Improved upper extremity function following low-frequency hybrid assistive neuromuscular dynamic stimulation therapy in a patient with hemiplegia: A case report

Background: Although hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy may improve upper extremity functionality in patients with paralysis or paresis due to stroke, it is usually only provided in hospitals as a frequent intervention during the phase of early recovery in stroke. Home-based rehabilitation is limited by frequency and duration of visits. Purpose: To investigate the effectiveness of low-frequency HANDS therapy using motor function assessment. Study design: Case report. Methods: We performed HANDS therapy for 1 month on the patient, who was a woman in her 70s with left-sided hemiplegia. It was initiated on day 183 post the onset of stroke. Movement and motor function were evaluated using the Fugl-Meyer Assessment upper-extremity (FMA-UE) motor items and the Motor Activity Log consisting of Amount of Use (MAL-AOU), as well as Quality of Movement (MAL-QOM) scales. This evaluation was performed before starting HANDS therapy and after its conclusion. Results: Following HANDS therapy, there was improvement in the FMA-UE (21 points → 28 points), MAL-AOU (0.17 points → 0.33 points), and MAL-QOM (0.08 points → 0.33 points) scores when compared to the scores before therapy, and the patient was able to use both hands for activities of daily living (ADLs). Conclusions: Low-frequency HANDS therapy combined with encouragement to include the affected hand in ADLs may improve upper extremity function in cases of paralysis.