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)To read this article in full you will need to make a payment
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References
- Recovery of motor function following stroke: profile and predictors.Physiother Canada. 1982; 34: 77-84
- Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study.Arch Phys Med Rehabil. 1994; 75: 394-398
- The restoration of motor function following hemiplegia in man.Brain. 1951; 74: 443-480
- Contractures in the post stroke wrist: a pilot study of its time course of development and its association with upper limb recovery.Clin Rehabil. 2003; 17: 88-95
- National clinical guidelines for stroke.3rd ed. Royal College of Physicians, London2008
- Therapeutic electrical stimulation to improve motor control and functional abilities of the upper extremity after stroke: a systematic review.Clin Rehabil. 2002; 16: 350-360
- Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke?.Stroke. 2000; 31: 2984-2988
- Electrical stimulation for preventing and treating post-stroke shoulder pain.Clin Rehabil. 2001; 15: 5-19
- Electrical stimulation of the wrist extensors in post-stroke hemiplegia.Stroke. 1999; 30: 1384-1389
- Effects of electrical stimulation on flexion contractures in the hemiplegic wrist.Clin Rehabil. 1997; 11: 123-130
- A pilot study investigating the effects of electrical stimulation on the wrist extensors on upper limb impairment and function in an acute stroke population.Abstracts of the 13th European Congress of Physical and Rehabilitation Medicine. 2002 May 28-31; (Brighton, UK): 298-299
- An approach to standardise, quantify and progress routine upper limb therapy for the stroke subjects: the Action Medical Research Upper Limb Therapy protocol.Hand Ther. 2009; 14: 60-68
- A pilot study to investigate the effects of electrical stimulation on recovery of hand function and sensation in subacute stroke patients.Neuromodulation. 2005; 8: 193-202
- A performance test for assessment of upper limb function in physical rehabilitation treatment and research.Int J Rehabil Res. 1981; 4: 483-492
- Functional evaluation: the Barthel index.Md State Med J. 1965; 14: 61-65
- Analysis of serial measurements in medical research.BMJ. 1990; 300: 230-235
- Spasticity and contractures at the wrist after stroke: time course of development and their association with functional recovery of the upper limb.Clin Rehabil. 2011; 25: 184-191
- Physical therapy interventions for patients with stroke in inpatient rehabilitation facilities.Phys Ther. 2005; 85: 238-248
- Electrostimulation for promoting recovery of movement or functional ability after stroke.Cochrane Database Syst Rev. 2006; (CD003241)
- Modification of motor control of wrist extension by mesh-glove electrical afferent stimulation in stroke patients.Arch Phys Med Rehabil. 1996; 77: 252-258
- Two theories of muscle strength augmentation using percutaneous electrical stimulation.Phys Ther. 1990; 70: 158-164
- Arm function after stroke—an evaluation of grip strength as a measure of recovery and a prognostic indicator.J Neurol Neurosurg Psychiatry. 1989; 52: 1267-1272
- Changes in intracortical excitability induced by stimulation of wrist afferents in man.J Physiol. 2001; 534: 891-902
- Dose-response relation between neuromuscular electrical stimulation and upper-extremity function in patients with stroke.Stroke. 2010; 41: 821-824
Article info
Publication history
Published online: June 06, 2012
Footnotes
Rosewilliam is now at the School of Health and Population Sciences, University of Birmingham, Birmingham, UK, and Malhotra is now at the Department of Emergency Medicine, SUNY Downstate Medical Center and Kings County Hospital, Brooklyn, NY.
Funded by Action Medical Research and Barnwood House Trust (AP0993).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Clinical Trial Registration No.: ISRCTN34651260.
In-press corrected proof published online on Jul 25, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
