10 th Annual Conference of the International FES Society July 2005 – Montreal, Canada Upper Extremity Functional Electrical Stimulation: Case Study of Neuromuscular Restorative Therapy Miller RC 1 , Popovic MR 1,2,3, , McIlroy W 1,3 , Verrier MC 1,3 1 Graduate Department of Rehabilitation Science, University of Toronto, Canada 2 Institute of Biomaterials and Biomedical Engineering, University of Toronto, Canada 3 Toronto Rehabilitation Institute, Canada rosalynn.miller@utoronto.ca Neuromuscular Restorative Therapy (NRT) is a therapeutic upper extremity intervention strategy which includes Functional Electrical Stimulation (FES) for muscle strengthening and provides functional training through the performance of meaningful tasks. Two individuals (P1 and P2) participated in three months of NRT. A single arm was chosen to receive the intervention; the other arm received no therapy. Participant’s with spinal cord injury (SCI) were assessed using American Spinal Injury Association (ASIA) scores, Spinal Cord Independence Measure (SCIM), and a kinematic task: Reach, Grasp, Transport, and Release (RGTR). Participant’s ASIA and SCIM scores, showed no substantial change. The participant’s performance of the RGTR demonstrated significant improvement in Successful Object Contact (SOC) in the treated arm (P1, p ≤ 0.001 and P2, p = 0.05). There was no significant change in the untreated arm (P1, p = 0.69 and P2, p = 0.64). It appears that despite the lack of change in ASIA and SCIM scores; following NRT, individuals with a chronic cervical SCI have increased success in grasping. 1. INTRODUCTION SCI is an injury to the spinal cord resulting in the impairment of motor and sensory function. Of the 1,050 new SCI’s that occur per year in Canada 1 (10-77 per million population in USA 2 ) 47% occur in the cervical region 1 (55% in USA 1 ). Following SCI an individual’s motor function demonstrates deficits which substantially affect independence, health, and quality of life. Hand function is critical to independence 3 ; however strategies to facilitate the recovery of upper extremity function are poorly understood 4 . The purpose of this study was to explore of the use of FES as a central element of an intervention strategy for the recovery of upper extremity function for individuals with SCI. 1.1. Functional Electrical Stimulation Surface FES is a methodology that uses electrical current to generate ordered muscle contractions propagating a series of muscular activations, facilitating the use of a limb in a functional manner (e.g. grasping a pop can). FES assists in movement therapy, providing exercise, and restoration of function 5 . FES is used primarily as a neuroprosthetic; however there are reports of restoration of upper extremity function following FES 6,7,8 . The reported restoration of function fostered the development of NRT. 1.2. Neuromuscular Restorative Therapy NRT is an integrative intervention strategy using FES to facilitate muscle strengthening and functional training while attempting movement re-acquisition. Principles of motor learning are combined with purposeful, meaningful, goal oriented movements. NRT combines FES facilitated muscle strengthening and functional training with active (no FES) movements and stretching. NRT is customized to the participants’ functional and motor abilities as well as rate of recovery. A Compex ® Motion stimulator (Medicompex SA, Ecublens, Switzerland) 9 is used to deliver the stimulation. 2. METHODS NRT occurred for one hour three times a week for three months. Two participants were assessed using the ASIA 10 scores, SCIM 11 scores, and a kinematic assessment of the RGTR. FES parameters used were: blocked asymmetric biphasic pulse with a width of 300μs, frequency of 40Hz, and amplitude 8- 50mA (muscle and individual dependent).