Combined effect of Brunnstrom's hand rehabilitation and functional electrical stimulation for improving hand function in patients with chronic stroke: A randomized controlled trial

Rahemun Akter; Nidhi Sharma; Sohel Ahmed; Adarsh Kumar Srivastav

doi:10.1016/j.jbmt.2023.04.021

Combined effect of Brunnstrom's hand rehabilitation and functional electrical stimulation for improving hand function in patients with chronic stroke: A randomized controlled trial

J Bodyw Mov Ther. 2023 Jul:35:84-90. doi: 10.1016/j.jbmt.2023.04.021. Epub 2023 Apr 28.

Authors

Rahemun Akter¹, Nidhi Sharma², Sohel Ahmed³, Adarsh Kumar Srivastav⁴

Affiliations

¹ Department of Physiotherapy and Rehabilitation, Mount Adora Hospital, Akhalia, Sylhet, 3100, Bangladesh.
² Department of Neuro-physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed-to-be) University, Mullana, 133207, Haryana, India.
³ Department of Physiotherapy and Rehabilitation, Mount Adora Hospital, Akhalia, Sylhet, 3100, Bangladesh; Physiotherapy Research Foundation, Akhalia, 3100, Sylhet, Bangladesh. Electronic address: ptsohel@gmail.com.
⁴ School of Health Science, Chhatrapati Shahu Ji Maharaj University, Kanpur, 208024, India.

PMID: 37330808
DOI: 10.1016/j.jbmt.2023.04.021

Abstract

Background: Motor recovery of the upper extremity is one of the most common challenging outcomes after stroke.

Objective: To find out the combined effects of Brunnstrom hand rehabilitation (BHR) and functional electrical stimulation for improving hand functions in patients with chronic stroke.

Study design: Randomized controlled trial.

Method: 25 participants, both male (n = 11) and female (n = 14), age group between 40 and 70 years were randomly divided into control group (n = 12) and experimental group (n = 13). The treatment protocol was continued 5 days per week, for 4 weeks. The experimental group received Brunnstrom hand training and functional electrical stimulation (FES) along with conventional physiotherapy. The control group received only conventional physiotherapy. Participants were evaluated at baseline and after 4 weeks of intervention.

Outcome measures: Fugl Meyer Assessment scale-upper extremity, Modified Ashworth scale, Handheld Dynamometer, and Jabsen Taylor Hand Function Test. Paired t-test was used to compare within-group variables and an independent t-test was used for between-group comparisons. P-value was set as 0.05 to minimize type-1 error.

Results: Statistically significant difference was obtained in favor of the experimental group undergoing FMA (p < .001), MAS (p = .004), JTHF (p = .018), and HHD (p < .001) in between-group analysis. However, both groups showed significant improvement [experimental group; FMA-UE (p < .001), MAS (p < .001); JTHF (p < .001), and HHD (p < .001), and control group; FMA-UE (p < .001), MAS (p < .001), JTHF (p < .001) and HHD (p < .001)] in within-group analysis at post-intervention.

Conclusion: Brunnstrom hand rehabilitation and FES in combination were found to be more effective in improving hand function than conventional physiotherapy treatment.

Clinical trial registration: URL: http://www.ctri.nic.in. No: CTRI/2019/06/019,905.

Keywords: Brunnstrom; Functional electrical stimulation; Stroke; Upper extremity.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Aged
Electric Stimulation
Female
Humans
Male
Middle Aged
Recovery of Function / physiology
Stroke Rehabilitation* / methods
Stroke*
Treatment Outcome
Upper Extremity