Author
it was safe for patients’ skin (6). Knutson et al. applied
a pulse amplitude of 40 mA for all patients and 60 mA
for one participant (7–9).
Regarding the third point, the target population of the
current study was early-phase stroke patients, most of
whom were in the flaccid paralysis stage and therefore
no patient with high muscular tension was observed. In
addition, patients with progressive stroke and in non-
stable condition were excluded. In our experience, the
muscular strength of patients with early-phase stroke
who receive early-phase neurological intervention re-
covers relatively faster than in those with subacute or
chronic stroke, and no abnormally increased muscular
tension was observed. After careful consideration, Ma-
nual Muscle Testing (MMT) was adopted for evalua-
ting the strength of the extensor carpi. However, group
manual muscle testing (i.e. hand-held dynamometer)
is also considered reasonable to measure the strength
of the muscle groups.
The parameters and protocol of CCFES and NMES
were clearly documented in the Methods section as
follows:
Parameters of CCFES AND NMES: “stimulators
(Weisi Corporation, Nanjing, China) used in this study
delivered biphasic rectangular current pulses; the pulse
frequency was set at 35 Hz, and the pulse amplitude
was set at 40 mA. The electrical stimulation intensity
was set at a sustainable level with full balanced WD
with tetanic contraction.”
Protocol of NMES: “Patients in the NMES group
received neuromuscular electrical stimulation (2 20-
min sessions each day). Each session consisted of 48
15-s sets, separated by 10 s of rest.”
Protocol of CCFES: “Patients in the CCFES group
were treated with contralaterally controlled functional
electrical stimulation (two 20-min sessions every day).
Each session consisted of 48 15-s sets, separated by
10 s of rest. Patients were prompted by sound cues
from the stimulator to actively extend both wrists, then
the paretic wrist was stimulated to complete WD, as-
sisted by the bioelectrical signal transmitted from the
non-paretic side, held still for 15 s when full WD was
achieved, then relaxed for 10 s.”
We consider the use of independent t-tests was
justified for statistical analysis of the continuous and
normally distributed demographic data. Wilcoxon
rank-sum test (also known as Mann–Whitney U test or
Mann–Whitney–Wilcoxon test) was used for analysis
of inter-group difference in active range of motion
(ROM) for WD, strength of extensor carpi and JHFT,
since those variables were not normally distributed.
As regards the sample size in the current study, 50
eligible patients were enrolled at baseline and 9 drop-
ped out, for a range of reasons, as documented in the
Results section.
Lastly, box-whisker plots were used to show the
distribution of the variables that were not normally
distributed, and these indicate medians and interquar-
tile range. Table III was designed principally to show
the statistical results in a uniform format rather than
presenting the distribution of the data.
Yu Zheng, Mao Mao, Yinghui Cao, Xiao Lu
Department of Rehabilitation Medicine, The First Affiliated
Hospital of Nanjing Medical University, Nanjing, China
E-mail: [email protected]
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