Stroke 101

Stroke assessed by a stroke physician. Their carofid arteries were Investigated using ootour Doppter imaging by a oonsutlant neuraradWogteL Patients with primary intraoerebra1 haemorrhage, total anterior drcutation strokes, posterior circula&on strokes or posterior circulation TIAs were excluded because carotid surgery would be inappropriate. Rnutts 726 patients were used h the analysis, Stepwfee logtefc regression demonstrated hat there were significant positive associations between severe carotid dfioosis and an IpsrlatBra) bruft, diabetes me&tus, and previous TIAs; and a negative a6sooiaSon with lacunar events. The sfrategy with the highest specrfcrty (97%) was 'any three of these lour features' but sensitivity was only 17V Tne s i r a ^ w S i the hkjhest sensitivity ( m ) was to use'one w more of the four features', but specificity was orty 22%. Conclusion None of the strategies Identified afl patients with severe carotid stenosis and also had a reasonable specificity. Where access to carotid imaging is severely limited, staple cfinical features are of some use in prioritising patients for imaging, but access to carotid imaging should ideafly be improved.

ELECTRICAL STIMULATION AT THE WRIST IN POST-STROKE HEMIPLEGIA J. POWELL, M. CAMERON, M. GRANAT, D. PANDYAN and D. J. STOTT Academic Section of Geriatric Medicine, University of Glasgow, Department of Physiotherapy, Royal Infirmary Glasgow, and Department of Bioengineering, University of Strathclyde Introduction Neuromuscular electrical stimulation (ES) has been suggested to enhance motor recovery after stroke. In a pilot study we have shown that short-term ES gives temporary improvements in contractures at the wrist (Clin Rehab 1997; 11: 123). Methods

We studied 60 hemiparetic patients (mean age 68 years) at 2-4 weeks after stroke in a randomised controlled parallel group study comparing standard rehabilitation treatment with standard treatment plus electrical stimulation of wrist extensors (3 times 30 minutes daily for 8 weeks). Movement at the wrist (an index of extensor power) was measured using purpose built strain guage apparatus. Upper limb disability was assessed using the Action Research Arm Test (ARAT). Observations were continued up to 32 weeks after study entry. Results

The change in moment at the wrist (at an angle of 0° extension) was significantly greater in the ES group than the controls at both 8 and 32 weeks (p=0.04, p=0.014). At week 8 the ARAT score had increased by a mean of 14.3 (SD 14.9) in the ES group compared to 6.9 (8.6) in the controls (p