Rehabilitation of Synkinetic Wrist Co-Contraction After Stroke

Treatment Interventions

The American Heart Association recommends functional electrical stimulation (FES) applied to wrist and forearm muscles for patients with impaired muscle contraction and wrist motor impairment, as an adjunctive therapy to motor practice 1, 2
FES should be used within the first 6 months post-stroke for optimal outcomes, and it produces improved muscle force in wrist extension and short-term increases in motor strength and control 1, 2
The American Academy of Neurology suggests that patients demonstrating ≥20 degrees of wrist extension AND ≥10 degrees of finger extension are eligible for constraint-induced movement therapy as the primary intervention, which requires 6-8 hours of daily training for at least 2 weeks 1, 3, 4

Patients with partial muscle function qualify for FES, and the presence of voluntary finger extension is a positive prognostic indicator for upper extremity motor recovery 2, 5

The American Stroke Association recommends implementing EMG-driven NMES robot-assisted wrist training as the first-line intervention for patients with abnormal co-contraction who do not meet constraint-induced therapy criteria 1, 2, 3, 4
If spasticity contributes to co-contraction, treat with antispastic positioning, range of motion exercises, stretching, and splinting, and consider botulinum toxin or phenol/alcohol for selected patients with disabling spasticity affecting wrist function 6