Electrical stimulation of wrist extensors in poststroke hemiplegia. Neuromuscular stimulation for upper extremity motor and functional recovery in acute hemiplegia. Positional feedback and electrical stimulation: an automated treatment for the hemiplegic wrist. Chronic motor dysfunction after stroke: recovering wrist and finger extension by electromyography-triggered neuromuscular stimulation. Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. Modification of motor control of wrist extension by mesh-glove electrical afferent stimulation in stroke patients. Stimulation with low frequency (1.7 Hz) transcutaneous electric nerve stimulation (low-tens) increases motor function of the post-stroke paretic arm. Electromyogram-triggered neuromuscular stimulation for improving the arm function of acute stroke survivors: a randomized pilot study. Functional electrical stimulation by means of the ‘Ness Handmaster Orthosis’ in chronic stroke patients: an exploratory 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
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 AND PURPOSE The purpose of this study was to assess the efficacy of neuromuscular stimulation in enhancing the upper extremity motor and functional recovery of acute stroke survivors . METHODS Forty-six stroke survivors admitted to an inpatient rehabilitation unit were r and omly assigned to receive either neuromuscular stimulation or placebo .  Twenty-eight subjects completed the study . The treatment group received surface neuromuscular stimulation to produce wrist and finger extension exercises . The control group received placebo stimulation over the paretic forearm . All subjects were treated 1 hour per day , for a total of 15 sessions . Outcomes were assessed in a blinded manner with the upper extremity component of the Fugl-Meyer Motor Assessment and the self-care component of the Functional Independence Measure at pretreatment , after treatment , and at 4 and 12 weeks after treatment . RESULTS The treatment subjects and control subjects had comparable baseline characteristics . Parametric analyses revealed significantly greater gains in Fugl-Meyer scores for the treatment group after treatment ( 13.1 versus 6.5 ; P=0.05 ) , at 4 weeks after treatment ( 17.9 versus 9.7 ; P=0.05 ) , and at 12 weeks after treatment ( 20.6 versus 11.2 ; P=0.06 ) . Functional Independence Measure scores were not different between groups at any of the time periods ( P>0.10 ) . CONCLUSIONS Data suggest that neuromuscular stimulation enhances the upper extremity motor recovery of acute stroke survivors . However , the sample size in this study was too small to detect any significant effect of neuromuscular stimulation on self-care function Positional feedback ( PF ) and electrical stimulation were combined in a new treatment modality for facilitating wrist extension in stroke patients . Thirty adult hemiparetic patients lacking normal voluntary wrist extension were r and omly placed in control and study groups . The control group received conventional therapy while the study group received positional feedback stimulation training ( PFST ) in addition to conventional treatment . At the end of the 4-week program , study patients showed a 280 % increase in isometric extension torque when the wrist was positioned in 30 degrees of extension and 70 % increase when positioned in 30 degrees of flexion . Control patients showed no significant changes in torque . Study patients made an average 200 % gain in selective range of motion over their starting levels while controls made only a 50 % increase . Treatment using automated PFST equipment allows controlled repetitive isotonic exercise and facilitation of wrist extension without continuous one-on-one therapist/patient supervision 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 Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia . A detailed study was carried out of recovery of arm function after acute stroke , and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning . In a single-blind r and omised trial , 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups . At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength , range and speed of movement . This effect seemed concentrated amongst those who had a milder initial impairment . More work is needed to discover the reasons for this improved recovery , and whether further development of this therapeutic approach might offer clinical ly significant gains for some patients OBJECTIVE To study the effect of mesh-glove afferent stimulation on motor control of voluntary wrist movement in stroke patients who have chronic neurological deficits . DESIGN Case series . Motor control was evaluated by surface EMG of the arm muscles and kinematics of voluntary wrist movements on 3 occasions : before and immediately after the initial session of mesh-glove stimulation , and then after a daily mesh-glove stimulation program conducted over several months . SETTING Tertiary care center . PATIENTS The inclusion criteria were : a history of stroke lasting longer than 6 months ; completion of a rehabilitation program during early recovery ; and preserved cognitive and communicative ability . Fourteen referred patients ( age 63 + /- 9yr ; time since stroke 31 + /- 22mo ) fulfilled the criteria and completed the daily stimulation program . INTERVENTION A single initial and then daily mesh-glove electrical afferent stimulation was applied to the h and of the involved upper limb for 20 to 30min . MAIN OUTCOME MEASURES Surface EMGs from the affected biceps brachii and wrist extensor muscles and amplitudes of wrist movements were analyzed . RESULTS The single , initial mesh-glove application had no effect on outcome measures . Following a daily mesh-glove stimulation program , however , both the amplitude of wrist extension movement and wrist extensor integrated EMG were significantly increased while coactivation of biceps brachii decreased . These findings were most prominent in subjects with partially preserved voluntary wrist movements . CONCLUSION We conclude that daily mesh-glove stimulation can modify altered motor control and improve voluntary wrist extension movement in stroke subjects with chronic neurological deficits 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 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 gain experience with ‘ Ness H and master Orthosis ’ treatment in chronic stroke patients , to identify suitable patients , and to study the effects of treatment . Design : Exploratory , uncontrolled trial with measurement of motor functions and muscle tone of the upper extremity prior to , during , upon completion , and six weeks after a treatment period . Setting : A rehabilitation centre in the Netherl and s. Subjects : Eighteen chronic stroke patients ( more than six months post stroke ) , who exhibited upper extremity dysfunction due to spastic paresis . Intervention : A 10-week therapy programme of functional electrical stimulation by means of the ‘ Ness H and master Orthosis ’ . Results : The results of 15 patients were available for analysis . The differences in motor score and muscle tone before and at the end of treatment were statistically significant ( p = 0.008 and 0.021 , respectively ) . The follow-up measurements showed that the effects on motor functions and muscle tone decreased after therapy completion . Stratification of the patients in two subgroups indicated that patients with initial high motor scores benefited most during the intervention period . Conclusion : The present study suggests that H and master treatment possesses therapeutic opportunities in chronic stroke patients with spastic paresis of the upper extremity 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
Background : Therapeutic electrical stimulation ( TES ) is a therapeutic strategy aim ed at improving impairments of the upper extremity in stroke .
Objective : Assessment of the available evidence on the effect of TES of the affected upper extremity in improving motor control and functional abilities  after stroke .