Long Term Effect of Contralaterally Controlled EMG-Modulated Electrical Stimulation Combined with Training and Botulinum Toxin A (BONT-A) Motor Point Block on Hand Function in Patients with Stroke

Objective: This study describes the long term effect of contralaterally controlled EMG modulated electrical stimulation combined with Botulinum Toxin A (BONT-A) motor point block and hand function training in stroke. Methods: Three stroke patients, onset ≥ 6 months, with paresis of wrist and fingers extensors (MRC 2/5), flexor spasticity >3 (MAS), were given BONT-A injections before training. The training consisted of 40 minutes electrical stimulation on the affected side, proportional to the EMG signal picked-up from the unaffected side, simultaneously doing hand function training, for 3-5 days/ week. Outcome measures were Box and Block Test (BBT) and Nine Hole Peg Test (NHPT) scored before, after training, and at follow-up of 4 and 9 months. After 18 sessions, grasp function (BBT) improved in 3 patients, pinch grip (NHPT) improved in 2 patients. One patient was lost to follow-up. At 4 and 9 months, BBT improved further in 1 patient, deteriorated in 1 patient, while NHPT deteriorated in both patients. Conclusion: Grasp function improved at long term follow-up in 1 chronic stroke patient who consistently used the affected dominanthand. No improvement was seen in 1 patient affected at the non-dominant hand. Improvement in pinch grip was lost at long term follow-up.