Can surface neuromuscular electrical stimulation of the wrist and hand combined with routine therapy facilitate recovery of arm function in patients with stroke?
OBJECTIVE
To investigate whether treatment with surface neuromuscular electrical stimulation to the wrist extensors improves recovery of arm function in severely disabled patients with stroke.


METHODS
Single blinded randomized controlled trial.


METHODS
Acute stroke unit and stroke rehabilitation wards of a university hospital.


METHODS
Patients with no upper limb function (Action Research Arm Test [ARAT] score 0) (N=90; mean age ± SD, 74±11y; 49% men) were recruited to the study within 6 weeks of stroke. Only 67 participants were alive at the end of the study and data from 66 of these people were analyzed.


METHODS
Participants were randomized to surface neuromuscular electrical stimulation using surface electrical stimulators for 30 minutes, twice in a working day for 6 weeks in addition to standardized upper limb therapy or just standardized upper limb therapy.


METHODS
The primary outcome measure was the ARAT score. Assessments were made at baseline and at 6, 12, 24, and 36 weeks after recruitment.


RESULTS
There were statistically significant improvements in measures of wrist extensor (mean difference 0.5; 95% confidence interval [CI], 0.0-1.0) and grip strength (mean difference 0.9; 95% CI, 0.1-1.7) over the treatment period. Arm function (ARAT score) was not significantly different between the groups over the treatment period at 6 weeks (mean difference 1.9; 95% CI, -2.9 to 6.8) or over the study period at 36 weeks (mean difference 6.4; 95% CI, -1.8 to 14.7), and the rate of recovery was not significantly different (mean difference 0.7; 95% CI, -0.2 to 1.6).


CONCLUSIONS
In patients with severe stroke, with no functional arm movement, electrical stimulation of wrist extensors improves muscle strength for wrist extension and grip, and larger studies are required to study its influence on arm function.
School of Health and Rehabilitation, Keele University, Keele, UK.
Sheeba
S
Rosewilliam
Shweta
S
Malhotra
Christine
C
Roffe
Peter
P
Jones
Anand D
AD
Pandyan
D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000503:physiopathology*; D006233:Persons with Disabilities / Q000534:rehabilitation*; D004599:Electric Stimulation Therapy; D005260:Female; D006429:Hemiplegia / Q000209:etiology* / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D012044:Regression Analysis; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome