Effectiveness of Functional Electrical Stimulation in Improving Clinical Outcomes in the Upper Arm following Stroke: A Systematic Review and Meta-Analysis

Abstract

Background. Different therapeutic methods are being used to prevent or decrease long-term impairments of the upper arm in stroke patients. Functional electrical stimulation (FES) is one of these methods, which aims to stimulate the nerves of the weakened muscles so that the resulting muscle contractions resemble those of a functional task. Objectives. The objective of this study was to review the evidence for the effect of FES on (1) shoulder subluxation, (2) pain, and (3) upper arm motor function in stroke patients, when added to conventional therapy. Methods. From the 727 retrieved articles, 10 (9 RCTs, 1 quasi-RCT) were selected for final analysis and were rated based on the PEDro (Physiotherapy Evidence Database) scores and the Sackett's levels of evidence. A meta-analysis was performed for all three considered outcomes. Results. The results of the meta-analyses showed a significant difference in shoulder subluxation in experimental groups compared to control groups, only if FES was applied early after stroke. No effects were found on pain or motor function outcomes. Conclusion. FES can be used to prevent or reduce shoulder subluxation early after stroke. However, it should not be used to reduce pain or improve upper arm motor function after stroke.

Upper limb function and functional independence in patients with shoulder pain after stroke

“…During the flaccid recovery stage, excessive and intense muscular stretching can occur, resulting in soft tissue lesions and consequent pain. During the spastic recovery stage, spasticity patterns (adduction and internal rotation) may trigger pain 12 . In addition, subluxation and the need for transfer assistance, which may result in inappropriate pulley use, are important factors in shoulder pain after stroke 2,3,4 .…”

A Novel In Vitro System for Comparative Analyses of Bone Cells and Bacteria under Electrical Stimulation

“…They are applied in deep brain stimulation [1], as well as in cochlear implants [2] or, one of the most present examples, cardiac pacemakers [3]. Moreover, ES is a therapeutic approach for chronic cutaneous wound-healing complications [4], paralyzed muscles, or prevention of muscle atrophy in immobilized patients [5–7]. Further fields of application are pain relief therapy [8] and transcorneal ES after ocular trauma or for treatment of optic neuropathy and retina degeneration [9, 10].…”

The Effect of Peripheral Nerve Stimulation on Shoulder Biomechanics

“…Additionally, subluxation was not included as an outcome measure in this study. The use of electrical stimulation has not been found to reduce subluxation in those past 6 months from stroke 28 , nor has PT been shown to reduce subluxation. Finally, the impairment measures in this study are indirect indicators of shoulder biomechanics and the measures chosen may not be important for the development and maintenance of HSP.…”