Electrical stimulation of wrist extensors in poststroke hemiplegia. Influence of Combined Afferent Stimulation and Task-Specific Training Following Stroke: A Pilot Randomized Controlled Trial Training-induced changes in the pattern of triceps to biceps activation during reaching tasks after chronic and severe stroke Clinical effects of combined bilateral arm training with functional electrical stimulation in patients with stroke Motor Training of Upper Extremity With Functional Electrical Stimulation in Early Stroke Rehabilitation A comparison of conventional and retrospective measures of change in symptoms after elective surgery The application of precisely controlled functional electrical stimulation to the shoulder, elbow and wrist for upper limb stroke rehabilitation: a feasibility study Rehabilitation of Reaching and Grasping Function in Severe Hemiplegic Patients Using Functional Electrical Stimulation Therapy Stroke motor recovery: active neuromuscular stimulation and repetitive practice schedules Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients Controlled study of neuroprosthetic functional electrical stimulation in sub-acute post-stroke rehabilitation. Two Coupled Motor Recovery Protocols Are Better Than One: Electromyogram-Triggered Neuromuscular Stimulation and Bilateral Movements Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke. Chronic motor dysfunction after stroke: recovering wrist and finger extension by electromyography-triggered neuromuscular stimulation. Chronic stroke motor recovery: duration of active neuromuscular stimulation Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Effects of therapeutic modalities on patients with post stroke shoulder pain. Clinical evaluation of Functional Electrical Therapy in acute hemiplegic subjects. Cutaneous electrical stimulation may enhance sensorimotor recovery in chronic stroke Myoelectrically driven functional electrical stimulation may increase motor recovery of upper limb in poststroke subjects: a randomized controlled pilot study. Relationship between functional electrical stimulation duty cycle and fatigue in wrist extensor muscles of patients with hemiparesis. Afferent stimulation provided by glove electrode during task-specific arm exercise following stroke Therapy of paretic arm in hemiplegic subjects augmented with a neural prosthesis: a cross-over study. Restitution of reaching and grasping promoted by functional electrical therapy. Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study) Repetitive facilitative exercise under continuous electrical stimulation for severe arm impairment after sub-acute stroke: A randomized controlled pilot study A home-based rehabilitation program for the hemiplegic upper extremity by power-assisted functional electrical stimulation Stimulation with low frequency (1.7 Hz) transcutaneous electric nerve stimulation (low-tens) increases motor function of the post-stroke paretic arm. Bilateral Upper Limb Training With Functional Electric Stimulation in Patients With Chronic Stroke Electromyogram-triggered neuromuscular stimulation for improving the arm function of acute stroke survivors: a randomized pilot study. Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial. Cortical effect and functional recovery by the electromyography-triggered neuromuscular stimulation in chronic stroke patients Effects of Functional Electric Stimulation on Upper Limb Motor Function and Shoulder Range of Motion in Hemiplegic Patients Electrical stimulation of wrist and fingers for sensory and functional recovery in acute hemiplegia Effect of transcutaneous electrical nerve stimulation (TENS) on Barthel Activities of Daily Living (ADL) Index score following stroke Outcome and time course of recovery in stroke. Part II: Time course of recovery. The Copenhagen Stroke Study. Low TENS treatment on post-stroke paretic arm: a three-year follow-up Effects of electrical stimulation on flexion contractures in the hemiplegic wrist Influence of electric somatosensory stimulation on paretic-hand function in chronic stroke. Functional electrical therapy for hemiparesis alleviates disability and enhances neuroplasticity. Can surface neuromuscular electrical stimulation of the wrist and hand combined with routine therapy facilitate recovery of arm function in patients with stroke? Functional electrical stimulation on chronic and acute hemiplegic shoulder subluxation. Clinical trial of electrical acupuncture on hemiplegic stroke patients. Cyclic functional electrical stimulation does not enhance gains in hand grasp function when used as an adjunct to onabotulinumtoxinA and task practice therapy: a single-blind, randomized controlled pilot study.
BACKGROUND AND PURPOSE It has been suggested that cyclic neuromuscular electrical stimulation ( ES ) may enhance motor recovery after stroke . We have investigated the effects of ES of the wrist extensors on impairment of wrist function and on upper-limb disability in patients being rehabilitated after acute stroke . METHODS We recruited 60 hemiparetic patients ( mean age , 68 years ) 2 to 4 weeks after stroke into a r and omized , controlled , parallel-group study comparing st and ard rehabilitation treatment with st and ard treatment plus ES of wrist extensors ( 3 times 30 minutes daily for 8 weeks ) . Isometric strength of wrist extensors was measured using a device built for that purpose . Upper-limb disability was assessed with use of the  Action Research Arm Test ( ARAT ) . Observations were continued for 32 weeks ( 24 weeks after the finish of ES or the control intervention phase ) . RESULTS The change in isometric strength of wrist extensors ( at an angle of 0 degrees extension ) was significantly greater in the ES group than the control group at both 8 and 32 weeks ( P=0.004 , P=0.014 by Mann Whitney U test ) . At week 8 the grasp and grip subscores of the ARAT increased significantly in the ES group compared with that in the control group ( P=0.013 and P=0.02 , respectively ) ; a similar trend was seen for the total ARAT score ( P=0.11 ) . In the subgroup of 33 patients with some residual wrist extensor strength at study entry ( moment at 0 degrees extension > 0 ) , the ARAT total score had increased at week 8 by a mean of 21.1 ( SD , 12.7 ) in the ES group compared with 10.3 ( SD , 9.0 ) in the control group ( P=0.024 , Mann Whitney U test ) ; however , at 32 weeks the differences between these 2 subgroups were no longer statistically significant . CONCLUSIONS ES of the wrist extensors enhances the recovery of isometric wrist extensor strength in hemiparetic stroke patients .  Upper-limb disability was reduced after 8 weeks of ES therapy , with benefits most apparent in those with some residual motor function at the wrist . However , it is not clear how long the improvements in upper-limb disability are maintained after ES is discontinued Background . Reorganization of the human motor cortex can be induced by specific patterns of peripheral afferent stimulation . The potential for afferent stimulation to facilitate the functional recovery associated with conventional rehabilitative techniques has not previously been investigated . Objective . The authors sought to determine whether combining appropriate afferent stimulation with task-specific training result ed in greater improvements than training alone in patients with impaired upper limb function in the subacute phase following stroke . Method . Twenty patients with hemiparesis due to stroke were allocated r and omly to either a stimulation or control group . All received 9 sessions of task-specific physiotherapy training over 3 weeks . Prior to each training session , associative electrical stimulation of the motor point of 2 h and muscles was given in the stimulation group , whereas the control group received sham stimulation .  Changes in dexterity were assessed using a grip-lift task , and st and ard measures of upper-limb function were made before and following the intervention . Corticospinal excitability was examined using transcranial magnetic stimulation . Results . Both groups showed comparable improvements in functional measures of upper-limb function . Of the 20 patients , only 14 could perform the grip-lift task , which is an objective measure of dexterity . Patients in the stimulation group From the Research Centre for Human Movement Control , School of exhibited significantly greater improvements in this task than the control group . There was no significant change in corticospinal excitability in either group . Conclusion . This pilot study provides preliminary data suggesting that targeted afferent stimulation may facilitate the response to conventional rehabilitation in patients with hemiparesis due to stroke , but these results need to be confirmed in a larger scale study This exploratory study was undertaken to investigate the mechanisms that contributed to improvements in upper limb function following a novel training program . Surface electromyography ( EMG ) was used to examine training-induced changes in the pattern of triceps and biceps activation during reaching tasks in stroke survivors with severe paresis in the chronic stage of recovery . The EMG data were obtained in the context of a single blind r and omised clinical trial conducted with 42 stroke survivors with minimal upper limb muscle activity and who were more than 6 months post-stroke . Of the 33 participants who completed the study , 10 received training of reaching using a non-robotic upper limb training device , the SMART Arm , with EMG triggered functional electrical stimulation ( EMG-stim ) , 13 received training of reaching using the SMART Arm alone , and 10 received no intervention . Each intervention group engaged in 12 1-h training sessions over a 4-week period . Clinical and laboratory measures of upper limb function were administered prior to training ( 0 weeks ) , at completion ( 4 weeks ) and 2 months ( 12 weeks ) after training . The primary outcome measure was ‘ upper arm function ’ which is Item 6 of the Motor Assessment Scale ( MAS ) . Laboratory measures consisted of two multijoint reaching tasks to assess ‘ maximum isometric force ’ and ‘ maximum distance reached ’ . Surface EMG  was used to monitor triceps brachii and biceps brachii during the two reaching tasks . To provide a comparison with normal values , seven healthy adults were tested on one of the reaching tasks according to the same procedure . Study findings demonstrated a statistically significant improvement in upper limb function for stroke participants in the two training groups compared to those who received no training however no difference was found between the two training groups . For the reaching tasks , all stroke participants , when compared to normal healthy adults , exhibited lower triceps and biceps activation and a lower ratio of triceps to biceps activation . Following training , stroke participants demonstrated increased triceps activation and an increased ratio of triceps to biceps activation for the task that was trained . Better performance was associated with greater triceps activation and a higher ratio of triceps to biceps activation . The findings suggest that increased activation of triceps as an agonist and an improved coordination between triceps and biceps could have mediated the observed changes in arm function . The changes in EMG activity were small relative to the changes in arm function indicating that factors , such as the contribution of other muscles of reaching , may also be implicated Cerebral vascular disease ( or stroke ) is the main cause of disabilities in adults . Upper-limb dysfunction after stroke usually exists , leading to severe limits of motor capabilities as well as daily activities . Therefore , effective treatment interventions for upper-limb rehabilitation after stroke are needed . Based on the neurophysiological evidence and clinical measures , combined bilateral arm training ( BAT ) with functional electric stimulation ( FES ) could improve h and function in stroke patients . In this study , we attempt to combine BAT with FES applying to the post-stroke paretic arm . A linear guide platform with FES feedback control was developed to execute the training of bilateral reaching movements . 35 stroke subjects were recruited and divided into two groups ( BAT with FES and BAT alone )  . 23 participants completed this experiment with 3-week intervention . According to our preliminary results , a favorable trend toward improvement in experimental group ( BAT with FES )  existed after treatment and at follow-up . Further analysis would be conducted to investigate the kinematic change on motor performance . Moreover , various treatment doses as well as more functional approaches would also be considered for better effects of upper limb rehabilitation after stroke Background . Functional electrical stimulation ( FES ) allows active exercises in stroke patients with upper extremity paralysis . Objective . To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and /or h and paralysis . Methods . For this pilot study , 23 acute and subacute stroke patients were r and omly assigned to the intervention ( n = 12 ) and control group ( n = 11 ) . Distributed over 4 weeks , FES training replaced 12 conventional training sessions in the intervention group . An Extended Barthel Index ( EBI ) subscore assessed the performance of activities of daily living ( ADL ) . The Chedoke McMaster Stroke Assessment ( CMSA ) measured h and and arm function and shoulder pain . The Modified Ashworth Scale ( MAS ) assessed resistance to passive movement . Unblinded assessment s were performed prior to and following the end of the training period . Results . The EBI subscore and CMSA arm score improved significantly in both groups . The CMSA h and function improved significantly in the FES group . Resistance to passive movement of finger and wrist flexors increased significantly in the FES group . Shoulder pain did not change significantly . None of the outcome measures , however , demonstrated significant gain differences between the groups . Conclusions . We did not find clear evidence for superiority or inferiority of FES . Our findings , and those of similar trials , suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences Background Measuring change is fundamental to evaluations , health services research and quality management . To date , the Gold-St and ard is the prospect i ve assessment of pre- to postoperative change . However , this is not always possible ( e.g. in emergencies ) . Instead a retrospective approach to the measurement of change is one alternative of potential validity . In this study , the Gold-St and ard ' conventional ' method was compared with two variations of the retrospective approach : a perceived-change design ( model A ) and a design that featured observed follow-up minus baseline recall ( model B ) . Methods In a prospect i ve longitudinal observational study of 185 hernia patients and 130 laparoscopic cholecystectomy patients ( T0 : 7 - 8 days pre-operative ; T1 : 14 days post-operative and T2 : 6 months post-operative ) changes in symptoms ( Hernia : 9 Items , Cholecystectomy : 8 Items ) were assessed at the three time points by patients and the conventional method was compared to the two alternatives . Comparisons were made regarding the percentage of missing values per question naire item , correlation between conventional and retrospective measurements , and the degree to which retrospective measures either over- or underestimated changes and time-dependent effects . Results Single item missing values in model A were more frequent than in model B ( e.g. Hernia repair at T1 : model A : 23.5 % , model B : 7.9 % . In all items and at both postoperative points of measurement , correlation of change between the conventional method and model B was higher than between the conventional method and model A. For both models A and B , correlation with the change calculated with the conventional method was higher at T1 than at T2 . Compared to the conventional model both models A and B also overestimated symptom-change ( i.e. improvement ) with similar frequency , but the overestimation was higher in model A than in model B. In both models , overestimation was lower at T1 than at T2 and lower after hernia repair than after cholecystectomy . Conclusions The retrospective method of measuring change was associated with a larger improvement in symptoms than was the conventional method . Retrospective assessment of change results in a more optimistic evaluation of improvement by patients than does the conventional method ( at least for hernia repair and laparoscopic cholecystectomy ) Background Functional electrical stimulation ( FES ) during repetitive practice of everyday tasks can facilitate recovery of upper limb function following stroke . Reduction in impairment is strongly associated with how closely FES assists performance , with advanced iterative learning control ( ILC ) technology providing precise upper-limb assistance . The aim of this study is to investigate the feasibility of extending ILC technology to control FES of three muscle groups in the upper limb to facilitate functional motor recovery post-stroke . Methods Five stroke participants with established hemiplegia undertook eighteen intervention sessions , each of one hour duration . During each session FES was applied to the anterior deltoid , triceps , and wrist/finger extensors to assist performance of functional tasks with real-objects , including closing a drawer and pressing a light switch . Advanced model-based ILC controllers used kinematic data from previous attempts at each task to up date the FES applied to each muscle on the subsequent trial . This produced stimulation profiles that facilitated accurate completion of each task while encouraging voluntary effort by the participant . Kinematic data were collected using a Microsoft Kinect , and mechanical arm support was provided by a SaeboMAS . Participants completed Fugl-Meyer and Action Research Arm Test clinical assessment s pre- and post-intervention , as well as FES-unassisted tasks during each intervention session . Results Fugl-Meyer and Action Research Arm Test scores both significantly improved from pre- to post-intervention by 4.4 points . Improvements were also found in FES-unassisted performance , and the amount of arm support required to successfully perform the tasks was reduced . Conclusions This feasibility study indicates that technology comprising low-cost hardware fused with advanced FES controllers accurately assists upper limb movement and may reduce upper limb impairments following stroke Objective . The aim of this study was to establish the efficacy of a therapeutic intervention based on functional electrical stimulation ( FES ) therapy to improve reaching and grasping function after severe hemiplegia due to stroke . Methods . A total of 21 subjects with acute stroke were r and omized into 2 groups , FES plus conventional occupational and physiotherapy ( FES group ) or only conventional therapy ( control group ) 5 days a week for 12 to 16 weeks . A third group of 7 subjects with chronic hemiplegia ( at least 5 months poststroke ) received only FES therapy ( chronic group ) and pre — post training changes were compared . FES was applied to proximal and then distal muscle groups during specific motor tasks . At baseline and at the end of treatment , grasping function was assessed using the Rehabilitation Engineering Laboratory H and Function Test , along with more st and ard measures of rehabilitation outcome . Results . The FES group improved significantly more than the control group in terms of object manipulation , palmar grip torque , pinch grip pulling force , Barthel Index , Upper Extremity Fugl — Meyer scores , and Upper Extremity Chedoke — McMaster Stages of Motor Recovery . The chronic stroke subjects demonstrated improvements in most categories , but the changes were not statistically significant . Conclusions . FES therapy with upper extremity training may be an efficacious intervention in the rehabilitation of reaching and grasping function during acute stroke rehabilitation Objective : To investigate progress toward motor recovery in patients with chronic hemiparesis ( mean time since stroke 3.2 years ) , comparing different types of practice schedules . Design : To increase voluntary control of the upper extremity , active neuromuscular stimulation was administered during blocked and r and om practice schedules as patients performed three specific movements : wrist/finger extension , elbow joint extension , and shoulder joint abduction . Methods : 34 stroke subjects volunteered to participate and were r and omly assigned to one of three treatment groups : blocked practice ( the same movement was repetitively performed on successive trials ) combined with active neuromuscular stimulation ; r and om practice ( different movements on successive trials ) along with active stimulation ; or no active stimulation assistance control group . Subjects completed two days of 90 minute training for each of two weeks with at least 24 hours of rest between sessions . A session was three sets of 30 successful active neuromuscular stimulation trials with the three movements executed 10 times/set . Results : Mixed design analyses on three categories of behavioural measures indicated motor improvements for the blocked and r and om practice /stimulation groups in comparison with the control group during the post-test period , with a larger number of blocks moved , faster premotor and motor reaction times , and less variability in the sustained muscular contraction task . Conclusions : Upper extremity rehabilitation intervention of active stimulation and blocked practice performed as well as stimulation/r and om practice . Moreover , these purpose ful voluntary movement findings support and extend sensorimotor integration theory to both practice schedules Background Assessment s of change in subjective patient reported outcomes such as health-related quality of life ( HRQoL ) are a key component of many clinical and research evaluations . However , conventional longitudinal evaluation of change may not agree with patient perceived change if patients ' underst and ing of the subjective construct under evaluation changes over time ( response shift ) or if patients ' have inaccurate re collection ( recall bias ) . This study examined whether older adults ' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay . It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced . Methods A prospect i ve longitudinal cohort design nested within a larger r and omised controlled trial was implemented . 103 hospitalised older adults participated in this investigation at a tertiary hospital facility . The  EQ-5D utility and Visual Analogue Scale ( VAS ) scores  were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable ( within three days of admission ) then again immediately prior to discharge . Three methods of change score calculation were used ( conventional change , patient perceived change and patient perceived change adjusted for recall bias ) . Agreement was primarily investigated using intraclass correlation coefficients ( ICC ) and limits of agreement . Results Overall 101 ( 98 % ) participants completed both admission and discharge assessment s. The mean ( SD ) age was 73.3 ( 11.2 ) . The median ( IQR ) length of stay was 38 ( 20 - 60 ) days . For agreement between conventional longitudinal change and patient perceived change : ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively . For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias : ICCs were 0.98 and 0.90 respectively . Discrepancy between conventional longitudinal change and patient perceived change was considered clinical ly meaningful for 84 ( 83.2 % ) of participants , after adjusting for recall bias this reduced to 8 ( 7.9 % ) . Conclusions Agreement between conventional change and patient perceived change was not strong . A large proportion of this disagreement could be attributed to recall bias . To overcome the invalidating effect of response shift ( on conventional change ) and recall bias ( on patient perceived change ) a method of adjusting patient perceived change for recall bias has been described OBJECTIVE Assess the effects of daily neuroprosthetic ( NESS H and master ) functional electrical stimulation in sub-acute stroke . DESIGN Controlled study , patients clinical ly stratified to 2 groups ; no active finger movement , and partial active finger movements , and then r and omized to control and neuroprosthesis groups . Observer blinded evaluations at baseline and completion of the 6-week study . SUBJECTS 22 patients with moderate to severe upper limb paresis 3 - 6 months post-onset . METHODS Patients in day hospital rehabilitation , receiving physical and occupational therapy 3 times weekly . The neuroprosthesis group used the device at home . RESULTS The neuroprosthesis group had significantly greater improvements in spasticity , active range of motion and scores on the functional h and tests ( those with partial active motion ) . Of the few patients with pain and oedema , there was improvement only among those in the neuroprosthesis group . There were no adverse reactions . CONCLUSION Supplementing st and ard outpatient rehabilitation with daily home neuroprosthetic activation improves upper limb outcomes Background and Purpose — Overcoming chronic hemiparesis from a cerebrovascular accident ( CVA ) can be challenging for many patients , especially after the first 12 months after the CVA . With the use of established motor control theories , the present study investigated electromyogram (EMG)-triggered neuromuscular stimulation and bilateral coordination training . Methods — Twenty-five CVA subjects volunteered to participate in this motor recovery protocol study . Subjects were r and omly assigned to 1 of 3 groups : ( 1 ) coupled protocol of EMG-triggered stimulation and bilateral movement ( n=10 ) ; ( 2 ) EMG-triggered stimulation and unilateral movement ( n=10 ) ; or ( 3 ) control ( n=5 ) . All participants completed 6 hours of rehabilitation during a 2-week period according to group assignments . Motor capabilities of the wrist and fingers were evaluated on the basis of 3 categories of motor tasks in a pretest-posttest control group design . Results — Significant findings for the ( 1 ) number of blocks moved in a functional task , ( 2 ) chronometric reaction times to initiate movements , and ( 3 ) sustained muscle contraction capability all favored the coupled bilateral movement training and EMG-triggered neuromuscular stimulation protocol group . In addition , the unilateral movement/stimulation group exceeded the control group in the number of blocks moved and rapid onset of muscle contractions . Conclusions — This new evidence is convincing in that subjects in the coupled protocol group were able to demonstrate enhanced voluntary motor control across 3 categories of tasks . Chronic hemiparesis decreased considerably in the wrist and fingers as CVA patients exp and ed their motor repertoire OBJECTIVE To examine and compare efficacy of 30- , 60- , and 120-minute repetitive task-specific practice ( RTP ) sessions incorporating use of an electrical stimulation neuroprosthesis ( ESN ) on affected upper-extremity ( UE ) movement . DESIGN Prospect i ve , single-blinded , r and omized controlled trial . SETTING Outpatient rehabilitation hospital . PARTICIPANTS Chronic stroke subjects ( N=32 ) exhibiting moderate , stable affected UE motor deficits . INTERVENTIONS Subjects participated in 30- , 60- , or 120-minute therapy sessions involving RTP incorporating the ESN , occurring every weekday for 8 weeks . During sessions , they wore the ESNs to enable performance of valued activities that they had identified . A fourth group participated in a 30-minute per weekday home exercise program . MAIN OUTCOME MEASURES Outcomes were evaluated using the UE section of the Fugl-Meyer Assessment of Sensorimotor Impairment ( FM ) , the Arm Motor Ability Test ( AMAT ) , the Action Research Arm Test ( ARAT ) , and Box and Block ( B&B ) 1 week before and 1 week after intervention . RESULTS After intervention , subjects in the 120-minute condition were the only ones to exhibit significant score increases on the FM ( P=.0007 ) , AMAT functional ability scale ( P=.002 ) , AMAT quality of movement scale ( P=.0002 ) , and ARAT ( P=.02 ) . They also exhibited the largest changes in time to perform AMAT tasks and in B&B score , but these changes were nonsignificant , ( P=.15 and P=.10 , respectively ) . CONCLUSIONS One hundred and twenty minutes a day of RTP augmented by ESN use elicits the largest and most consistent UE motor changes in moderately impaired stroke subjects BACKGROUND AND PURPOSE After stroke , many individuals have chronic unilateral motor dysfunction in the upper extremity that severely limits their functional movement control . The purpose of this study was to determine the effect of electromyography-triggered neuromuscular electrical stimulation on the wrist and finger extension muscles in individuals who had a stroke > or = 1 year earlier . METHODS Eleven individuals volunteered to participate and were r and omly assigned to either the electromyography-triggered neuromuscular stimulation experimental group ( 7 subjects ) or the control group ( 4 subjects ) . After completing a pretest involving 5 motor capability tests , the poststroke subjects completed 12 treatment sessions ( 30 minutes each ) according to group assignments . Once the control subjects completed 12 sessions attempting wrist and finger extension without any external assistance and were posttested , they were then given 12 sessions of the rehabilitation treatment . RESULTS The Box and Block test and the force-generation task ( sustained muscular contraction ) revealed significant findings ( P<0 . 05 ) . The experimental group moved significantly more blocks and displayed a higher isometric force impulse after the rehabilitation treatment . CONCLUSIONS Two lines of evidence clearly support the use of the electromyography-triggered neuromuscular electrical stimulation treatment to rehabilitate wrist and finger extension movements of hemiparetic individuals > or = 1 year after stroke . The treatment program decreased motor dysfunction and improved the motor capabilities in this group of poststroke individuals Active neuromuscular stimulation is an effective behavioral intervention for motor recovery improvements after a stroke . However , the most effective active neuromuscular stimulation duration s have not been determined . The present experiment investigated active stimulation duration s ( 0 , 5 , and 10 s ) coupled with bilateral movements on progress toward motor recovery in wrist and finger extension . Twenty-six stroke survivors with chronic hemiparesis were r and omly assigned to the stimulation duration groups , and subjects completed 4 days of rehabilitation training over a 2-week period . Mixed design analyses of variance on the Box and Block scores , chronometric reaction times , and force modulation of the sustained muscle contraction task revealed distinct motor recovery improvements for both the 5 and 10 s stimulation duration groups in comparison to the 0 s duration control group . Further , the number of blocks moved by the 10-s duration group exceeded those moved by the 5-s duration group . In conclusion , the 5 and 10 s duration active stimulation/bilateral movement groups decreased residual motor dysfunctions that persisted beyond 12 months post stroke BACKGROUND AND PURPOSE To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm , the effects of change in motor function over time on the accuracy of prediction were evaluated , and a prediction model for the probability of regaining dexterity at 6 months was developed . METHODS In 102 stroke patients , dexterity and paresis were measured with the  Action Research Arm Test , Motricity Index , and Fugl-Meyer motor evaluation .  For model development , 23 c and i date determinants were selected . Logistic regression analysis was used for prognostic factors and model development . RESULTS At 6 months , some dexterity in the paretic arm was found in 38 % , and complete functional recovery was seen in 11.6 % of the patients . Total anterior circulation infa rcts , right hemisphere strokes , homonymous hemianopia , visual gaze deficit , visual inattention , and paresis were statistically significant related to a poor arm function . Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity ( Action Research Arm Test > or=10 points ) from 74 % ( positive predictive value [ PPV ] , 0.74 ; 95 % confidence interval [ CI ] , 0.63 to 0.86 ) to 94 % ( PPV , 0.83 ; 95 % CI , 0.76 to 0.91 ) at 6 months . No change in probabilities of prediction dexterity was found after 4 weeks . CONCLUSIONS Based on the Fugl-Meyer scores of the flaccid arm , optimal prediction of arm function outcome at 6 months can be made within 4 weeks after onset . Lack of voluntary motor control of the leg in the first week with no emergence of arm synergies at 4 weeks is associated with poor outcome at 6 months A r and omized clinical trial was conducted to find out the effects of physical modalities transcutaneous electrical nerve stimulation ( TENS ) and ultrasonic therapy ( UST ) on the patients with post stroke shoulder pain in the Department of Physical Medicine & Rehabilitation & Department of Neurology , Bangab and hu Sheikh Mujib Medical University ( BSMMU ) from 1st July 2006 to 31st December 2006 . In that period a total of 750 stroke patients attended the stroke clinic of the Department of Neurology , BSMMU , of which 150(20 % ) patients presented with post stroke shoulder pain . Among the patients with post stroke shoulder pain , 45(6 % ) patients were included in the study . The aim of the study was to find out the improvement with proper and timely physical therapy and to study the comparative efficacy of TENS or UST therapy on shoulder pain in stroke patients . Results of this study showed that most of the patients were elderly and maximum number of patients ( 86.66 % ) was diagnosed as adhesive capsulitis . In each group , pain reduction and increase of muscle strength was same , TENS showed better improvement of muscle strength . There was complete recovery of tenderness by both TENS and UST . Significant improvement was observed after treatment in each group except in active internal rotation in UST group . But in comparison between two groups , Group A ( TENS ) showed statistically significant better improvement in all planes of pain free range of motion than Group B except active abduction which was better improved in group B ( UST ) and in case of passive abduction , passive external rotation and passive extension , TENS had better effect than UST . It may be concluded that TENS and UST both are effective but TENS may be safer and superior to ultrasonic therapy ( UST ) in the treatment of the patients with post stroke shoulder pain This paper describes a clinical r and omized single-blinded study of the effects of Functional Electrical Therapy ( FET ) on the paretic arms of subjects with acute hemiplegia caused by strokes .  FET is an exercise program that comprises voluntary arm movements and opening , closing , holding , and releasing of objects that are assisted by a neural prosthesis ( electrical stimulation ) . FET consisted of a 30 min everyday exercise for 3 consecutive weeks in addition to conventional therapy .  Twenty-eight acute hemiplegic subjects participated in a 6 mo study . The subjects were divided into lower functioning groups ( LFGs ) and higher functioning groups ( HFGs ) based on their capacity to voluntarily extend the wrist and fingers against the gravity , and were r and omly assigned to controls or FET groups . The outcomes included the Upper Extremity Function Test , the coordination of elbow and shoulder movements , spasticity of key muscles of the paretic arm , and Reduced Upper Extremity Motor Activity Log .  FET and control groups showed a recovery trend in all outcome measures . The gains in  FET groups were much larger compared with the gains in control groups . The speed of recovery in FET groups was substantially faster compared with the recovery rate in control groups during the first 3 weeks ( treatment ) . The LFG subjects showed less improvement than the HFG in both the FET and control groups Objective : To investigate whether cutaneous electrical stimulation has a role in the enhancement of sensorimotor function in chronic stroke . Subjects and setting : Fifty-nine patients with chronic stroke received cutaneous stimulation during their three-week-long inpatient rehabilitation . Thirty-two received active treatment in the paretic h and and eight received no-current placebo treatment in the paretic h and . Nineteen patients received active stimulation of the paretic foot . None received stimulation in both upper and lower limbs . Intervention : Cutaneous stimulation was delivered twice daily via a special glove/sock electrode . Main outcome measures : Modified Motor Assessment Scale , 10-metre walking test , paretic limb function , limb skin sensation and somatosensory evoked potentials ( SEP ) were performed before and after the treatment . Results : Modified Motor Assessment Scale ( p < 0.001 ) , 10-metre walking test ( p < 0.05 ) , paretic h and function ( p < 0.01 ) , upper limb skin sensation ( p < 0.01 ) and SEP normality classification of paretic upper limb ( p < 0.01 ) and paretic lower limb ( p < 0.5 ) improved significantly in the treatment group ( n = 51 ) after three weeks of stimulation . When active h and treatment and placebo h and treatment were compared , a significant improvement in the sensory and motor function was observed only in the actively treated group . Conclusions : Cutaneous stimulation had positive effects in the motor performance , limb sensation and the configuration of SEP of the paretic limb in chronic stroke patients The objective of this r and omized controlled pilot study was to assess the feasibility and effectiveness of myoelectrically controlled functional electrical stimulation ( MeCFES ) for rehabilitation of the upper limb in poststroke subjects . Eleven poststroke hemiparetic subjects with residual proximal control of the arm , but impaired volitional opening of the paretic h and , were enrolled and r and omized into a treated and a control group . Subjects received 3 to 5 treatment sessions per week until totaling 25 sessions . In the experimental group , myoelectric activity from wrist and finger extensors was used to control stimulation of the same muscles . Patients treated with MeCFES ( n = 5 ) had a significant ( p = 0.04 ) and clinical ly important improvement in Action Research Arm Test score ( median change 9 points ) , confirmed by an Individually Prioritized Problem Assessment self-evaluation score . This improvement was maintained at follow-up . The control group did not show a significant improvement ( p = 0.13 ) . The reduced sample size of participants , together with confounding factors such as spontaneous recovery , calls for larger studies to draw definite conclusions . However , the large and persistent treatment effect seen in our results indicate that MeCFES could play an important role as a clinical tool for stroke rehabilitation The purpose of this study was to investigate , in a sample of patients with hemiparesis secondary to cerebrovascular accident , the relationship between the ratio of stimulus on time to off time and muscle fatigue using a commercial electrical stimulation unit . An experimental model was used to test the hypothesis that the smaller the stimulus off time relative to stimulus on time , the greater will be the muscle fatigue over time . The wrist extensor muscles of 18 patients with hemiparesis were stimulated electrically , and isometric force output was recorded continuously using an adapted strain gauge-recorder apparatus . For each testing session , peak on time of the electrical stimulus was set at 5 seconds , and off time was set at 5 , 15 , or 25 seconds . Six r and omly assigned treatment groups participated in three separate treatment sessions in a different order at 48-hour intervals . Treatment sessions were continued either until wrist extensor muscle force output decreased to 50 % of its initial value or for a maximum of 30 minutes . Data analysis revealed that significant differences in muscle tension developed among all duty cycles ( p less than .01 ) . Duty-cycle ratios of 1:1 , 1:3 , and 1:5 were shown to be progressively less fatiguing . Within the limits of this investigation , the 1:5 duty-cycle ratio was determined to be the best suited for initial use in programs of prolonged stimulation to the wrist extensor muscles of patients with hemiparesis . The hypothesis was accepted that the smaller the stimulus off time ( rest interval ) with respect to the stimulus on time , the greater will be the muscle fatigue over time Background : Sensory amplitude electrical stimulation ( SES ) and repetitive task practice reduce impairments and arm dysfunction when delivered separately following stroke . Objective : To determine if home-based , task-specific arm exercise was more effective when administered concurrent with SES . Methods : Thirty-eight subjects with chronic stroke and mean Fugl-Meyer Assessment ( FMA ) score 28/66 ( 15–45 ) participated . Subjects were r and omly assigned to an SES ( n = 20 ) or sham stimulation ( n = 18 ) group . Subjects engaged in task-based home exercise for 30 minutes , twice daily , for four weeks while wearing a glove electrode on the impaired h and . Experimental subjects received SES while control subjects received sham stimulation during exercise . Primary outcome measures : FMA and Arm Motor Ability Test ( AMAT ) . Results : There were no significant between-group differences for outcome measures . There was a significant difference between the pre- and post-test scores in the SES group AMAT median time ( P = 0.003 95 % confidence interval ( CI ) : −14.304 , −6.365 ; effect size : 0.84 ) . Practice time was not associated with changes in outcomes . Subjects with more sensorimotor dysfunction had significantly greater improvements on AMAT median time ( P = 0.037 ) . There was a significant relationship between baseline FMA score and FMA change score ( r = 0.402 ; P = 0.006 ) . Conclusions : This study describes a unique SES delivery system via glove electrode that enabled delivery of SES during home-based arm task practice in stroke survivors .  Task practice with concurrent SES did not demonstrate significantly better effects than task practice with sham stimulation , however there was a trend for greater improvement in one activity measure There are indications that both intensive exercise and electrical stimulation have a beneficial effect on arm function in post-stroke hemiplegic patients . We recommend the use of Functional Electrical Therapy ( FET ) , which combines electrical stimulation of the paretic arm and intensive voluntary movement of the arm to exercise daily functions . FET was applied 30 min daily for 3 weeks . Forty-one acute hemiplegics volunteered in the 18-months single blinded cross-over study ( CoS ) . Nineteen patients ( Group A ) participated in FET during their acute hemiplegia , and 22 patients ( Group B ) participated in FET during their chronic phase of hemiplegia . Group B patients were controls during FET in acute hemiplegia , and Group A patients were  controls during the FET in chronic hemiplegia . Thirty-two patients completed the study . The outcomes of the Upper Extremity Function Test ( UEFT ) were used to assess the ability of patients to functionally use objects , as were the Drawing Test ( DT ) ( used to assess the coordination of the arm ) , the Modified Ashworth Scale , the range of movement , and the question naire estimating the patients ' satisfaction with the usage of the paretic arm . Patients who participated in the FET during the acute phase of hemiplegia ( Group A ) reached functionality of the paretic arm , on average , in less than 6 weeks , and maintained this near-normal use of the arm and h and throughout the follow-up . The gains in all outcome scores were significantly larger in Group A after FET and at all follow-ups compared with the scores before the treatment . The gains in patients who participated in the FET in the chronic phase of hemiplegia ( Group B ) were measurable , yet not significant . The speed of recovery was larger during the period of the FET compared with the follow-up period . The gains in Group A were significantly larger compared with the gains in Group B. The FET greatly promotes the recovery of the paretic arm if applied during the acute phase of post-stroke hemiplegia Functional electrical therapy ( FET ) is a new term describing a combination of functional electrical stimulation that generates life-like movement and intensive exercise in humans with central nervous system lesions . We hypothesized that FET can promote a significant recovery of functioning if applied in subacute stroke subjects . The study included 16 stroke subjects divided into a low functioning group ( LFG ) and a high functioning group ( HFG ) based on their ability to control wrist and fingers and r and omly associated into FET and controls . The FET consisted of 30 min daily sessions during 3 weeks . The exercise comprised functional use of daily necessary activities ( e.g. , writing , using a telephone receiver , and drinking from a can ) . The outcome presented in this article is the upper-extremity function test performed before and after the therapy . The change in performance of the HFG group was significant . The number of successful repetitive movements in 2 min was doubled and 1.6 times increased for controls , and the time to perform the movement was decreased by 71 % percent and by 36 % in controls . In the LFG FET group , the difference in performance was the following . First , the number of tasks was increased from 0 to 6 ( total of 11 tasks ) . Second , the averaged number of successful repetitive movements was increased from 0 to 3 . The functional improvement in the FET LFG is probably not sufficient to make the more affected arm/h and effective for daily necessities ; thus , the FET effects could deteriorate over a longer time . The subjects from the control LFG made only a marginal improvement . The follow-up for each subject will continue for 12 months after the beginning of the treatment BACKGROUND Acute coronary , cerebrovascular , and peripheral vascular events have common underlying arterial pathology , risk factors , and preventive treatments , but they are rarely studied concurrently . In the Oxford Vascular Study , we determined the comparative epidemiology of different acute vascular syndromes , their current burdens , and the potential effect of the ageing population on future rates . METHODS We prospect ively assessed all individuals presenting with an acute vascular event of any type in any arterial territory irrespective of age in a population of 91 106 in Oxfordshire , UK , in 2002 - 05 . FINDINGS 2024 acute vascular events occurred in 1657 individuals : 918 ( 45 % ) cerebrovascular ( 618 stroke , 300 transient ischaemic attacks [ TIA ] ) ; 856 ( 42 % ) coronary vascular ( 159 ST-elevation myocardial infa rct ion , 316 non-ST-elevation myocardial infa rct ion , 218 unstable angina , 163 sudden cardiac death ) ; 188 ( 9 % ) peripheral vascular ( 43 aortic , 53 embolic visceral or limb ischaemia , 92 critical limb ischaemia ) ; and 62 unclassifiable deaths . Relative incidence of cerebrovascular events compared with coronary events was 1.19 ( 95 % CI 1.06 - 1.33 ) overall ; 1.40 ( 1.23 - 1.59 ) for non-fatal events ; and 1.21 ( 1.04 - 1.41 ) if TIA and unstable angina were further excluded . Event and incidence rates rose steeply with age in all arterial territories , with 735 ( 80 % ) cerebrovascular , 623 ( 73 % ) coronary , and 147 ( 78 % ) peripheral vascular events in 12 886 ( 14 % ) individuals aged 65 years or older ; and 503 ( 54 % ) , 402 ( 47 % ) , and 105 ( 56 % ) , respectively , in the 5919 ( 6 % ) aged 75 years or older . Although case-fatality rates increased with age , 736 ( 47 % ) of 1561 non-fatal events occurred at age 75 years or older . INTERPRETATION The high rates of acute vascular events outside the coronary arterial territory and the steep rise in event rates with age in all territories have implication s for prevention strategies , clinical trial design , and the targeting of funds for service provision and research Abstract Objective : To investigate the effectiveness of repetitive facilitative exercise ( RFE ) under surface neuromuscular electrical stimulation ( NMES ) in patients with post-stroke hemiplegia . Methods : This r and omized , controlled , observer-blinded , pilot trial r and omized 27 adults with severe arm impairment [ Fugl-Meyer Arm scale ( FMA ) ≤ 20 ] due to stroke of 3–13 weeks duration into three groups and provided treatment on a 4-week , 40 minutes/day , 5 days/week schedule . The RFE-under-NMES group were given 100–150 repetitions of st and ardized movements of shoulder , elbow and wrist joints of their affected arm with concurrent low-amplitude NMES for each corresponding musculature . The RFE group was given the same exercise regimen but without NMES . The control group was treated with a conventional arm rehabilitation programme without NMES . FMA was assessed at baseline and 4 weeks . Results : All 27 participants ( nine in each group ) completed the trial . At 4 weeks , the RFE-under-NMES group evidence d significantly greater improvement compared with the control group on the FMA ( p = 0.003 ) , but not with the RFE group ( p = 0.092 ) . The RFE group showed improvement compared with the control group , but it was not significant ( p = 0.199 ) . Conclusions : RFE under NMES is feasible in clinical setting s and may be more effective than conventional rehabilitation in lessening arm impairment after sub-acute stroke Purpose . To assess the effects of daily power-assisted functional electrical stimulation ( FES ) home program therapy in chronic stroke . Methods . A total of 20 consecutively enrolled stroke patients with spastic upper-extremity impairments > 1 year after stroke were recruited for this non-blinded r and omized controlled trial . Subjects were assigned to control and FES groups and followed for 5 months . The FES group used a power-assisted FES device to induce greater muscle contraction by electrical stimulation in proportion to the integrated electromyography ( EMG ) signal picked up on surface electrodes . Target muscles were the extensor carpi radialis longus ( ECRL ) and extensor carpi radialis brevis ( ECRB ) , extensor digitorum communis ( EDC ) , extensor indicis proprius ( EIP ) , and deltoid ( Del ) . Patients underwent 30 ∼ 60 min FES sessions at home about 6 days/week . Root mean square ( RMS ) of ECRL , EDC and Del maximum voluntary EMGs , active range of motion ( ROM ) of wrist and finger extension and shoulder flexion , modified Ashworth scale ( MAS ) , and clinical tests were investigated before and after FES training . Results . The FES group displayed significantly greater improvements in RMS , active ROM , MAS and functional h and tests , and was able to smoothly perform activities of daily life using the hemiplegic upper extremities . Conclusions . Daily power-assisted FES home program therapy can effectively improve wrist and finger extension and shoulder flexion . Proprioceptional sensory feedback might play an important role in power-assisted FES therapy The object of this study is to determine if the functional motor capacity of the paretic extremity can be improved by stimulation with low intensity low frequency ( 1.7 Hz ) transcutaneous electric nerve stimulation ( Low-TENS ) , started 6 - 12 months after a stroke . Forty-four patients who had a paretic arm as a consequence of their first stroke were included and r and omly assigned to either a treatment group ( n = 26 ) or a control group ( n = 18 ) . Patients in both groups received physiotherapy at a day-care center , usually twice a week . The treatment group received , in addition , Low-TENS for 60 min , five days a week for three months . Results showed that motor function increased significantly in the treatment group , compared to controls . The Low-TENS did not decrease either pain or spasticity . It is concluded that stimulation by means of Low-TENS could be a valuable complement to the usual training of arm and h and function in the rehabilitation of stroke patients Background . The recovery rate of upper limb function after stroke is poor when compared with independent walking . Therefore , effective methods are warranted for upper limb rehabilitation . Objective . The aim of this study was to investigate the effectiveness of functional electric stimulation ( FES ) with bilateral activities training on upper limb function . Methods . This study was a double-blinded r and omized controlled trial . Twenty patients were recruited 6 months after the onset of stroke and completed 15 training sessions . Participants were r and omly assigned to the FES group or to the control group . Each session consisted of stretching activities ( 10 minutes ) , FES with bilateral tasks ( 20 minutes ) , and occupational therapy treatment ( 60 minutes ) . The participants used a self-trigger mechanism , with an accelerometer as a motion detector , for generating an electric stimulation pattern that was synchronized with the bilateral upper limb activities during the training . The participants in the control group received the same duration of stretching and occupational therapy training except that they just received placebo stimulation with the bilateral tasks . The outcome measures included Functional Test for the Hemiplegic Upper Extremity ( FTHUE ) , Fugl — Meyer Assessment ( FMA ) , grip power , forward reaching distance , active range of motion of wrist extension , Functional Independence Measure , and Modified Ashworth Scale . Results . At baseline comparison , there was no significant difference in both groups . After 15 training sessions , the FES group had significant improvement in FMA ( P = .039 ) , FTHUE ( P = .001 ) , and active range of motion of wrist extension ( P = .020 ) when compared with the control group . Conclusions . Bilateral upper limb training with FES could be an effective method for upper limb rehabilitation of stroke patients after 15 training sessions OBJECTIVE To assess the efficacy of electromyogram (EMG)-triggered neuromuscular stimulation ( EMG-stim ) in enhancing upper extremity motor and functional recovery of acute stroke survivors . DESIGN A pilot r and omized , single-blinded clinical trial . SETTING Freest and ing inpatient rehabilitation facility . PATIENTS Nine subjects who were within 6 weeks of their first unifocal , nonhemorrhagic stroke were r and omly assigned to either the EMG-stim ( n = 4 ) or control ( n = 5 ) group . All subjects had a detectable EMG signal ( > 5 microV ) from the surface of the paretic extensor carpi radialis and voluntary wrist extension in synergy or in isolation with muscle grade of < 3/5 . INTERVENTION All subjects received two 30-minute sessions per day of wrist strengthening exercises with EMG-stim ( experimental ) or without ( control ) for the duration of their rehabilitation stay . MAIN OUTCOME MEASURES Upper extremity Fugl-Meyer motor assessment and the feeding , grooming , and upper body dressing items of the Functional Independence Measure ( FIM ) were assessed at study entry and at discharge . RESULTS Subjects treated with EMG-stim exhibited significantly greater gains in Fugl-Meyer ( 27.0 vs 10.4 ; p = .05 ) , and FIM ( 6.0 vs 3.4 ; p = .02 ) scores compared with controls . CONCLUSION Data suggest that EMG-stim enhances the arm function of acute stroke survivors OBJECTIVE To compare response to upper-limb treatment using robotics plus motor learning ( ML ) versus functional electrical stimulation ( FES ) plus ML versus ML alone , according to a measure of complex functional everyday tasks for chronic , severely impaired stroke survivors . DESIGN Single-blind , r and omized trial . SETTING Medical center . PARTICIPANTS Enrolled subjects ( N=39 ) were > 1 year postsingle stroke ( attrition rate=10 % ; 35 completed the study ) . INTERVENTIONS All groups received treatment 5d/wk for 5h/d ( 60 sessions ) , with unique treatment as follows : ML alone ( n=11 ) ( 5h/d partial- and whole-task practice of complex functional tasks ) , robotics plus ML ( n=12 ) ( 3.5h/d of ML and 1.5h/d of shoulder/elbow robotics ) , and FES plus ML ( n=12 ) ( 3.5h/d of ML and 1.5h/d of FES wrist/h and coordination training ) . MAIN OUTCOME MEASURES Primary measure : Arm Motor Ability Test ( AMAT ) , with 13 complex functional tasks ; secondary measure : upper-limb Fugl-Meyer coordination scale ( FM ) . RESULTS There was no significant difference found in treatment response across groups ( AMAT : P≥.584 ; FM coordination : P≥.590 ) . All 3 treatment groups demonstrated clinical ly and statistically significant improvement in response to treatment ( AMAT and FM coordination : P≤.009 ) . A group treatment paradigm of 1:3 ( therapist/patient ) ratio proved feasible for provision of the intensive treatment . No adverse effects . CONCLUSIONS Severely impaired stroke survivors with persistent ( > 1y ) upper-extremity dysfunction can make clinical ly and statistically significant gains in coordination and functional task performance in response to robotics plus ML , FES plus ML , and ML alone in an intensive and long- duration intervention ; no group differences were found . Additional studies are warranted to determine the effectiveness of these methods in the clinical setting We investigated the effect of electromyography (EMG)-triggered neuromuscular electrical stimulation ( NMES ; EMG-stim ) on functional recovery of the hemiparetic h and and the related cortical activation pattern in chronic stroke patients . We enrolled 14 stroke patients , who were r and omly assigned to the EMG-stim ( n=7 ) or the control groups ( n=7 ) . The EMG-stim was applied to the wrist extensor of the EMG-stim group for two sessions ( 30 min/session ) a day , five times per week for 10 weeks . Four functional tests ( box and block , strength , the accuracy index , and the on/offset time of muscle contraction ) and functional MRI ( fMRI ) were performed before and after treatment . fMRI was measured at 1.5 T in parallel with timed finger flexion-extension movements at a fixed rate . Following treatment , the EMG-stim group showed a significant improvement in all functional tests . The main cortical activation change with such functional improvement was shifted from the ipsilateral sensorimotor cortex ( SMC ) to the contralateral SMC . We demonstrated that 10-week EMG-stim can induce functional recovery and change of cortical activation pattern in the hemiparetic h and of chronic stroke patients Wang RY , Yang YR , Tsai MW , Wang WTJ , Chan RC : Effects of functional electric stimulation on upper limb motor function and shoulder range of motion in hemiplegic patients . Am J Phys Med Rehabil 2002;81:283–290 . Objectives The present study examines functional electric stimulation ( FES ) applied on patients with hemiplegia of short and long duration for the purpose of upper limb motor recovery and increasing shoulder range of motion . Design Patients with hemiplegia with subluxation participating in the study were placed into a short- duration group or a long- duration group . Subjects in each group were then r and omly assigned to either the control or the experimental subgroup . The experimental groups of both short- and long- duration groups received FES therapy in which the supraspinatus and posterior deltoid muscles were induced to contract repetitively up to 6 hr a day for 6 wk . Duration of FES session and muscle contraction/relaxation ratio were progressively increased as performance improved . The experimental groups also received a second 6-wk FES therapy 6 wk after completing the first FES therapy . Results After the first 6-wk FES therapy , the experimental group of short- duration hemiplegia showed significant improvements in motor recovery as indicated by Fugl-Meyer scores compared with the control group . Such significant improvement did not occur for the experimental group of long- duration hemiplegia . The changes in the second FES treatment program were insignificant . Conclusions This study suggests that patients with hemiplegia of short duration are effectively trained by FES  for motor recovery Objective : To investigate the effects of a short-term electrical stimulation in conjunction with neurodevelopmental exercises on sensory and functional recovery of hemiparetic upper limb in acute stroke patients . Design : Controlled clinical trial with alternate allocation . Setting : Acute inpatient medical care setting of a university hospital . Subjects : Thirty-six acute stroke patients ( 18 TENS group ; 18 control group ) who experienced their first stroke were studied . Intervention : Both groups received 1 h/day neurodevelopmental exercises in accordance with Bobath for 10 days . In addition to exercises the TENS group received electrical stimulation of the wrist and finger extensors for 1 h. Main outcome measures : Kinaesthesia and position sense tests , a h and function test and a h and movement scale were performed before and after treatment . Results : Both groups showed considerable improvement in kinaesthesia sense and position sense after treatment . Comparison of the two groups after treatment revealed that this difference was not significant ( P>0.05 ) . Both groups showed improvement in h and movement scores ( P<0.05 ) , whereas h and function improved only in the TENS group ( P<0.05 ) . Conclusion : The results of this study indicated that additional stimulation of the h and and fingers leads to an improved sensorimotor outcome immediately after the intervention Objective : To evaluate the effectiveness of transcutaneous electrical nerve stimulation ( TENS ) and placebo TENS on the level of activities of daily living ( ADL ) of stroke patients . Setting : A university hospital . Patients : Patients who had had a stroke 30–240 days before entry to a university rehabilitation centre . Design : Controlled design with block r and omization and blinded assessment . Intervention : All patients had Todd – Davies exercises  . In group 1 ( n = 30 ) TENS with frequency of 100 Hz was used at an intensity that the patient could tolerate ; in group 2 ( n = 30 ) patients were given placebo TENS . The treatment protocol consisted of 40 sessions ( eight weeks ) . Outcomes : The Barthel Index for daily living activities was used to measure functional changes over time , and the Ashworth Scale was used to measure spasticity in the elbow , knee and ankle . These measurements were made prior to and following the treatment by assessors unaware of the patient 's group allocation . Results : There were 30 patients in each group . Patients in group 1 ( active TENS ) were more disabled at entry to the study . Statistically significant improvements were recorded in all parameters such as feeding , transfer , hygiene , toileting , bathing , walking , climbing stairs , dressing , bowel and bladder care for group 1 ( p<0.001 ) but only in some items in group 2 . The change in total score was significant in both groups but the difference in the change score between the two groups was statistically significant ( p<0.001 ) . Spasticity was reduced in the active treatment group . Conclusion : TENS appears to be an effective adjunct in the regaining of motor functions and improving ADL in hemiplegic patients , but the accidental imbalance in severity of disability at entry makes interpretation uncertain OBJECTIVE To determine the time course of both neurological and functional recovery from stroke . DESIGN Prospect i ve , consecutive , and community based . SETTING The stroke unit of a hospital in Copenhagen , Denmark . This setting receives all acute stroke patients admitted from a well-defined catchment area of 239,886 inhabitants within the city of Copenhagen .  Acute treatment as well as all stages of rehabilitation are cared for within the stroke unit regardless of age , stroke severity , and premorbid condition . PATIENTS 1,197 patients with acute stroke . MAIN OUTCOME MEASURES Weekly examinations of neurological deficits ( using the Sc and inavian Neurological Stroke Scale ) and functional disabilities ( Activity of Daily Living ( ADL ) measured by the Barthel Index ) were performed from the time of acute admission to the end of rehabilitation . These evaluations were repeated 6 months poststroke . Time course of recovery was stratified according to initial stroke severity and disability . RESULTS Functional recovery was completed within 12.5 weeks ( 95 % confidence interval ( CI ) 11.6 to 13.4 ) from stroke onset in 95 % of the patients . However , 80 % of the patients had reached their best ADL function within 6 weeks ( CI 5.3 to 6.7 ) from onset . The time course of functional recovery was strongly related to initial stroke severity . Best ADL function was reached within 8.5 weeks ( CI 8 to 9 ) in patients with initially mild strokes , within 13 weeks ( CI 12 to 14 ) in patients with moderate strokes , within 17 weeks ( CI 15 to 19 ) in patients with severe strokes , and within 20 weeks ( CI 16 to 24 ) in patients with very severe strokes . After these time-points , no significant changes occurred . However , a valid prognosis of functional outcome can be made much earlier . Best ADL function was reached by 80 % of the patients with initially mild strokes within 3 weeks ( CI 2.6 to 3.4 ) , within 7 weeks ( CI 6 to 8) of the patients with moderate strokes , and within 11.5 weeks ( CI 10 to 13 ) of the patients with severe and very severe strokes . The time course of neurological recovery followed a pattern similar to that of functional recovery , but preceeded functional recovery by 2 weeks on average . CONCLUSIONS A reliable prognosis can in all stroke patients be made within 12 weeks from stroke onset . Even in patients with severe and very severe strokes , neurological and functional recovery should not be expected after the first 5 months Objective : To determine whether stroke patients with initial increases in arm motor recovery following low-frequency transcutaneous electrical nerve stimulation ( low TENS ) treatment go on to show long-term benefits . Also whether the same therapy results in long-term improvements in motor function , spasticity or activities of daily living ( ADL ) . Design : A three-year follow-up study . Subjects : Twenty-eight stroke patients , who had participated in a r and omized trial of daily treatment with low-frequency ( 1.7 Hz ) transcutaneous electrical nerve stimulation ( low TENS ) on the paretic arm for three months starting 6–12 months after stroke . Outcomes : Fugl-Meyer Motor Performance Scale for evaluation of changes in arm motor function . A 6-point Ashworth Scale to measure spasticity . Barthel Index to evaluate performance in ADL . Results : Motor function of the paretic arm had deteriorated in both treatment and control groups . Increased spasticity was seen in both groups . ADL score remained at a similar level in the low TENS group , whereas the control group had deteriorated during the same time period . Conclusions : Low TENS stimulation started 6–12 months after stroke may not have a specific effect on arm motor function years after completion of treatment Objective : To study the effects of electrical stimulation ( ES ) on  flexion contractures in the hemiplegic wrist . Design : The investigation was carried out following an OFF ( two weeks with rehabilitation only ) - ON ( two weeks with ES treatment and rehabilitation ) - OFF ( two weeks rehabilitation only ) fixed protocol . Setting : A stroke ward and an outpatient stroke service . Subjects : Eleven hemiplegic subjects with reduced range of extension and increased resistance to passive movement at the wrist . Main measure : Quantitative measures of the hemiplegic posture at the wrist , passive range of extension and resistance to passive extension of the wrist . Measurements were taken at the start of the study and then at two-weekly intervals . Two extra measurements were taken at the end of the ON period . Results : Following two weeks treatment with ES the posture of the wrist improved and the passive range of extension increased . However , there were no significant changes in the resistance to passive movement . These benefits appeared largely to be lost two weeks after ES was discontinued . Conclusions : Short-term ES gives temporary improvements in contractures at the wrist in poststroke hemiplegia OBJECTIVE To test the influence of electric somatosensory stimulation on performance of the Jebsen-Taylor H and Function Test ( JTHFT ) , a widely used assessment of functional h and motor skills , by the paretic arm in patients with chronic stroke . DESIGN Initially , patients trained for several sessions until reaching plateau performance on the JTHFT . Subsequently , they entered a crossover r and omized study , design ed to evaluate the influence of somatosensory stimulation on JTHFT performance . SETTING A research laboratory . PARTICIPANTS Nine patients with chronic stroke ( > /=1.5 y ) who acutely had marked weakness ( paralysis of the upper extremity is evaluated as equal or below Medical Research Council [ MRC ] grade 2 ) followed by improvement to an MRC grade of 4.24+/-0.43 ( range , 3.5 - 4.9 ) and Fugl-Meyer Assessment ( FMA ) score of 86.43%+/-2.02 % at the time of testing . INTERVENTIONS Two hours of electric somatosensory stimulation was applied to the ( 1 ) paretic h and , ( 2 ) paretic leg , or ( 3 ) no stimulation in different sessions , in a r and omized order . MAIN OUTCOME MEASURE The time required to complete the JTHFT was analyzed by using repeated- measures analysis of variance ( ANOVA ) with factors time ( pre- , postintervention ) and intervention ( paretic h and , paretic leg , no stimulation ) followed by post hoc testing . RESULTS Significant effects of intervention and intervention by time interaction ( P<.01 ) on JTHFT time was revealed by repeated- measures ANOVA . Post hoc testing documented improvements in JTHFT time with paretic h and stimulation alone ( P<.005 ) , an effect that appeared more prominent in subjects with lower FMA scores . CONCLUSIONS Somatosensory stimulation applied to a paretic limb can benefit performance of a functional test in patients with chronic stroke . This result supports the proposal that electric sensory stimulation in combination with training protocol s may enhance the benefit of customary neurorehabilitative treatments and possibly motor learning Impaired motor and sensory function is common in the upper limb in humans after cerebrovascular stroke and it often remains as a permanent disability . Functional electrical stimulation therapy is known to enhance the motor function of the paretic h and ; however , the mechanism of this enhancement is not known . We studied whether neural plasticity has a role in this therapy-induced enhancement of the h and motor function in 20 hemiparetic subjects with chronic stroke ( age 53 ± 6 years ; 7 females and 13 males ; 10 with cerebral infa rct ion and 10 with cerebral haemorrhage ; and time since incident 2.4 ± 2.0 years ) . These subjects were r and omized to functional electrical therapy or conventional physiotherapy group . Both groups received upper limb treatment ( twice daily sessions ) for two weeks .  Behavioral h and motor function and neurophysiologic transcranial magnetic stimulation ( TMS )  tests were applied before and after the treatment and at 6-months follow-up . TMS is useful in assessing excitability changes in the primary motor cortex . Faster corticospinal conduction and newly found muscular responses were observed in the paretic upper limb in the functional electrical therapy group but not in the conventional therapy group after the intervention . Behaviourally , faster movement times were observed in the functional electrical therapy group but not in the conventionally treated group . Despite the small number of heterogeneous subjects , functional exercise augmented with individualized electrical therapy of the paretic upper limb may enhance neuroplasticity , observed as corticospinal facilitation , in chronic stroke subjects , along with moderate improvements in the voluntary motor control of the affected limb OBJECTIVE To investigate whether treatment with surface neuromuscular electrical stimulation to the wrist extensors improves recovery of arm function in severely disabled patients with stroke . DESIGN Single blinded r and omized controlled trial . SETTING Acute stroke unit and stroke rehabilitation wards of a university hospital . PARTICIPANTS Patients with no upper limb function ( Action Research Arm Test [ ARAT ] score 0 ) ( N=90 ; mean age ± SD , 74±11y ; 49 % men ) were recruited to the study within 6 weeks of stroke . Only 67 participants were alive at the end of the study and data from 66 of these people were analyzed . INTERVENTIONS Participants were r and omized to surface neuromuscular electrical stimulation using surface electrical stimulators for 30 minutes , twice in a working day for 6 weeks in addition to st and ardized upper limb therapy or just st and ardized upper limb therapy . MAIN OUTCOME MEASURE The primary outcome measure was the ARAT score . Assessment s were made at baseline and at 6 , 12 , 24 , and 36 weeks after recruitment . RESULTS There were statistically significant improvements in measures of wrist extensor ( mean difference 0.5 ; 95 % confidence interval [ CI ] , 0.0 - 1.0 ) and grip strength ( mean difference 0.9 ; 95 % CI , 0.1 - 1.7 ) over the treatment period . Arm function ( ARAT score ) was not significantly different between the groups over the treatment period at 6 weeks ( mean difference 1.9 ; 95 % CI , -2.9 to 6.8 ) or over the study period at 36 weeks ( mean difference 6.4 ; 95 % CI , -1.8 to 14.7 ) , and the rate of recovery was not significantly different ( mean difference 0.7 ; 95 % CI , -0.2 to 1.6 ) . CONCLUSIONS In patients with severe stroke , with no functional arm movement , electrical stimulation of wrist extensors improves muscle strength for wrist extension and grip , and larger studies are required to study its influence on arm function OBJECTIVE The present study investigated and assessed the effectiveness of a functional electrical stimulation ( FES ) program in the management of  acute and chronic shoulder subluxation .  DESIGN By their postonset duration , hemiplegic subjects with subluxation participating in the study were placed into a short- duration group and a long- duration group . Subjects in each group were further assigned r and omly to either a control subgroup or an experimental subgroup . The experimental subgroups of both short and long duration received FES therapy in which supraspinatus and posterior deltoid were induced to contract repetitively up to 6 hr/day for 6 wk . The duration of the FES session and muscle contraction/relaxation ratio were progressively increased as performance improved . RESULTS The experimental subgroup of short duration showed significant improvements in reducing subluxation as indicated by x-ray compared with the control subgroup of short duration after the first FES treatment . The same effect was not shown for the experimental subgroup of long duration . The second FES treatment program only result ed in an insignificant change of shoulder subluxation for both the short- and long- duration subgroups . CONCLUSIONS The present study suggests that hemiplegic subjects with short postonset duration are effectively trained for shoulder subluxation by the first FES treatment program . The same FES showed not to be effective when applied to the subjects with subluxation of > 1 yr To assess the efficacy of electrical acupuncture in the rehabilitation of patients with hemiplegia in stroke , we r and omized 128 patients within 2 wk of stroke onset to receive either comprehensive rehabilitation plus electrical acupuncture  ( n = 59 ) or comprehensive rehabilitation only  ( n = 59 ) . Electrical acupuncture was administered by electrical stimulation of acupuncture points through adhesive surface electrodes five times per week . Neurological status ( Brunnstrom 's stage ) and the Chinese version of the Functional Independence Measure were assessed before treatment and at discharge . Patients treated with electrical acupuncture had a shorter duration of hospital stay for rehabilitation and better neurological and functional outcomes than the control group had , with a significant difference in scores for self-care and locomotion ( P = 0.02 ) . This result did not postulate the previous study that acupuncture therapy for stroke patients should depend on needle manual and " de qi " response . We suggest that electrical acupuncture through adhesive surface electrodes in conjunction with current optimal rehabilitation programs is a convenient and effective therapy for stroke patients OBJECTIVE To determine whether onabotulinumtoxinA injections and task practice training with or without functional electrical stimulation ( FES ) improve upper limb motor function in chronic spastic hemiparesis . DESIGN R and omized controlled trial . SETTING Outpatient spasticity clinic . PARTICIPANTS Participants ( N=23 ) had chronic spastic hemiparesis with moderate-severe h and impairment based on Chedoke-McMaster Assessment greater than or equal to 2 . INTERVENTIONS OnabotulinumtoxinA injections followed by 12 weeks of postinjection task practice . Participants r and omly assigned to FES group were also fitted with an orthosis that provided FES . MAIN OUTCOME MEASURES Motor Activity Log (MAL)-Observation was the primary outcome . Secondary outcomes were Action Research Arm Test ( ARAT ) and MAL-Self-Report . RESULTS For the entire cohort , MAL-Observation mean item scores improved significantly from baseline to week 6 ( P=.005 ) but did not remain significant at week 12 . MAL-Self-Report mean item scores improved significantly ( P=.009 ) from baseline to week 6 and remained significantly higher ( P=.014 ) at week 12 . ARAT total scores also improved significantly from baseline to week 6 ( P=.018 ) and were sustained at week 12 ( P=.032 ) . However , there were no significant differences between the FES and no-FES groups for any outcome variable over time . CONCLUSIONS Rehabilitation strategies that combine onabotulinumtoxinA injections and task practice therapy are feasible and effective in improving upper-limb motor function and reducing spasticity in patients with chronic spastic hemiparesis . However , the cyclic FES protocol used in this study did not increase gains achieved with the combination of onabotulinumtoxinA and task practice alone
Background Stroke can lead to significant impairment of upper limb function which affects performance of activities of daily living ( ADL ) .
Functional electrical stimulation ( FES ) involves electrical stimulation of motor neurons such that muscle groups contract and create or augment a moment about a joint .
Whilst lower limb FES was established in post-stroke rehabilitation , there is a lack of clarity on the effectiveness of upper limb FES .
This systematic review aims to evaluate the effectiveness of post-stroke upper limb FES on ADL and motor outcomes .