Adding Contralaterally Controlled Electrical Stimulation of the Triceps to Contralaterally Controlled Functional Electrical Stimulation of the Finger Extensors Reduces Upper Limb Impairment and Improves Reachable Workspace but not Dexterity: A Randomized Controlled Trial.
Jayme S Knutson, Nathaniel S Makowski, Mary Y Harley and 4 others
PMID 32167957WHAT IT FOUND
Adding triceps stimulation to hand-focused electrical therapy improved arm reach and reduced impairment, but did not improve hand dexterity or perceived daily use compared to hand therapy alone.
The added component helps reach, not fine motor control.
Key findings
01The primary outcome, manual dexterity measured by the Box and Blocks Test, showed no significant difference between the group receiving arm-and-hand stimulation and the group receiving hand-only stimulation.
02Participants receiving arm-and-hand stimulation had significantly greater improvements in reachable workspace and upper limb motor impairment scores compared to those receiving hand-only stimulation.
03There were no significant differences between groups in patient-reported outcomes, such as the number of daily tasks performed or the perceived amount of use of the affected limb.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Randomization to the cyclic NMES group was stopped early, leaving that group underpowered for comparisons. Eligibility criteria were changed mid-study to include patients up to 2 years post-stroke, which may affect generalizability. Participants and therapists could not be blinded to the treatment assignment. The study did not assess neuroplasticity mechanisms. Subgroup analyses were exploratory and not powered for statistical significance.
Declared interests
The study was supported by the National Institutes of Health (NIH).
The easy way to misread this
Do not assume that improved laboratory measures of reach and impairment translate to better functional hand use or dexterity in daily life. The primary outcome for dexterity was null, and patient-reported outcomes showed no benefit from adding the arm stimulation component.