In order to objectively evaluate recovery of wrist extension function in patients after stroke using surface electromyography,this study compared the outcomes of different acupuncture methods on functional wrist extension and optimized a therapeutic protocol.Forty patients with cerebral infarction or cerebral hemorrhage were randomly divided into treatment and control groups.Surface electromyography signal of the agonistic muscle,synergistic muscle and antagonistic muscle of bilateral wrist joints in extension was collected using Thought Technology Ltd 10-channel surface electromyography instrument.Integrated electromyogram (IEMG),median frequencies and root mean square were extracted to evaluate the function of bilateral wrist joints.In addition to routine rehabilitation treatment,patients received electroacupuncture twice a day for a total of 20 days.The control group patients received electroacupuncture at Shousanli (S110),Waiguan (SJ5) acupoints at a 2 Hz continuous wave with a single 30 minute stimulus intensity that patients could tolerate and that exhibited obvious muscular contraction.The treatment group patients received triple directional needling at the Shanglian (SI9) and Waiguan (SJ5) acupoints with a 50 Hz intermittent wave and a single 15 minute stimulus intensity that exhibited proper repeated wrist extension,A 10-channel surface electromyography instrument was used to obtain the surface electromyography signal of the agonistic muscle (extensor carpi radialis longus) of the dorsal wrist on the affected side in extension prior to and after treatment.The maximum (MAX) and IEMG were extracted.The effect of treatment was determined by assessing range of motion,Fugl-Meyer scale,Barthel Activities of Daily Living Index scores,and neurological function deficits score.The IEMG and root mean square and median frequencies of the agonistic muscle,synergistic muscle and antagonistic muscle on the affected side were significantly lower than on the healthy side (P < 0.01).After treatment,the MAX and IEMG of the agonistic muscle (extensor carpi radialis longus) on the affected side were increased in both groups.The range of motion,Fugl-Meyer scale,and Barthel Activities of Daily Living Index scores were also increased in both groups,while the neurological function deficit scores of the affected upper limbs were decreased.The clinical outcomes were significantly better in the treatment group than in the control group as evidenced by the successful outcome rate of 90% (treatment group) versus 55% (control group).Surface electromyography can be used to objectively and sensitively evaluate the muscular function and motion in patients with cerebrovascular disease.Taken together,these data suggest that triple directional needling can effectively improve functional wrist extension following stroke,contribute to reconstruction of wrist extension function,and result in a better therapeutic outcome than routine acupuncture.Triple directional needling can improve the muscular contraction of the agonistic muscle of the dorsal wrist on the affected side,increase the power in unit time,and thereby enhance the muscular power of the extensor carpi radialis longus on the affected side.