Summary:Conventional neuromuscular electrical stimulation (NMES) results in surface muscle contraction but high electrical stimulation intensity is required to activate the deep muscles. Therefore, NMES is not useful for training at complicated sites such as the forearm. To make NMES more effective we developed a hybrid training method (HYB), consisting of electrically stimulated antagonists to resist agonist muscle contractions. The purpose of this study was to compare the effects of HYB on the forearm as compared with NMES alone, and to determine whether HYB had any adverse effects on complex hand movements. Thirty subjects were randomly distributed into three groups: a HYB program group, an isometric electrical stimulation group (ES), and a control group (CN). Subjects trained 3 times a week for 6 weeks. Each session consisted of 10 sets of 10 reciprocal 2-sec wrist flexions and extensions separated by 1-min rest intervals. Wrist flexion\extension torques, grip strengths (GS), forearm flexor\extensor cross sectional areas (CSA), and hand dexterity (Purdue Pegboard (PEG) test, finger tapping (Tapping) test were measured. The HYB group demonstrated statistically significant increases in wrist extension torques (22.8%, p<0.01), forearm flexor CSA (9.6%, p<0.01), and in forearm extensor CSA (5.1%, p<0.05) at the end of training. There was no increase in torque or CSA in the ES or CN groups. Hand dexterity showed no significant differences in any of the three groups. HYB had no adverse effect on hand function and was more effective in forearm training than NMES alone.

The annual incidence of stroke is in the USA 795,000, and the annual incidence of traumatic brain injury is 1.7 million [1,2]. With an expected increase in the aged population during the next decade, we can foresee an increased number of stroke and traumatic head and neck injuries. Stroke, head, and neck injuries leave the affected person with various sensory, motor, and/or autonomic defects [3,4]. These diseases affect the activities of daily living as well as occupational activities later in life. Upper limb and hand function plays an important role in our daily life. In particular, functional disorders of the hands are directly linked to the