Assessing the Effect of Functional Electrical Stimulation Training with the Xcite on Hand and Arm Function in Persons with Multiple Sclerosis

Abstract

The purpose of this study was to assess the effects functional electrical stimulation (FES) training of the hand and arm in persons with multiple sclerosis (MS). This is a case series of four individuals with MS with varying hand and arm dysfunction, and Expanded Disability Status Scale (EDSS) scores ranging from 3.0-7.0. Two participants completed 1-hour FES sessions, 3 times per week for 8 weeks and two participants completed 10 weeks. Every session the following four hand and arm exercises were performed on the non-dominant limb: feeding, forward reach and grasp, opposition and lumbrical pinch on the Xcite iFES Clinical Station (Restorative Therapies, Baltimore, MD). Pre and post-testing was divided into two days. The first day included the Sollerman’s hand function test, the Functional Independence Measure (FIM; self-care only), the Capabilities of Upper Extremity (CUE) instrument and the Grasp and Release Test (GRT). The second testing day participants performed grip strength testing (palmar and tip pinch) and two tasks on a haptic wrist device; a tracking task and a proprioception task to assess the effects of the FES training protocol. Pre-testing was completed within 24-72 hours prior to the first FES session and post-testing was within 72 hours of the final FES session. Three of the four participants showed marked improvements in palmar and tip pinch grip strength. Participants did not show meaningful improvement in the Sollerman’s hand function test. The grasp and release test provided mixed results, two participants improved, two were inconsistent across the 6 items. When assessing the functional questionnaires, virtually no change was seen on the FIM and the CUE. Regarding the haptic wrist device testing, some improvement was seen in the tracking and proprioception task but most was not meaningful improvement in the trained limb. Anecdotally, most of the participants reported experiencing improved function in day to day life. The results of this study suggest that thrice-weekly FES of the hand and arm with the Xcite clinical station for 8-10 weeks may elicit functional improvements in individuals with MS. However, more research is required to better understand optimal training parameters and limitations of this therapy.