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Stroke – Upper Limb Recovery Prediction (SAFE Score) — SCE Neurology MCQ

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HardNeurorehabilitationStroke – Upper Limb Recovery Prediction (SAFE Score)SCE Neurology

Three weeks after a left hemispheric stroke, a patient has visible contraction in the right wrist and finger extensors but cannot move the arm against resistance. Wrist extension is 5 degrees and finger extension is absent. There is no focal spasticity or shoulder pain. Which adjunct is supported within a comprehensive upper-limb rehabilitation programme?

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Correct answer: C — A therapist-guided trial of upper-limb electrical stimulation

NICE advises that upper-limb electrical stimulation should not be offered routinely, but a trial can be considered within a comprehensive rehabilitation programme when muscle contraction is present but the person cannot move the arm against resistance. Treatment is continued only if strength and the ability to practise functional tasks improve, and it should be guided by a qualified rehabilitation professional. Constraint-induced movement therapy requires at least 20 degrees of wrist extension and 10 degrees of finger extension, which this patient does not have. Routine splinting and robot-assisted arm training are not recommended, and botulinum toxin has no target without focal spasticity.

Reference: NICE NG236, stroke rehabilitation in adults, recommendations: https://www.nice.org.uk/guidance/ng236/chapter/recommendations