# Contralaterally Controlled FES plus Video Games for Hand Therapy after Stroke

> **NIH VA I01** · LOUIS STOKES CLEVELAND VA MEDICAL CENTER · 2022 · —

## Abstract

Hemiparesis of the upper limb is one of the most serious impairments resulting from stroke.
Approximately 75% of the over 795,000 strokes that occur annually in the United States cause some degree of
upper extremity paralysis. Up to 65% of stroke survivors still cannot use their affected hand to assist with
activities of daily living 6 months after their stroke. The proposed project is a clinical trial that compares the
effects of an innovative neuromuscular electrical stimulation therapy to a therapy that integrates the electrical
stimulation with interactive hand therapy video games. The purpose of the proposed research is to address the
need for effective upper limb rehabilitation therapies by evaluating the effects of these treatments on both hand
and brain function.
 Contralaterally controlled functional electrical stimulation (CCFES) is an innovative neuromuscular
electrical stimulation (NMES) treatment for improving recovery of hand function after stroke. CCFES stimulates
the paretic hand to open in proportion to the degree of volitional opening of the contralateral unimpaired hand.
This enables stroke patients to perform active repetitive hand opening exercises at home and practice
functional tasks with a therapist in the lab. Significant improvements in dexterity, upper extremity impairment,
and activity limitation measures have been shown with CCFES, but the magnitude of improvement depends on
the severity and chronicity of impairment. It may be possible to improve outcomes in both moderately and
severely impaired patients by increasing the motor relearning qualities of the home-based part of the
treatment, which comprises 70% of the total treatment hours. Therefore, in this study, we integrate CCFES
with custom-designed attention-engaging, goal-oriented, skill-requiring CCFES-assisted hand therapy video
games (HTVG) and compare the effects of the combined treatment (CCFES+HTVG) to the effects of CCFES
alone. The video game component is expected to enhance the treatment effect because the CCFES-mediated
games are more goal-oriented and require greater motor planning, motor control, and concentration than
CCFES-mediated repetitive hand opening exercises, and therefore may produce more adaptive neuroplastic
effects in the brain.
 This project will enroll 52 chronic stroke patients and randomize them to 12 weeks of either
CCFES+HTVG or CCFES in order to: 1) determine if integrating HTVG and CCFES leads to greater
improvement in dexterity, impairment, activity limitation, and quality of life, 2) determine how severity of
impairment and time post-stroke influences the relative effects of the treatments, thereby defining
subpopulations most likely to benefit, and 3) elucidate and compare how the treatments affect cortical
activation during a hand motor control task (fMRI assessment). This will be the first randomized controlled trial
that integrates video games and neuromuscular electrical stimulation in such a way that the stimulation is
del...

## Key facts

- **NIH application ID:** 10348792
- **Project number:** 5I01RX002249-06
- **Recipient organization:** LOUIS STOKES CLEVELAND VA MEDICAL CENTER
- **Principal Investigator:** Jayme S. Knutson
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-03-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10348792

## Citation

> US National Institutes of Health, RePORTER application 10348792, Contralaterally Controlled FES plus Video Games for Hand Therapy after Stroke (5I01RX002249-06). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10348792. Licensed CC0.

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