Efficacy of Sensory Electrical Stimulation Versus Alternating Electromyography-Guided Electrical Stimulation on Functional Recovery of the Hand in Chronic Stroke: A Randomized Controlled Trial

Abstract

Background Impaired hand function can limit independence. Sensory electrical stimulation (SES) and alternating electromyography-guided electrical stimulation (Alt-EMG) differ in stimulation characteristics and voluntary effort requirements, but comparative evidence is limited. Objective To compare SES and Alt-EMG, each combined with conventional physical therapy, on upper-limb motor function, spasticity, and muscle strength in chronic stroke. Methods This three-arm, assessor-blinded randomized controlled trial included 60 adults aged 45–65 years, 6–18 months post-stroke, allocated equally to SES, Alt-EMG, or control groups (n = 20 each). The primary outcome was the Action Research Arm Test (ARAT); Modified Ashworth Scale (MAS) and Medical Research Council (MRC) scores were secondary outcomes. ARAT was analyzed using ANCOVA adjusted for baseline score and age; ordinal outcomes were analyzed nonparametrically. Benjamini–Hochberg and Holm corrections addressed multiplicity. Results All participants completed the 12-week intervention. Treatment group significantly predicted adjusted post-intervention ARAT scores (F (2,55) = 23.19, P < .001, partial η 2 =.46). Adjusted mean gains versus control were 12.05 points for SES and 12.44 points for Alt-EMG (both P < .001), with no significant difference between active groups. Significant between-group differences were observed for shoulder, elbow, and wrist spasticity and most muscle-strength measures, except finger extensors. Conclusions SES and Alt-EMG combined with conventional physical therapy produced greater improvement in upper-limb motor function than conventional physical therapy alone over 12 weeks. No difference was observed between SES and Alt-EMG for the primary outcome.