Functional electrical stimulation (FES) may modify the poor prognosis of stroke survivors with severe motor loss of the upper extremity: a preliminary study.

OBJECTIVES: This nonblinded, block-randomized clinical trial tested the hypothesis that task-oriented functional electrical stimulation (FES) can enhance the recovery of upper-extremity volitional motor control and functional ability in patients with poor prognosis. DESIGN: Ischemic stroke survivors (FES + exercise group, n = 13, 17.4 +/- 7.6 days after stroke, and exercise-only group n = 13, 23.8 +/- 10.9 days after stroke) trained with task-specific exercises, 30 min, twice each day. The FES group practiced the exercises combined with FES that enabled opening and closing of the paretic hand and continued with FES without exercises for up to 90 mins of additional time twice a day. Both groups trained for 12 wks. Volitional motor control (modified Fugl-Meyer [mF-M]), hand function (Box & Blocks [B&B], and Jebsen-Taylor light object lift [J-T]) were video recorded for both upper extremities at baseline and at 4, 8, and 12 wks. RESULTS: Mean mF-M score of the FES group (24 +/- 13.7) was significantly better (P = 0.05) at 12 wks compared with the control group that scored 14.2 +/- 10.6 points. The B&B mean score did not reach statistical significance (P = 0.058) in favor of the FES group (10.5 +/- 2.4 blocks) over the control group (2.5 +/- 4.9 blocks). The J-T task time did not differ between groups. Eight (FES) compared with three (control) patients regained the ability to transfer five or more blocks (P = 0.051), and six (FES) compared with two (control) completed the J-T task in 30 sec or less after 12 wks of training (P = 0.09). CONCLUSIONS: FES + exercise as used in this preliminary study is likely to minimize motor loss, but it may not significantly enhance the ability to use the upper extremity after ischemic stroke. Anecdotally, more patients may regain some functional ability after training with FES compared with training without FES. Patients with severe motor loss may require prolonged task-specific FES training.

A systematic review of health-related quality of life and hearing aids: final report of the American Academy of Audiology Task Force On the Health-Related Quality of Life Benefits of Amplification in Adults.

This is the final report of the American Academy of Audiology Task Force on the Health-Related Quality of Life (HRQoL) Benefits of Amplification in Adults. A systematic review with meta-analysis examined evidence pertaining to the use of hearing aids for improving HRQoL for adults with sensorineural hearing loss (SNHL). Relevant search strings applied to the CENTRAL, CINAHL, Cochrane Reviews, ComDisDome, EBMR, and PubMed databases identified randomized controlled trial, quasi-experimental, and nonexperimental pre-post test designed studies. Sixteen studies met a priori criteria for inclusion in this review. A random-effects meta-analysis showed differential results for generic versus disease-specific HRQoL measures for within- and between-subject designs. Although generic measures used for within-subject designs did not demonstrate HRQoL benefits from hearing aids, mean effect sizes and confidence intervals for within-subject designs and disease-specific instruments suggested that hearing aids have a small-to-medium impact on HRQoL. Further, the between-subject studies supported at least a small effect for generic measures, and when measured by disease-specific instruments, hearing aids had medium-to-large effects on adults' HRQoL. This review concludes that hearing aids improve adults' HRQoL by reducing psychological, social, and emotional effects of SNHL. Future studies should include control groups using randomized controlled trials.

Functional electrical stimulation enhancement of upper extremity functional recovery during stroke rehabilitation: a pilot study.

OBJECTIVE: To test if functional electrical stimulation (FES) can enhance the recovery of upper extremity function during early stroke rehabilitation. METHODS: Open-label block-randomized trial, begun during inpatient rehabilitation and continued at the patients' home. Patients were assigned to either FES combined with task-specific upper extremity rehabilitation (n = 7) or a control group that received task-specific therapy alone (n = 8) over 12 weeks. Outcome measures . Hand function (Box & Blocks, B & B; Jebsen-Taylor light object lift, J-T) and motor control (modified Fugl-Meyer, mF-M) were video-recorded for both upper extremities at baseline, 4, 8, and 12 weeks. RESULTS: B&B mean score at 12 weeks favored (P = .049) the FES group (42.3 +/- 16.6 blocks) over the control group (26.3 +/- 11.0 blocks). The FES group J-T task was 6.7 +/- 2.9 seconds and faster (P = .049) than the 11.8 +/- 5.4 seconds of the control group. Mean mF-M score of the FES group at 12 weeks was 49.3 +/- 5.1 points out of 54, compared to the control group that scored 40.6 +/- 8.2 points (P = .042). All patients regained hand function. CONCLUSION: Upper extremity task-oriented training that begins soon after stroke that incorporates FES may improve upper extremity functional use in patients with mild/moderate paresis more than task-oriented training without FES.