Effectiveness of electrical stimulation therapy in improving arm function after stroke: a systematic review and a meta-analysis of randomised controlled trials

Abstract

Objective: The aim of this study is to investigate the effectiveness of electrical stimulation in arm function recovery after stroke. Methods: Data were obtained from the PubMed, Cochrane Library, Embase, and Scopus databases from their inception until 12 January 2019. Only randomized controlled trials (RCTs) reporting the effects of electrical stimulation on the recovery of arm function after stroke were selected. Results: Forty-eight RCTs with a total of 1712 patients were included in the analysis. The body function assessment, Upper-Extremity Fugl-Meyer Assessment, indicated more favorable outcomes in the electrical stimulation group than in the placebo group immediately after treatment (23 RCTs ( n = 794): standard mean difference (SMD) = 0.67, 95% confidence interval (CI) = 0.51–0.84) and at follow-up (12 RCTs ( n = 391): SMD = 0.66, 95% CI = 0.35–0.97). The activity assessment, Action Research Arm Test, revealed superior outcomes in the electrical stimulation group than those in the placebo group immediately after treatment (10 RCTs ( n = 411): SMD = 0.70, 95% CI = 0.39–1.02) and at follow-up (8 RCTs ( n = 289): SMD = 0.93, 95% CI = 0.34–1.52). Other activity assessments, including Wolf Motor Function Test, Box and Block Test, and Motor Activity Log, also revealed superior outcomes in the electrical stimulation group than those in the placebo group. Comparisons between three types of electrical stimulation (sensory, cyclic, and electromyography-triggered electrical stimulation) groups revealed no significant differences in the body function and activity. Conclusion: Electrical stimulation therapy can effectively improve the arm function in stroke patients.

Mirror therapy simultaneously combined with electrical stimulation for upper limb motor function recovery after stroke: a systematic review and meta-analysis of randomized controlled trials

“…The meta-analysis conducted by Vafadar et al 6 also showed no significant effects of functional electrical stimulation in addition to conventional therapy on upper limb motor function after stroke. By contrast, a recent meta-analysis conducted by Yang et al 30 reported that electrical stimulation is effective to recover upper extremity motor function in stroke patients.…”

Neuromuscular electrical stimulation‐promoted plasticity of the human brain

“…via EMG registration) were superior to those following FES alone, it was not generally the case that cumulative effect size estimates were obtained. In a more recent analysis that was restricted to the outcomes of randomized controlled trials (RCTs) engaging chronic stroke survivors, Yang et al (2019) reported that the changes in function (as assessed by the Fugl-Meyer test) and activity (e.g. as assessed by the Action Research Arm Test) arising from 'cyclic' FES (not triggered by voluntary contraction) and EMG-triggered FES could not be distinguished in terms of their quantified effects (although both were superior to control).…”

“…Direct compensation for motor disability (i.e. the 'adaptive' response) aside, assessment of the evidence gathered in contemporary systematic reviews and meta-analyses suggests that NMES delivered at levels sufficient to generate fused contractions (Nascimento et al 2014;Howlett et al 2015;Monte-Silva et al 2019;Yang et al 2019) is capable of promoting restorative changes in a number of neurological disorders that are at least equivalent to those brought about by conventional therapy. It also appears to have a positive effect on the functional status of older adults who do not have neurological conditions (Langeard et al 2017).…”

Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation

“…However, combined voluntary and FES-induced contractions produced larger activations in the M1 and S1 areas compared to FES alone [ 57 ]. Although these studies suggest that voluntary activations can provide additional benefits compared to electrical stimulation of muscle and nerves alone, recent controlled trials investigating cyclic FES (i.e., without voluntary drive) and EMG-triggered FES (i.e., with voluntary drive) concluded that functional benefits may not be different between the two modes of delivery in stroke patients [ 90 , 156 ]. On the practical level, individuals with neurological impairments may not always be able to generate sufficient or correct sequence of voluntary muscle contractions to reinforce electrical stimulation delivery.…”