Table of Contents Author Guidelines Submit a Manuscript
Neural Plasticity
Volume 2017, Article ID 2350137, 5 pages
Review Article

Hybrid Assistive Neuromuscular Dynamic Stimulation Therapy: A New Strategy for Improving Upper Extremity Function in Patients with Hemiparesis following Stroke

1Department of Physical Medicine and Rehabilitation, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, Japan
2Department of Rehabilitation Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan
3Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan
4Department of Rehabilitation Medicine, Keio University Hospital, 35 Shinanomachi, Shinjuku, Tokyo, Japan

Correspondence should be addressed to Toshiyuki Fujiwara; pj.en.ten-os.5cx@ijufot

Received 22 September 2016; Revised 18 December 2016; Accepted 26 December 2016; Published 16 January 2017

Academic Editor: J. Michael Wyss

Copyright © 2017 Toshiyuki Fujiwara et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) therapy is one of the neurorehabilitation therapeutic approaches that facilitates the use of the paretic upper extremity (UE) in daily life by combining closed-loop electromyography- (EMG-) controlled neuromuscular electrical stimulation (NMES) with a wrist-hand splint. This closed-loop EMG-controlled NMES can change its stimulation intensity in direct proportion to the changes in voluntary generated EMG amplitudes recorded with surface electrodes placed on the target muscle. The stimulation was applied to the paretic finger extensors. Patients wore a wrist-hand splint and carried a portable stimulator in an arm holder for 8 hours during the daytime. The system was active for 8 hours, and patients were instructed to use their paretic hand as much as possible. HANDS therapy was conducted for 3 weeks. The patients were also instructed to practice bimanual activities in their daily lives. Paretic upper extremity motor function improved after 3 weeks of HANDS therapy. Functional improvement of upper extremity motor function and spasticity with HANDS therapy is based on the disinhibition of the affected hemisphere and modulation of reciprocal inhibition. HANDS therapy may offer a promising option for the management of the paretic UE in patients with stroke.