ACPOC - The Association of Children's Prosthetic-Orthotic Clinics Founded in 1978

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Improvement of Hand Function in Children with Arthrogryposis following Neuromuscular Electrical Stimulation (NMES)-A Preliminary Report

The purpose of this study was to determine if NMES is appropriate for children with arthrogryposis and can result in improved joint range of motion (ROM) and/or voluntary use of the stimulated extremity.

Three children, ages 12 to 18 months, participated in the study. Chronaxie values were determined for upper extremity musculature, but only finger flexors were intact bilaterally for all children and these were chosen for NMES. Finger ROM, prehension patterns and hand use were documented on videotape prior to initiating NMES, and biweekly thereafter to indicate progress. One extremity was randomly chosen for stimulation while the other served as the control. Stimulus parameters included an asymmetrical, balanced biphasic waveform with a 330 microsec phase duration, 30 Hz frequency, 1:3 ON:OFF ratio, and 12-17 mA current. Families were asked to perform one 30 minute NMES session daily while passively ranging the fingers. Unwanted motion was controlled with splints. OT was continued to maintain/improve ROM in the shoulder and elbow.

Improvements in PROM and AROM of the MP, PIP, and DIP joints were observed. Prehension tended to change from an ulnar to radial and palmar to distal pattern. This was not observed with the control extremity. Passive elbows ROM was improved through conventional therapy. With the improvement in elbow range and grasp patterns, parents reported increased functional use of the stimulated extremity. These gains were maintained after the stimulation was withdrawn.

Results indicate that NMES may be an appropriate adjunct to conventional intervention for some arthrogrypotic children who may benefit functionally.

Shriners Hospital for Crippled Children, 8400 Roosevelt Boulevard, Philadelphia, PA 19152