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de Kroon JR, IJzerman MJ, Lankhorst GJ, Zilvold G: Electrical stimulation of the upper limb in stroke: Stimulation of the extensors of the hand vs. alternate stimulation of flexors and extensors. Am J Phys Med Rehabil 2004;83:592–600.To investigate whether there is a difference in functional improvement in the affected arm of chronic stroke patients when comparing two methods of electrical stimulation.Explanatory trial in which 30 chronic stroke patients with impaired arm function were randomly allocated to either alternating electrical stimulation of the extensor and flexor muscles of the hand (group A) or electrical stimulation of the extensors only (group B). Primary outcome measure was the Action Research Arm test to assess arm function. Grip strength, Motricity Index, Ashworth Scale, and range of motion of the wrist were secondary outcome measures.Improvement on the Action Research Arm test was 1.0 point in group A and 3.3 points in group B; the difference in functional gain was 2.3 points (95% confidence interval, −1.06 to 5.60). The success rate (i.e., percentage of patients with a clinically relevant improvement of >5.7 points on the Action Research Arm test) was 27% in group B (four patients) and 8% in group A (one patient). The differences in functional gain and success rate were not statistically significant, neither were the differences between the two groups on the secondary outcome measures.The difference between the two stimulation strategies was not statistically significant.