically relevant research data that was funded by a Reeve Foundation grant and published this week by Milos Popovic.
For many years Popovic, at the Toronto Rehab Institute, has been working on electrical stimulation and neuroprosthetics to improve hand grasp and walking in people with spinal cord injuries. Functional electrical stimulation (FES) systems have gotten quite sophisticated and have been in use for a number of years, even commercially. But what Popovic found is quite remarkable: after a few weeks of FES therapy on hand function, a group of incomplete quads gained meaningful voluntary hand function without further need of the stimulation. In other words, the therapy seems to have reawakened arm and hand muscles – a biological revelation.
Said Popovic (pictured): "This is a seminal paper as it shows that one can dramatically change the hand function in SCI patients using FES technology. It also goes against the notion that SCI patients have to have surgeries, tendon transfers or neuroimplants to restore hand function (which is common belief in the field). Also, this approach is cheaper, has no side effects, has no pain involved, and every physiotherapist or occupational therapist can deliver it. "
Here's the experiment: Two sets of 12 patients were randomized – that means some get the treatment, others don’t. These were incomplete spinal cord injuries within the previous six months; none could grasp objects.
Function was measured using three tools: FIM, Functional Independence Measure; SCIM, Spinal Cord Independence Measure; TRI-HFT, Toronto Rehabilitation Institute Hand Function Test.
They all received conventional occupational therapy five days per week for eight weeks. Nine were randomly chosen (three didn't stay in the trial) to also receive an hour of FES therapy daily; the other 12 patients had an additional hour of conventional occupational therapy only. As reported in the paper, the patients who underwent FES therapy had "significantly reduced disability and improved voluntary grasping."
Those who got occupational therapy only saw a "gentle improvement" in their grasping ability. The measured improvement with FES was significantly greater.
From the paper
We hypothesize that by providing both the command input and system’s output to the central nervous system repetitively over enough time, this type of treatment may facilitate functional reorganization within the sensorimotor network. It is important to add that during the intervention the subjects were performing grasping tasks repetitively. We believe that the combination of performing diverse and meaningful tasks with high repetition and subject’s persistent active engagement (all subjects had to devote 100% of their attention to the tasks performed) may have played a critical role in retraining voluntary grasping functions. These strategies are fully in tune with recent findings in the field of neuroplasticity and suggest that the proposed FET is potentially another effective method that can be used to retrain the neuromuscular system.
"What we now know is that through some interventions like this, you can actually change the way the brain operates to relearn the tasks that have been lost as a result of injury," he told a Canadian TV reporter.
Also from the report
The positive results, as well as results of our preceding study, suggest that individuals with SCI would benefit from FET for grasping and voluntary hand function. We recommend at least 40 one-hour sessions of FET to try to improve upper limb function. Only after the patient has not shown signs of improvement should other invasive procedures be considered, such as implanted neuroprostheses for grasping and tendon transfers. We have trained more than 30 occupational therapists, physiotherapists, and biomedical engineers to administer the FET. Most of the physiotherapists and occupational therapists already knew how to use electrical stimulation systems, so minimal additional training, up to 2 hours, was needed. Donning and doffing the system requires no more than 5 minutes. From a logistics perspective, FET may be easily integrated into existing occupational therapy programs without requiring additional treatment hours or funds beyond those needed to purchase a programmable FES system.
Popovic noted that the study was limited in its follow up: "despite considerable effort we failed to attract the subjects to take part in a 6-month follow-up assessment. This can be explained by the fact that the majority of the subjects were discharged home or to long-term care facilities that were far from the study site."
The paper, “Functional Electrical Stimulation Neurorehabilitation and Neural Repair: Therapy of Voluntary Grasping Versus Only Conventional Rehabilitation
,” appeared in the journal Neurorehabilitation and Neural Repair.
By Sam Maddox