Published Online
on October 19, 2006

A more recent version of this article appeared on December 1, 2006

This Article Full Text (PDF) All Versions of this Article: 37/12/2995    most recent 01.STR.0000248969.78880.82v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Church, C. Articles by Rodgers, H. Search for Related Content PubMed PubMed Citation Articles by Church, C. Articles by Rodgers, H. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Rehabilitation, Stroke

Submitted on July 14, 2006
Accepted on August 8, 2006

Randomized Controlled Trial to Evaluate the Effect of Surface Neuromuscular Electrical Stimulation to the Shoulder After Acute Stroke

Catherine Church MD; Christopher Price MD; Anand D. Pandyan PhD; Stuart Huntley MBBS; Richard Curless MBBS; and Helen Rodgers MBChB^*

From Department of Geriatric Medicine (C.C., C.P. S.H., R.C., H.R.), Northumbria Healthcare NHS Trust, North Tyneside General Hospital, North Shields, Tyne and Wear UK and Wansbeck General Hospital, Ashington, Northumberland, UK; School of Clinical Medical Sciences (C.C., C.P., R.C., H.R.), Newcastle University, Newcastle, UK; School of Population and Health Sciences (C.C., H.R.), Newcastle University, Newcastle, UK; School of Health & Rehabilitation (A.D.P.), Institute of Ageing, University of Keele, Keele, UK.

^* To whom correspondence should be addressed. E-mail: helen.rodgers{at}newcastle.ac.uk.

Background and Purpose--Surface neuromuscular electrical stimulation (sNMES) after stroke aims to improve upper limb function and reduce shoulder pain, but current evidence of effectiveness is inconclusive. We have undertaken a randomized controlled trial to evaluate sNMES to the shoulder after acute stroke.

Methods--One hundred seventy-six patients, within 10 days of stroke onset, were randomized to receive sNMES or placebo in addition to stroke unit care. The primary outcome measure was upper limb function measured by the Action Research Arm Test (ARAT) 3 months after stroke. Secondary outcome measures included other measures of upper limb function, upper limb impairment, pain, disability, and global health status. Outcome assessments were blinded.

Results--There was no difference in arm function between groups in terms of the primary outcome measure. The median ARAT at 3 months was 50 in the intervention group and 55.5 in the control group (P=0.068). Significant differences were seen at 3 months in favor of the control group for other measures of arm function and impairment: grasp and gross movement subsections of the ARAT, Frenchay Arm Test, and the arm subsection of the Motricity Index. Secondary analysis suggested that these differences were most marked in subjects with severe initial upper limb weakness.

Conclusions--A 4-week program of sNMES to the shoulder after acute stroke does not improve functional outcome and may worsen arm function in severely impaired stroke patients. "Routine" use of sNMES to the proximal affected upper limb after acute stroke cannot be recommended.

Key words: arm • function • randomized controlled trials • rehabilitation

This article has been cited by other articles:

				T. Baba, M. Kameda, T. Yasuhara, T. Morimoto, A. Kondo, T. Shingo, N. Tajiri, F. Wang, Y. Miyoshi, C. V. Borlongan, et al. Electrical Stimulation of the Cerebral Cortex Exerts Antiapoptotic, Angiogenic, and Anti-Inflammatory Effects in Ischemic Stroke Rats Through Phosphoinositide 3-Kinase/Akt Signaling Pathway Stroke, November 1, 2009; 40(11): e598 - e605. [Abstract] [Full Text] [PDF]

				S. Mangold, C. Schuster, T. Keller, A. Zimmermann-Schlatter, and T. Ettlin Motor Training of Upper Extremity With Functional Electrical Stimulation in Early Stroke Rehabilitation Neurorehabil Neural Repair, February 1, 2009; 23(2): 184 - 190. [Abstract] [PDF]

				S. J. Page and J. Chae Surface Electrical Stimulation for the Affected Shoulder After Stroke: Reconsidering the Findings of Church and Colleagues Stroke, August 1, 2007; 38(8): e71 - e71. [Full Text] [PDF]

				C. Church, C. Price, A. D. Pandyan, S. Huntley, R. Curless, and H. Rodgers Response to Letter by Page and Chae Stroke, August 1, 2007; 38(8): e72 - e73. [Full Text] [PDF]