![]() It innervates the flexor-pronator muscles in the forearm and most muscle groups in the hand and controls flexion of the wrist, abduction of the thumb, and flexion of the fingers. The median nerve mixed with sensory and motor fibers is a primary important nerve of the hand. Meanwhile, peripheral electrical stimulation-induced brain plasticity contributes to the long-term functional improvement. These noninvasion peripheral electrical stimulation therapies can stimulate the senses, increase muscle power and movement function, and decrease limb spasticity through various stimulus currents and protocols. Currently, the peripheral electrical stimulation includes the functional electrical stimulation (FES), the transcutaneous or neuromuscular electrical stimulation (TENS or NMES), and the transcutaneous electrical acupoint stimulation (TEAS) which combined the meridian theory of traditional Chinese medicine and repetitive sensory stimulation (RSS). The peripheral electrical stimulation has been confirmed as a safe and effective treatment for functional recovery after stroke by stimulating the peripheral neuromuscular system and inducing the cortical plasticity. The clinical effects of tDCS depend on the injured site and the stimulus parameters, and it is difficult to achieve precision function therapy, such as the promotion of upper limb function. The transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that can initiate a long-term potentiation or long-term depression and then induce the cortical plasticity and improve the nerve functional restoration of the upper limb motor, movement planning and preparation, and hemispatial neglect. Recently, the electrical stimulation applied to the brain and peripheral nervous system has been recognized as a promising treatment for functional recovery after stroke. Consequently, it is urgent to establish and explore some efficacious treatments for improving upper limb functional recovery after cerebral ischemia. To date, the commonly applied rehabilitation techniques such as classical physiotherapy and impairment-oriented training are limited by efficacy. Thus, restoration of upper limb function is vital to the treatment and rehabilitation of stroke. The impaired upper limb severely limits the independent daily activities of stroke patients. Only 5–20% of the patients achieve complete functional recovery after 6 months of onset. The upper limb extremity impairments are the most frequent dysfunction following stroke that is, more than 70% of stroke patients suffer from the paretic arm. Although the application of developing medical technology decreases the rates of stroke mortality significantly, most survivors still suffer from neurological deficits such as motor, memory, and cognitive dysfunctions, which results in an immense economic burden on society and families. Stroke is the leading cause of death and long-term disability around the world. The UG-MNES could be an effective alternative intervention for stroke with upper limb extremity impairments. In conclusion, the UG-MNES is a safe and feasible treatment for stroke patients with upper limb extremity impairments and could significantly improve the motor function of the affected upper limb, especially in the first intervention. Compared to the control group, all evaluation indices used in this trial were improved significantly in the UG-MNES group after 2 and 4 weeks of intervention particularly, the first intervention of UG-MNES immediately improved all the assessment items significantly. After 4 weeks of intervention, the functions of the upper limbs on the hemiplegic side in both groups achieved significant recovery. ![]() All the participants completed the trial without any side effects or adverse events during the intervention. The secondary outcomes were the Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK), Hand Function Rating Scale, Brunnstrom Stages, and Barthel Index scores for motor and daily functions. The Fugl-Meyer Assessment for upper extremity motor function (FMA-UE) was used as the primary outcome. Both groups received routine rehabilitation and the UG-MNES group received an additional ultrasound-guided electrical stimulation of the median nerve at 2 Hz, 0.2 ms pulse-width for 20 minutes with gradual intensity enhancement. Sixty-three stroke patients (2-3 months of onset) were randomly divided into control and UG-MNES groups. Here, we proposed a percutaneous direct median nerve stimulation guided by ultrasound (ultrasound‐guided median nerve electrical stimulation, UG-MNES) and evaluated its feasibility and effectiveness in the treatment of stroke patients with upper limb extremity impairments. Peripheral electrical nerve stimulation enhances hand function during stroke rehabilitation.
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