Stretch alone may be ineffective for the treatment and prevention of contracture because it does not address possible underlying causes of contracture, namely muscle weakness and spasticity (Ada et al 2006). Weakness and spasticity buy Onalespib are common impairments after acquired brain injury. They immobilise joints in stereotypical postures predisposing them to contracture (Ada et al 2006, Fergusson et al 2007). Stretch provided in conjunction with interventions

addressing weakness and spasticity may be more effective than stretch alone. Electrical stimulation is increasingly used to increase strength and reduce spasticity in people with GS-7340 ic50 acquired brain injury. A systematic review concluded that electrical stimulation has a modest beneficial effect on muscle strength after stroke (Glinsky et al 2007). Two of the What is already known on this topic: Stretch alone may not affect contracture, perhaps because it does not address underlying muscle weakness and spasticity. Electrical stimulation can increase strength and reduce spasticity in some patients at risk of contracture. What this study adds: The effect of electrical stimulation for contracture management was not clear. While further research is needed to clarify the effectiveness of electrical stimulation, it may be reasonable

to use electrical stimulation in conjunction with splinting because it is inexpensive and not associated with discomfort or pain. It may be appropriate to use stronger doses of electrical stimulation than that used in the study. The possible therapeutic effect of electrical stimulation for contracture management is supported by a trial in people with stroke (Bakhtiary and Fatemy 2008), which reported a small treatment effect of electrical stimulation on passive ankle dorsiflexion range of motion (mean between-group difference 5 degrees, 95% CI 2 to 7). While this trial suggests that Resminostat electrical stimulation is therapeutic,

supramaximal levels of electrical stimulation for 9 minutes a day were applied (ie, the intensity was set at 25% over the intensity needed to produce a maximum contraction). Supramaximal doses are not commonly used clinically because of the associated discomfort. It is not clear how Bakhtiary and Fatemy overcame this problem. We were interested in whether we could replicate these results using a similar protocol of electrical stimulation but with a lower and more readily tolerated intensity of electrical stimulation applied for 1 hour a day rather than 9 minutes a day. We were also interested in combining electrical stimulation with stretch as this has not been investigated previously.