Journal of Rehabilitation Medicine 51-2 | Page 28
J Rehabil Med 2019; 51: 103–108
ORIGINAL REPORT
CONTRALATERALLY CONTROLLED FUNCTIONAL ELECTRICAL STIMULATION
IMPROVES WRIST DORSIFLEXION AND UPPER LIMB FUNCTION IN PATIENTS
WITH EARLY-PHASE STROKE: A RANDOMIZED CONTROLLED TRIAL
Yu ZHENG, MD, PhD#, Mao MAO, BS#, Yinghui CAO, BS and Xiao LU, MD, PhD
From the Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
#These authors contributed equally to this work.
Objectives: To investigate the effectiveness of
contralaterally controlled functional
electrical stimulation (CCFES) on the recovery of
active wrist dorsiflexion and upper limb function in
patients with early-phase stroke (<15 days post-
stroke).
Methods: Patients in the CCFES group were treated
with routine rehabilitation combined with CCFES,
while those in the conventional neuromuscular elec-
trical stimulation (NMES) group were treated with
routine rehabilitation combined with NMES. Time
intervals from stroke onset to appearance of wrist
dorsiflexion, and from onset of treatment to appea-
rance of wrist dorsiflexion were recorded (in days).
Functional assessments were also performed at ba-
seline and endpoint.
Results: Nineteen out of 21 patients in the CCFES
group and 12 out of 20 patients in the NMES group re-
gained active wrist dorsiflexion during the treatment
and follow-up period (90.5% vs 60%, p = 0.025).
The mean time interval from onset of treatment to
appearance of active wrist dorsiflexion was signif-
cantly shorter in the CCFES group than in the NMES
group (p < 0.001). The CCFES group had signifcantly
higher scores for upper extremity
function (p = 0.001), strength of extensor car-
pi (p = 0.002), active ROM for wrist dorsiflexion
(p = 0.003), activities of daily living score (p = 0.023)
and ICF score (p < 0.001) than the NMES group at
the endpoint.
Conclusion: CCFES signifcantly shortened the time
for regaining wrist dorsiflexion, and improved the
upper extremity function and general health of pa-
tients with early-phase stroke. CCFES therefore has
potential as a clinical intervention.
Key words: stroke; contralaterally controlled functional elec-
trical stimulation; neuromuscular electrical stimulation; wrist
dorsiflexion; early-phase rehabilitation.
Accepted Nov 16, 2018; Epub ahead of print Jan 22, 2019
J Rehabil Med 2019; 51: 103–108
Correspondence address: Xiao Lu, Department of Rehabilitation Medi-
cine, The First Affiliated Hospital of Nanjing Medical University, Nan-
jing, China. E-mail: [email protected]
S
troke is a leading cause of disability with high
morbidity and mortality. Approximately 75% of
patients with stroke have upper extremity dysfunction
LAY ABSTRACT
After a stroke, it is essential that recovery of function
of the upper limb is maximized in order to enable acti-
vities of daily living. The hand plays an important role
in the function of the upper limb. This study examined
the effectiveness of contralaterally controlled functio-
nal electrical stimulation (CCFES) on recovery of acti-
ve dorsiflexion of the wrist and upper limb functioning
in patients in the early-phase after stroke (<15 days
post-stroke). CCFES significantly shortened the time
for regaining wrist dorsiflexion, and improved the up-
per extremity function and general health of patients
with early-phase stroke, compared with conventional
neuro
muscular electrical stimulation. CCFES therefore
has potential as a clinical intervention.
(1). Impaired motor function of the upper extremity
is a major factor in preventing patients returning to
their usual activities. In addition to routine medical
treatment, early-phase rehabilitation helps improve
motor function and activities of daily living (ADL) (2).
Moreover, well-prescribed rehabilitation may shorten
the course of recovery from stroke, help patients return
to the community earlier, improve their quality of life,
and reduce the cost of medication (3).
Recovery of upper extremity functioning is essential
for improving ADL ability in patients with stroke (4).
The hands play an important role in functioning of the
upper extremities. Hand function and, in particular,
extensor function, is difficult to recover once impaired,
Therefore, specific rehabilitation interventions, which
are considered the first step in re-gaining full extension
of the hand, are essential in the recovery of wrist dor-
siflexion (WD). Early recovery of active WD contri-
butes not only to a better outcome for upper extremity
functioning, but also to improved outcome for ADL.
Over the past decades, neuromuscular electrical
stimulation (NMES), an electrical stimulation that
provides passive training for the wrist dorsi-extensor,
has been integrated into certain specific rehabilitation
prescriptions (5–7). NMES triggers the movement
using electrical stimulation. The frequency and amp-
litude of biphasic rectangular current pulses are pre-set
and fixed during the whole training course.
In contrast, controlled functional electrical stimula-
tion (CCFES) is an intervention technique developed
recently to improve the function of the paretic upper
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977
doi: 10.2340/16501977-2510