Finger-Equipped Electrode Electrical Stimulation for Severe Upper-Limb Paresis in the Acute Phase of Stroke: A Retrospective Case Series

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Finger-Equipped Electrode Electrical Stimulation for Severe Upper-Limb Paresis in the Acute Phase of Stroke: A Retrospective Case Series

Cite this article as: Nakamori T, Kitayama S, Hamamachi K (October 04, 2025) Finger-Equipped Electrode Electrical Stimulation for Severe Upper-Limb Paresis in the Acute Phase of Stroke: A Retrospective Case Series. Cureus 17(10): e93838. doi:10.7759/cureus.93838

 

Abstract

 Aim and objective

Severe upper-limb paresis during the acute phase of stroke significantly limits functional recovery. Finger-equipped electrode electrical stimulation (FEE-ES) enables therapists to synchronize electrical stimulation (ES) with the patient’s motor intent, even in the absence of voluntary movement. However, evidence regarding its feasibility and preliminary therapeutic effects in the acute phase of stroke remains limited. Therefore, this study aimed to evaluate the feasibility, safety, and potential therapeutic effects of FEE-ES in patients in the acute phase of stroke who present with severe upper-limb paresis.

Materials and methods

We retrospectively examined six patients (mean age: 56.0 ± 15.0 years) with a first-ever stroke and severe upper-limb paresis (baseline Fugl-Meyer Assessment for Upper Extremity (FMA-UE) ≤19), without severe cognitive or attentional deficits. FEE-ES was applied for approximately one month during the acute phase as part of the rehabilitation program. Upper-limb motor function was assessed using the FMA-UE and the upper-limb items of the Stroke Impairment Assessment Set (SIAS). Spasticity and skin integrity were monitored throughout the intervention.

Results

The median baseline FMA-UE score was 4.0 (range: 4-6) points, which improved to 16.0 (range: 7-27) points after one month (p = 0.031, Wilcoxon signed-rank exact test; effect size r = 0.86). The Hodges-Lehmann estimator indicated a median improvement of 11 points (95% confidence interval: 3-23). Three patients exceeded the minimal clinically important difference (MCID) of 10 points. The median SIAS-Knee-Mouth and Finger Function scores increased from 0 to 1.5, and from 0.5 to 1.0, respectively. However, no increase in spasticity or skin complications was observed. Four participants had follow-up assessments at two months after stroke onset, and all exhibited continued functional gains.

Conclusion

This retrospective case series demonstrated that FEE-ES in the acute phase of stroke is feasible, safe, and may be associated with significant improvements in upper-limb motor function in patients with severe paresis. Notably, some individuals exhibited continued functional gains beyond the acute stage, suggesting that early synchronization of motor intent with ES may promote long-term recovery. Although preliminary, these findings support the potential of FEE-ES as an adjunct rehabilitation strategy and highlight the need for additional controlled studies to confirm efficacy and optimize protocols. 

Introduction

Upper-limb motor paresis occurs in approximately 70% of patients following cerebrovascular disorders, and only approximately 20% of those with severe paresis achieve complete functional recovery^[1]. Impaired upper-limb function significantly limits independence in activities of daily living (ADLs) and reduces quality of life (QOL), highlighting the urgent need for effective rehabilitation interventions. Electrical stimulation (ES) therapy is one such promising approach. Among its modalities, electromyography (EMG)-triggered neuromuscular electrical stimulation (NMES), which synchronizes ES with voluntary muscle activity, has demonstrated efficacy in improving motor function^[2]. However, detecting voluntary movements in patients with severe paresis is often difficult, limiting the applicability of EMG-triggered stimulation. To address this challenge, a finger-equipped electrode electrical stimulation (FEE-ES) has been developed as a novel therapeutic approach. Unlike conventional EMG-triggered NMES, FEE-ES enables therapists to deliver stimuli manually through finger-attached electrodes, allowing ES to be synchronized with the patient’s motor intention, even when voluntary EMG activity is undetectable^[3]. This key technical difference broadens the potential application of ES to patients with severe upper-limb paresis who would otherwise be excluded from EMG-triggered therapies.While FEE-ES has demonstrated clinical utility in chronic strok^[3], its application in the acute phase remains underexplored, with evidence limited to case reports and lacking systematic evaluation^[4]. Given that the acute phase of stroke represents a critical period for neuroplasticity and functional recovery^[5], introducing FEE-ES during this stage could offer substantial benefits. However, few studies have examined its feasibility, safety, and preliminary effects in patients with acute-phase stroke and severe upper-limb paresis, underscoring the need for empirical data.Therefore, the present study retrospectively analyzed the clinical course of six such patients who underwent FEE-ES in the acute phase to evaluate its feasibility, safety, and preliminary therapeutic effects.