A Randomised Controlled Trial of Stimulation of Triceps as an Adjunct to Motor Training of Paretic Arm in Stroke Patients

Backrground: 30-60% of patients with stroke have no arm function.Spasticity causes hyperactivity in those muscles that can lead to decreased activity of their antagonists. Thus biceps spasticity can cause reduced control of triceps amounting to reduced reach function which is usually an important therapeutic goal. Some studies have evaluated efficacy of electrical stimulation (ES) on spasticity.

Aims: Purpose of the trial was to assess effect of stimulation of triceps on forward reach distancein stroke patients.

Settings and Design: Prospective, analytical, experimental, randomized and open trial done in Physiotherapy OPD of a tertiary care hospital.

Methods and Material: 50 post stroke patients, in the age group of 30 to 60year withspasticity of shoulder, elbow, wrist and hand muscles of affected extremity up to grade 2 on Ashworth Scale and Brunnstrom sequential recovery stage 3 or 4; were assessed for modified Tardieu Scale(MTS), active elbow extension range at elbow(AROM) and forward reach distance(FRD). They were randomly assigned to either of the Conventional (CG) or Experimental Group (EG). CG received motor training only whereas the EG received motor training and ES to triceps on affected upper extremity. After 3 weeks they were evaluated again for the above outcomes. Statistical tests were non-parametric tests as the data obtained was not normally distributed, as analyzed using Shapiro-Wilk test for normality. Wilcoxon Sign rank test for comparing medians in all 3 outcome measures. Mann Whitney test was also used to compare percent mean differences in both groups for all 3 outcome measures.

Results: FRD, AROM and MTS improved after 3 weeks in CG with significance of p-value of 0.0122 each and in experimental group with significance of p-value of 0.0121 each. FRD showed insignificant change between groups with p-value of 0.207. The mean percent difference in MTS, AROM and FRD was 0.007, 0.007 and 0.977 respectively.

Conclusions: Electrical Stimulation when given to the triceps muscle as an adjunct to the motor training has shown additional improvement in reducing the biceps spasticity, improving AROM but not significantly improving the FRD.