OBJECTIVE: To investigate whether treatment with surface neuromuscular electrical stimulation (sNMES) to the wrist extensors improves recovery of arm function in severely disabled patients with stroke. DESIGN: Single blinded randomized controlled trial. SETTING: Acute stroke unit and stroke rehabilitation wards of a University Hospital. PARTICIPANTS: Patients with no upper limb function (Action Research Arm Test (ARAT) score 0) were recruited to the study within 6 weeks of stroke. Ninety patients were recruited, 23 died, 67 completed the study and were included in the analysis (mean age 73 years). INTERVENTIONS: Participants were randomized to sNMES using surface electrical stimulators for 30 mins twice in a working day for six weeks in addition to standardised upper limb therapy or just standardised upper limb therapy. MAIN OUTCOME MEASURE: The primary outcome measure was ARAT. Assessments were made at baseline, 6, 12, 24 and 36 weeks after recruitment. RESULTS: There were statistically significant improvements in measures of wrist extensor (mean difference was 0.5; 95% CI 0.0 to 1.0) and grip strength (mean difference 0.9; 95% CI 0.1 to 1.7) over the treatment period. Arm function (ARAT) was not significantly different between the groups over the treatment period at six weeks (mean difference was 1.9; 95% CI -2.9 to 6.8) or over the study period at 36 weeks (mean difference 6.4; 95% CI -1.8 to 14.7) and rate of recovery was not significantly different (mean difference 0.7; 95% CI -0.2 to 1.6). CONCLUSION: In patients with severe stroke, with no functional arm movement electrical stimulation of wrist extensors improves muscle strength for wrist extension and grip and larger studies are required to study its influence on arm function.

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