Tenberg Sarah, Weinig Jonas, Niederer Daniel, Vogt Lutz, Leisse Markus, Müller Steffen
Department of Computer Science/Therapeutic Sciences, Trier University of Applied Sciences, Trier, Germany.
Department of Sports Medicine and Exercise Physiology, Goethe-University Frankfurt, Frankfurt am Main, Germany.
PM R. 2025 Sep;17(9):1055-1068. doi: 10.1002/pmrj.13368. Epub 2025 May 13.
Electrical stimulation is an effective treatment method for improving motor function after stroke, but the optimal current type for patients with stroke and arm paresis remains unclear.
To compare the effects of kilohertz frequency with low-frequency current on stimulation efficiency, electrically induced force, discomfort, and muscle fatigue in patients with stroke.
A randomized crossover study.
Neurological inpatient rehabilitation clinic in Germany.
A total of 23 patients with arm paresis after stroke within the last 6 months were recruited, 21 were enrolled, and 20 completed the study (7 females; mean ± SD: 66 ± 12 years; 176 ± 11 cm; 90 ± 19 kg; 57 ± 34 days since stroke).
All patients underwent both kilohertz and low-frequency stimulation in a randomized order on 2 days (48-hour washout). Each day included a step protocol with a gradual increase in stimulation intensity, starting at the first measurable force (up to 12 steps, 1 mA increments, 8 seconds stimulation, 60 second rest) and a fatigue protocol (30 repetitions, 8 second stimulation, 3 second rest).
Primary outcome was stimulation efficiency (electrically induced force/stimulation intensity) [N/mA], measured during each step of the stepwise increase in current intensity protocol.
Linear-mixed-effects models showed significantly higher stimulation efficiency for low-frequency stimulation (mean difference 0.14 [95% confidence interval, 0.01-0.27 N/mA], p = .031). However, current type did not significantly affect electrically induced force, level of discomfort, or muscle fatigue (p > .05).
The findings suggest that low-frequency stimulation is more efficient than kilohertz-frequency stimulation. However, both current types yield similar effects on force, discomfort, and fatigue, making them both viable options for wrist extensor stimulation in patients after stroke. Considering the variability among individuals, customizing the current type based on electrically induced force and perceived discomfort may enhance therapeutic outcomes. Further research on the long-term treatment effects of both current types is warranted.
电刺激是改善中风后运动功能的有效治疗方法，但对于中风合并手臂麻痹患者的最佳电流类型仍不明确。
比较千赫兹频率电流与低频电流对中风患者刺激效率、电诱发力、不适感和肌肉疲劳的影响。
一项随机交叉研究。
德国的神经科住院康复诊所。
共招募了23例在过去6个月内中风后出现手臂麻痹的患者，21例被纳入研究，20例完成了研究（7名女性；平均±标准差：66±12岁；身高176±11厘米；体重90±19千克；中风后57±34天）。
所有患者在2天内以随机顺序接受千赫兹和低频刺激（洗脱期48小时）。每天包括一个逐步增加刺激强度的阶梯方案，从第一个可测量的力开始（最多12步，每次增加1毫安，刺激8秒，休息60秒）和一个疲劳方案（30次重复，刺激8秒，休息3秒）。
主要结局是刺激效率（电诱发力/刺激强度）[N/mA]，在电流强度逐步增加方案的每个步骤中测量。
线性混合效应模型显示低频刺激的刺激效率显著更高（平均差异0.14 [95%置信区间，0.01 - 0.27 N/mA]，p = 0.031）。然而，电流类型对电诱发力、不适程度或肌肉疲劳没有显著影响（p > 0.05）。
研究结果表明低频刺激比千赫兹频率刺激更有效。然而，两种电流类型对力量、不适和疲劳产生相似的影响，使其成为中风后患者腕伸肌刺激的可行选择。考虑到个体差异，根据电诱发力和感知不适定制电流类型可能会提高治疗效果。有必要对两种电流类型的长期治疗效果进行进一步研究。
