Electrical Stimulation for Motor Recovery and Function

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Electrical Stimulation for Motor Recovery and
Function

• Barbara M. Doucet, PhD, OTR
• Assistant Professor, K12 Scholar
• Department of Occupational Therapy
• University of Texas Medical Branch, Galveston, TX

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Education Training

• Bachelor of Science, Occupational Therapy
• Louisiana State University Medical Center, New
  Orleans, LA
• Master of Health Science, Allied Health Education
• Louisiana State University Medical Center, New
  Orleans, LA
• PhD, Kinesiology
• University of Texas at Austin

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Education Training

• Clinical practice 20 years serving adult
  neurological population in various rehabilitation
  settings
• University of Texas Human Movement Science
  Neuromuscular Physiology Laboratory, 2002-2007
• Assistant Professor, UTMB, August 2007
• K12 Award, September 2008

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Career Goals

• Independent federally-funded researcher
• Integral part of a transdisciplinary team of
  researchers driven to explore questions in
  rehabilitation research
• Successful scientific contributor to a
  nationally-recognized institutional program that
  supports faculty in their research efforts

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Career Goals

• Specific Research Interests
• Explore the effects of electrical stimulation
  (ES) on motor recovery in the upper extremity
  (UE) of persons with neurological impairment,
  specifically, stroke
• Explore the effects of intensive, focused
  intervention for UE motor recovery in chronic
  stroke.

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Research Career Development Activities
Electrical Stimulation and Neuromuscular Fatigue
PROJECT 2 Electrical Stimulation for UE
Motor Recovery in Brain Injury Stroke, Galveston
PROJECT 1 Electrical Stimulation
Nutritional Support in Hospitalized Elders, UTMB
PROJECT 3 Electrical Stimulation in Skilled
Nursing Settings, Galveston
Initial Pilot Project Unfunded Pending
American Heart Assn.
Funding Pending Moody Endowment of Galveston
Claude D. Pepper Older Americans/ UTMB Sealy
Center on Aging Award, 2008
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Presentation Objectives

• Background
• Overview of Previous Research
• Current Data
• Future Directions

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Neuromuscular Electrical Stimulation (ES)

• Commonly used modality in rehabilitation
• Assists in recovery of motor control
• Rapid fatigue
• Goal maximize force output minimize fatigue
• Constant vs. variable patterns

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Variable Patterns of ES

• Constant pattern for 90s followed by variable
  pattern for 90s
• Variable patterns maximizes force time integral
  (FTI)
• Doublet pattern most effective
• Young older

Collected from thenar muscle in young healthy
n10 avg. age 23.25
yrs.
(Doucet Griffin, Muscle Nerve, June 2008)
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Variable ES and Stroke

• Force decline with constant pattern
• Variable (doublet) pattern more effective in
  maximizing force time integral

Collected from thenar muscle in chronic stroke
n10 avg.
age 63.80 yrs. avg. time post stroke 5
5.52 years
(Doucet Griffin, Muscle Nerve, January 2009)
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Intensive ES for Chronic Stroke

• Higher vs. lower frequency?
• ES 1Xdaily 4X/week X4 weeks
• High freq group Increased pinch and thumb
  adductor strength pre-post
• Lower frequency group trended toward greater
  gain in endurance

Pre Post
Individuals with chronic stroke, n16 avg. age
65 9.60 yrs. time post stroke 5 4.14 years
(Doucet Griffin, in submission to Stroke, 2009)
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ES for Motor Recovery in Stroke

• Previous work confirms effectiveness of ES with
  shoulder
• (Paci, Nanetti, Rinaldi, 2005 Ada
  Foongchomcheay, 2002)
• More recent work focuses on wrist and hand
  function and positive ES benefit
• (deKroon, Ijzerman, Chae, Lankhorst, Zilvold,
  2005)
• Advances in ES technology for stroke
  rehabilitation

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ES in Brain Injury Stroke

• Pilot study
• Standard therapies only, n5
• Standard therapies ES, n5
• Question Does addition of wrist extension ES
  improve UE functional outcomes?
• Device Portable ES unit, Empi 300PV
• 15 session protocol
• ES 2X/day X 35 minutes targeting wrist extension
• Currently 2 clients completed 1 enrolled
• Outcome measures Sensation, Arm/Hand Recovery,
  Coordination, Strength, Function, EMG

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ES in Action
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Results Function
7 Ind 6 Mod I 5 Sup A 4 Min A 3 Mod A 2
Max A 1 Dep
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Results Strength
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Results EMG
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Career Development Needs

• Further develop and refine
• Data collection and analysis skills
• Grant writing skills for federal funding
• Rehabilitation research knowledge

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Future Directions

• Continue work on current projects to establish a
  line of chronic stroke research at UTMB
• Brain Injury/Stroke Pilot Project
• Expect completion this year
• UTMB Hospitalized Elders Project
• Data collection to begin this month
• Skilled Nursing Project
• Pending funding announcement June 2009
• Preliminary data for K23 submission
• Mentored Patient-Oriented Research Career
  Development Award

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Research Team

• Douglas Paddon-Jones, PhD, Lead Mentor
• Kenneth Ottenbacher, PhD
• Beatriz Abreu, PhD, OTR
• Gretchen Stone, PhD, OTR

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Acknowledgements

• K12 HD055929 National Institutes of Health
  National Center for Medical and Rehabilitation
  Research (NICHD) and National Institute for
  Neurological Disorders Stroke
• Claude D. Pepper Older Americans Independence
  Center/UTMB Sealy Center on Aging