THE FUNCTIONAL VALUE OF ELECTRICAL MUSCLE STIMULATION FOR THE REHABILITATION OF THE HAND IN STROKE PATIENTS

The influence of suprathreshold electrical stimulation of the extensor and flexor carpi radialis muscles an biomechanical and functional mov ement parameters is compared with the effect of a standardized active repetitive training of hand and fingers. Twelve patients suffering fro m ischaemic lesions in the territory of the middle cerebral artery par ticipated in the study, which was conducted using a multiple baseline design. Following a baseline phase that lasted between one and three w eeks all patients received electrical muscle stimulation for 20 minute s twice daily. In a third phase the repetitive training of hand and fi ngers was conducted for 20 minutes twice daily. Both interventions wer e applied in addition to conventional occupational therapy and physiot herapy. With the exception of spasticity in hand and finger flexors, r epetitive electrical muscle stimulation does not improve biomechanical or functional motor parameters of the centrally paretic hand and arm. The repetitive motor training, however, is appropriate to improve bio mechanical and functional movement parameters significantly. Apart fro m a possible effect on the muscle cell itself, the electrical muscle s timulation is thought to represent a mainly sensory, i.e. propriocepti ve, and cutaneous intervention, whereas the active motor training is c haracterized by a continuous sensorimotor coupling within motor centre s of the brain. The underlying neurophysiological mechanisms as well a s basic principles concerning the role of afferent input for motor lea rning and recovery are discussed.