Can treatment with electrical stimulation, to the wrist, be justified in the severely disabled acute stroke patient (an invited review)‎

الملخص EN

Background: Disability following a stroke is common and loss of arm function significantly reduces participation and independence.

Patients who tend not to recover hand function in the acute stages of their stroke have a poor prognosis for recovery of arm function.

Therefore, there is a need to develop effective and efficient rehabilitation therapies to facilitate the recovery of hand function.

Design: Secondary analysis of data from a previously published randomised controlled trial aimed at investigating the effects of surface electrical stimulation of the wrist on recovery of arm function.

Inclusion criteria: Subjects were selected for the secondary analysis if they had no upper limb functional movement at recruitment (measured using the Action Research Arm test - ARAT and the nine hole peg test - NHPT).

Treatment: Subjects in the control group received routine physiotherapy and additional therapist contact time.

In addition to routine therapy, subjects in the treatment group received treatment with surface electrical stimulation to the wrist extensors for a period of eight weeks after recruitment.

Outcome measures: Contractures and impairment (measured using a custom built device), arm function and dexterity measured using the ARAT and NHPT.

Primary outcome measure was the ARAT and primary end-points were changes over the study period analysed using an independent sample Mest.

Following an initial measure at recruitment, and prior to randomisation, measurements were taken at week-4, week-8, week-20 and week-32 from baseline.

Results: The eontrol group had 14 patients and treatment group 16.

Improvements in arm function and dexterity were greater in the treatment group (p = 0.050 & 0.058).

Adaptive shortening was seen in both groups over the study period, it appeared to be less in the treatment group, but the changes were not significant (p > 0.10) between groups.

Grip strength improved in both groups but changes were not significant (p > 0.10) between groups.

The change in the ability to actively extend (i.e.

active isometric extension strength) was greater in the treatment group (p <0.01).

Discussion & Conclusion: Electrical stimulation of the wrist extensors may facilitate the recovery of arm function in severely disabled acute stroke patients.

This recovery may be associated with improvements in wrist and finger extensor control.