Long-term effect of task-oriented functional electrical stimulation in chronic Guillain Barré syndrome–a single-subject study

Objective Functional electrical stimulation (FES) can enhance motor learning of hand fine motor skills in neurological diseases with upper motoneuron lesions. Nevertheless, FES is rarely applied in patients with chronic Guillan-Barré syndrome (GBS) with preserved deep tendon reflexes allowing for stimulation via nerve. This single case report documents the results of an FES-supported, task-oriented grasp training to regain hand closure and pinch grip. Study design Single-subject repeated measures study. Setting International FES Centre®, Swiss Paraplegic Centre Nottwil. Methods Three individually defined goals were formulated and scored by using the goal attainment scale. With a focus on these goals, FES was applied bilaterally to improve hand closure and pinch grip. Based on principles of motor learning FES was executed together with task-oriented movements. The hand closure distance (cm) between the tip of the middle finger and the palmar side of the hand was measured and the achievement of personal, predefined goals evaluated. Results After 16 weeks of daily stimulation, hand closure could be voluntarily performed. Regained opposition of the thumb to the index finger enabled improved individually defined fine motor control. Restored function remained unchanged in the follow-up at 6 months without stimulation. Conclusion Improving fine motor skills in chronic GBS with intact deep tendon reflexes was possible utilizing FES combined with task-oriented grasp training. These improvements were maintained over time indicating the combination was effective in promoting functionally meaningful motor gains.