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Can Surface Neuromuscular Electrical Stimulation of the Wrist and Hand Combined With Routine Therapy Facilitate Recovery of Arm Function in Patients With Stroke?

      Abstract

      Rosewilliam S, Malhotra S, Roffe C, Jones P, Pandyan AD. 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.

      Design

      Single blinded randomized controlled trial.

      Setting

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

      Participants

      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.

      Interventions

      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.

      Main Outcome Measure

      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.

      Key Words

      List of Abbreviations:

      ARAT (Action Research Arm Test), BI (Barthel Index), NMES (neuromuscular electrical stimulation), sNMES (surface neuromuscular electrical stimulation)
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