Effects of hybrid assistive neuromuscular dynamic stimulation therapy for hemiparesis after pediatric stroke: a feasibility trial

Background: Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy, consisting of a wrist-hand splint and an integrated volitional control electrical stimulator to stimulate the extensor digitorum communis, is effective for chronic hemiparesis after stroke in adults. We investigated the feasibility and effects of HANDS therapy for patients with pediatric stroke by performing a longitudinal study. Methods: Twelve patients with chronic hemiparetic pediatric stroke (aged 14–38 years) wore the herapeutic device for 3 weeks. The device was active for 8 h during the daytime, and patients were instructed to use their paretic hand as much as possible. Upper extremity items of the Fugl-Meyer Motor Assessment Scale and the Stroke Impairment Assessment Set motor test were used to measure motor function and were compared before and after the intervention with the Wilcoxon signed rank test. Results: All patients were fully compliant with the therapy with no adverse events. After the intervention, both treatment endpoints improved significantly (p <.05). The effect size for upper extremity items of the Fugl-Meyer Motor Assessment Scale was medium (d = 0.59). Conclusion: This preliminary study demonstrated the feasibility and effectiveness of HANDS therapy in patients with pediatric stroke.Implications for rehabilitation Pediatric stroke is a very rare disease and patients are forced to live with sequelae in most of the rest of their lives. Hybrid assistive neuromuscular dynamic stimulation therapy is effective for upper limb paralysis of adult stroke. Hybrid assistive neuromuscular dynamic stimulation therapy was adaptable even for children, and improvement of upper limb paralysis was observed even in a relatively short period of intervention.