title: The addition of electrical stimulation to progressive resistance training does not enhance the wrist strength of people with tetraplegia: a randomized controlled trial.
abstract: OBJECTIVE
  To determine whether the addition of electrical stimulation to progressive resistance training increases the voluntary strength of the wrist muscles in people with tetraplegia.
  
  
  METHODS
  Assessor-blind within-subject randomised controlled trial.
  
  
  METHODS
  Two Australian spinal cord injury units and the community.
  
  
  METHODS
  Sixty-four wrists of 32 people with tetraplegia and bilateral weakness of the wrist extensor or flexor muscles (grade 2 - 4 Medical Research Council grades).
  
  
  METHODS
  Participants' wrists were randomly allocated to one of two conditions. Wrist muscles of the experimental arm received electrical stimulation superimposed on progressive resistance training. The wrist muscles of the contralateral arm received sham electrical stimulation superimposed on progressive resistance training. Both arms received 6 sets of 10 contractions three times a week for eight weeks such that the only difference between arms was the application of electrical stimulation.
  
  
  METHODS
  The primary outcome was maximal voluntary isometric strength. Secondary outcomes were a fatigue resistance ratio representing voluntary and electrically-stimulated endurance. Measurements were taken at the start and end of the eight-week treatment period.
  
  
  RESULTS
  The mean treatment effect (95% Confidence Interval) of electrical stimulation for voluntary strength was 0.04 Nm (95% CI, -0.5 to 0.6; p =0.89). The mean treatment effect (95% CI) for fatigue ratio representing voluntary endurance and electrically-stimulated endurance was -0.01 (95% CI, -0.1 to 0.1; p =0.78) and -0.07 (95% CI, -0.3 to 0.1; p =0.47), respectively.
  
  
  CONCLUSIONS
  Voluntary strength of the wrist is not enhanced by the addition of electrical stimulation to progressive resistance training programs in people with tetraplegia.
authors.affiliation: Rehabilitation Studies Unit, Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia. J.Glinsky@usyd.edu.au
authors.forename: Joanne
authors.initials: J
authors.lastname: Glinsky
authors.forename: Lisa
authors.initials: L
authors.lastname: Harvey
authors.forename: Pauline
authors.initials: P
authors.lastname: van Es
authors.forename: Shane
authors.initials: S
authors.lastname: Chee
authors.forename: Simon C
authors.initials: SC
authors.lastname: Gandevia
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018763:Muscle Fatigue; D053580:Muscle Strength; D018908:Muscle Weakness / Q000534:rehabilitation; D011782:Quadriplegia / Q000534:rehabilitation*; D055070:Resistance Training; D013119:Spinal Cord Injuries / Q000150:complications; D014953:Wrist / Q000503:physiopathology*; D055815:Young Adult