Electrostimulation Plus Task Training Improves Upper Limb Function After Stroke
Adjunctive electrostimulation may improve outcomes in stroke patients undergoing upper limb rehabilitation.
Adding myoelectrically controlled functional electrostimulation (MeCFES) to task-oriented training (TOT) results in greater improvement in upper limb function than conventional rehabilitation and TOT in patients in the post-stroke subacute period, according to findings from a multicenter randomized controlled trial published in PLoS One.
A total of 82 patients with acute and chronic stroke were randomly assigned to either adjunctive MeCFES with TOT (n=38) or a conventional rehabilitation care regimen that also included TOT (n=44). Each group underwent twenty-five 45-minute rehabilitation sessions during the 5- to 6-week study period. Improved Action Research Arm Test (ARAT) and improved Upper Extremity section of the Fugl Meyer scale (FMA-UE) scores were the primary outcomes of this study. In addition, investigators used the Disability of the Arm Shoulder and Hand questionnaire to determine subjective improvements following intervention.
Of the 82 patients included in the analysis, 68 completed the study and 45 were evaluated at 5-week follow-up. Both groups experienced a significant improvement in both FMA-UE (median improvement: M-TOT 4.5; C-TOT 3.5) and ARAT (median improvement: MeCFES TOT group 3.0; C-TOT group 2.0). A greater percentage of patients in the post-stroke subacute phase who underwent adjunct MeCFES experienced greater improvement at follow-up than patients undergoing conventional rehabilitation with TOT (57.9% vs 33.2%, respectively; difference in percentage improved 24.7%; 95% CI, –4.0-48.6).
This investigators were unable to obtain definitive conclusions regarding MeCFES efficacy when used with TOT for upper limb rehabilitation following stroke, primarily due to the study's inability to achieve the predicted sample size.
According to the investigators, patients in the post-stroke subacute phase are “more likely to have an improvement in response to whichever treatment, due also to concomitant spontaneous recovery.”
Jonsdottir J, Thorsen R, Aprile I, et al. Arm rehabilitation in post stroke subjects: A randomized controlled trial on the efficacy of myoelectrically driven FES applied in a task-oriented approach. PLoS One. 2017;12(12):e0188642.