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

https://doi.org/10.1016/j.apmr.2012.05.017Get rights and content

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.

Section snippets

Methods

This single blind randomized controlled trial with an independent assessor was carried out at a university hospital between 2004 and 2008.

All adult patients with a first stroke who had no arm function (defined as a score of 0 in the Grasp subsection of the Action Research Arm Test [ARAT])11 within 6 weeks of onset and who had no contraindications to sNMES were considered for trial inclusion. Participants were excluded if they were medically unstable, if they had a history of osteoarthritis,

Results

Of the 90 participants recruited, 23 patients died during the course of the study because of study-unrelated causes such as respiratory infections, recurrent stroke, and cardiac arrest (recalculated power is reported in the sample size estimation section). This resulted in the study having 5 patients fewer than originally calculated. The data from 1 participant who refused baseline measurements (because of stress) after randomization were still included in the analysis. The reasons for loss of

Discussion

The main findings of this study are that surface neuromuscular stimulation of forearm muscles significantly improves wrist extension strength and grip strength in patients with stroke who had no active movement at the start of treatment. We also found nonsignificant improvements in complex functional arm movements (ARAT). Wider activities of daily living (BI) did not improve. The effect of treatment ceased after the discontinuation of the intervention. This could be due to reduced focus on

Conclusions

In patients with severe stroke and no functional arm movement, electrical stimulation of the wrist extensors improves extensor muscle strength and grip strength, but there were no significant improvements in terms of improvements in the range of movement. There is some evidence that this treatment facilitated recovery of arm function. It is not clear as to whether this functional improvement was a direct result of plasticity or was secondary to strength gains. The functional improvement,

Acknowledgments

We thank all the clinicians and nurses from the University Hospital at North Staffordshire for supporting the study.

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    • Cited by (0)

    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.

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    Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.