Feasibility and potential effects of using the electro-dress Mollii on spasticity and functioning in chronic stroke

Susanne Palmcrantz, Gaia Valentina Pennati, Hanna Bergling, Jörgen Borg, Susanne Palmcrantz, Gaia Valentina Pennati, Hanna Bergling, Jörgen Borg

Abstract

Background: Spasticity after lesions of central motor pathways may be disabling and there is a need for new, cost-effective treatment methods. One novel approach is offered by the electro-dress Mollii®, primarily designed to enhance reciprocal inhibition of spastic muscles by multifocal, transcutaneous antagonist stimulation.

Methods: The Mollii® suit was set individually for 20 participants living with spasticity and hemiplegia after stroke and used in the home setting for 6 weeks. Usability and perceived effects were monitored by weekly telephone interviews. Outcome was assessed by use of the NeuroFlexor™ method for quantification of the neural component (NC) of resistance to passive stretch (spasticity), and the modified Ashworth scale (MAS) for total resistance, Fugl-Meyer Assessment of motor recovery for sensorimotor function in upper (FM-UE) and lower extremities (FM-LE), activity performance with the Action Research Arm Test (ARAT), Berg balance scale, 10 m and 6 min walk tests, and perceived functioning with the Stroke Impact Scale.

Results: Compliance was high (mean 19.25 of 21 sessions). Perceived positive effects were reported by 60% and most commonly related to decreased muscle tone (n = 9), improved gait pattern function (n = 7) and voluntary movement in the upper extremity (n = 6). On a group level, the NC decreased significantly in the wrist flexors of the affected hand (p = 0.023) and significant improvements according to FM-UE (p = 0.000) and FM-LE (p = 0.003) were seen after the intervention. No significant difference was detected with MAS or assessed activity performance, except for the ARAT (p = 0.000). FM-UE score change correlated significantly and fairly with the perceived effect in the upper extremity (r 0.498 p = 0.025) and in the corresponding analysis for the FM-LE and perceived effect in the lower extremity (r = 0.469 p = 0.037).

Conclusion: This study indicates that the Mollii® method is feasible when used in the home setting to decrease spasticity and improve sensorimotor function. The results may guide a larger controlled study combined with rehabilitation interventions to enhance effects on activity and participation domains.

Trial registration: NCT04076878 . Registered 2 September 2019 - Retrospectively registered.

Keywords: Clinical assessments; Home setting; Outcome; Self-administered; Self-perceived; Spasticity; Stroke.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Donning of the Mollii® suit – trousers [1] and jacket [2] and connection of the control unit to the suit [3]
Fig. 2
Fig. 2
Questions asked in weekly telephone interviews
Fig. 3
Fig. 3
Neural component (NC) before (M1) and after the 6 weeks intervention (M2)

References

    1. Lance JW. Spasticity: disordered motor control. In: Feldman RG, Young RR, Koella WP, editors. Symposium Synposis. 4. 1980. pp. 485–494.
    1. Gracies JM. Pathophysiology of spastic paresis. II: emergence of muscle overactivity. Muscle Nerve. 2005;31(5):552–571.
    1. Sommerfeld DK, Eek EU, Svensson AK, Holmqvist LW, von Arbin MH. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke. 2004;35(1):134–139.
    1. Lundstrom E, Terent A, Borg J. Prevalence of disabling spasticity 1 year after first-ever stroke. Eur J Neurol. 2008;15(6):533–539.
    1. Urban PP, Wolf T, Uebele M, Marx JJ, Vogt T, Stoeter P, et al. Occurence and clinical predictors of spasticity after ischemic stroke. Stroke. 2010;41(9):2016–2020.
    1. Bakheit AM, Fedorova NV, Skoromets AA, Timerbaeva SL, Bhakta BB, Coxon L. The beneficial antispasticity effect of botulinum toxin type a is maintained after repeated treatment cycles. J Neurol Neurosurg Psychiatry. 2004;75(11):1558–1561.
    1. Brashear A, Gordon MF, Elovic E, Kassicieh VD, Marciniak C, Do M, et al. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. N Engl J Med. 2002;347(6):395–400.
    1. McCrory P, Turner-Stokes L, Baguley IJ, De Graaff S, Katrak P, Sandanam J, et al. Botulinum toxin a for treatment of upper limb spasticity following stroke: a multi-Centre randomized placebo-controlled study of the effects on quality of life and other person-centred outcomes. J Rehabil Med. 2009;41(7):536–544.
    1. Andringa A, van de Port I, van Wegen E, Ket J, Meskers C, Kwakkel G. Effectiveness of botulinum toxin treatment for upper limb spasticity Poststroke over different ICF domains: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019;100(9):1703–1725.
    1. Ward AB, Wissel J, Borg J, Ertzgaard P, Herrmann C, Kulkarni J, et al. Functional goal achievement in post-stroke spasticity patients: the BOTOX (R) economic spasticity trial (BEST) J Rehabil Med. 2014;46(6):504–513.
    1. Wissel J, Ganapathy V, Ward AB, Borg J, Ertzgaard P, Herrmann C, et al. OnabotulinumtoxinA improves pain in patients with post-stroke spasticity: findings from a randomized, double-blind, placebo-controlled trial. J Pain Symptom Manag. 2016;52(1):17–26.
    1. Gupta AD, Chu WH, Howell S, Chakraborty S, Koblar S, Visvanathan R, et al. A systematic review: efficacy of botulinum toxin in walking and quality of life in post-stroke lower limb spasticity. Syst Rev. 2018;7(1):1.
    1. Mahmood A, Veluswamy SK, Hombali A, Mullick A, Manikandan N, Solomon JM. Effect of transcutaneous electrical nerve stimulation on spasticity in adults with stroke: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019;100(4):751–768.
    1. Mills PB, Dossa F. Transcutaneous electrical nerve stimulation for Management of Limb Spasticity a systematic review. Am J Phys Med Rehab. 2016;95(4):309–318.
    1. Marcolino MAZ, Hauck M, Stein C, Schardong J, Pagnussat AS, Plentz RDM. Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials. Disabil Rehabil. 2018;1:1–13.
    1. Perez MA, Field-Fote EC, Floeter MK. Patterned sensory stimulation induces plasticity in reciprocal ia inhibition in humans. J Neurosci. 2003;23(6):2014–2018.
    1. Tinazzi M, Zarattini S, Valeriani M, Romito S, Farina S, Moretto G, et al. Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation (TENS) of forearm muscles: evidence of reciprocal inhibition and facilitation. Exp Brain Res. 2005;161(4):457–464.
    1. Ertzgaard P, Alwin J, Sorbo A, Lindgren M, Sandsjo L. Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial. Eur J Phys Rehabil Med. 2018;54(4):507–517.
    1. Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther. 1984;64(1):35–40.
    1. Nordin A, Murphy MA, Danielsson A. Intra-rater and inter-rater reliability at the item level of the action research arm test for patients with stroke. J Rehabil Med. 2014;46(8):738–745.
    1. Pennati GV, Plantin J, Borg J, Lindberg PG. Normative NeuroFlexor data for detection of spasticity after stroke: a cross-sectional study. J Neuroeng Rehab. 2016;13:30.
    1. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Maryland State Med J. 1965;14:61–65.
    1. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699.
    1. World Health Organization. International classification of functioning, disability and health; 2018. . Accessed 4 Aug 2020.
    1. Lindberg PG, Gaverth J, Islam M, Fagergren A, Borg J, Forssberg H. Validation of a new biomechanical model to measure muscle tone in spastic muscles. Neurorehabil Neural Repair. 2011;25(7):617–625.
    1. Gaverth J, Sandgren M, Lindberg PG, Forssberg H, Eliasson AC. Test-retest and inter-rater reliability of a method to measure wrist and finger spasticity. J Rehabil Med. 2013;45(7):630–636.
    1. Gaverth J, Eliasson AC, Kullander K, Borg J, Lindberg PG, Forssberg H. Sensitivity of the NeuroFlexor method to measure change in spasticity after treatment with botulinum toxin a in wrist and finger muscles. J Rehabil Med. 2014;46(7):629–634.
    1. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206–207.
    1. Fleuren JF, Voerman GE, Erren-Wolters CV, Snoek GJ, Rietman JS, Hermens HJ, et al. Stop using the Ashworth scale for the assessment of spasticity. J Neurol Neurosurg Psychiatry. 2010;81(1):46–52.
    1. Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13–31.
    1. Wade DT, Wood VA, Heller A, Maggs J, Langton HR. Walking after stroke. Measurement and recovery over the first 3 months. Scand J Rehabil Med. 1987;19(1):25–30.
    1. Kosak M, Smith T. Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke. J Rehabil Res Dev. 2005;42(1):103–107.
    1. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992;83(Suppl 2):S7–11.
    1. Berg K, Wood-Dauphinee S, Williams JI. The balance scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27(1):27–36.
    1. Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Stroke. 1999;30(10):2131–2140.
    1. Duncan PW, Bode RK, Min Lai S, Perera S. Glycine antagonist in neuroprotection Americans I. Rasch analysis of a new stroke-specific outcome scale: the stroke impact scale. Arch Phys Med Rehabil. 2003;84(7):950–963.
    1. Portney LGWM. Foundation of Clinical Research: application to practice. Upper Sadler River: Prentice Hall 912; 2000.
    1. Plantin J, Pennati GV, Roca P, Baron JC, Laurencikas E, Weber K, et al. Quantitative assessment of hand spasticity after stroke: imaging correlates and impact on motor recovery. Front Neurol. 2019;10:836.
    1. Lorentzen J, Grey MJ, Crone C, Mazevet D, Biering-Sorensen F, Nielsen JB. Distinguishing active from passive components of ankle plantar flexor stiffness in stroke, spinal cord injury and multiple sclerosis. Clin Neurophysiol. 2010;121(11):1939–1951.
    1. Alibiglou L, Rymer WZ, Harvey RL, Mirbagheri MM. The relation between Ashworth scores and neuromechanical measurements of spasticity following stroke. J Neuroeng Rehab. 2008;5:18.
    1. Andringa A, van Wegen E, van de Port I, Kwakkel G, Meskers C. Measurement properties of the NeuroFlexor device for quantifying neural and non-neural components of wrist hyper-resistance in chronic stroke. Front Neurol. 2019;10:730.
    1. Dodd KC, Nair VA, Prabhakaran V. Role of the Contralesional vs. Ipsilesional hemisphere in stroke recovery. Front Hum Neurosci. 2017;11:1.
    1. Sunnerhagen KS, Olver J, Francisco GE. Assessing and treating functional impairment in poststroke spasticity. Neurology. 2013;80(3 Suppl 2):S35–S44.
    1. Naro A, Leo A, Russo M, Casella C, Buda A, Crespantini A, et al. Breakthroughs in the spasticity management: are non-pharmacological treatments the future? J Clin Neurosci. 2017;39:16–27.
    1. Bolognini N, Russo C, Edwards DJ. The sensory side of post-stroke motor rehabilitation. Restor Neurol Neurosci. 2016;34(4):571–586.

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