Effectiveness of Contralaterally Controlled Functional Electrical Stimulation versus Neuromuscular Electrical Stimulation on Upper Limb Motor Functional Recovery in Subacute Stroke Patients: A Randomized Controlled Trial

Abstract

Purpose. To compare the effectiveness of contralaterally controlled functional electrical stimulation (CCFES) versus neuromuscular electrical stimulation (NMES) on motor recovery of the upper limb in subacute stroke patients. Materials and Methods. Fifty patients within six months poststroke were randomly assigned to the CCFES group ( n = 25 ) and the NMES group ( n = 25 ). Both groups underwent routine rehabilitation plus 20-minute stimulation on wrist extensors per day, five days a week, for 3 weeks. Fugl-Meyer Assessment of upper extremity (FMA-UE), action research arm test (ARAT), Barthel Index (BI), and surface electromyography (sEMG) were assessed at baseline and end of intervention. Results. After a 3-week intervention, FMA-UE and BI increased in both groups ( p < 0.05 ). ARAT increased significantly only in the CCFES group ( p < 0.05 ). The changes of FMA-UE, ARAT, and BI in the CCFES group were not greater than those in the NMES group. The improvement in sEMG response of extensor carpi radialis by CCFES was greater than that by NMES ( p = 0.026 ). The cocontraction ratio (CCR) of flexor carpi radialis did not decrease in both groups. Conclusions. CCFES improved upper limb motor function, but did not show better treatment effect than NMES. CCFES significantly enhanced the sEMG response of paretic extensor carpi radialis compared with NMES, but did not decrease the cocontraction of antagonist.

Effectiveness of contralaterally controlled functional electrical stimulation vs. neuromuscular electrical stimulation for recovery of lower extremity function in patients with subacute stroke: A randomized controlled trial

“…For the sEMG evaluation, the improvement of RMS of the tibialis anterior in the CCFES group was significantly higher than that in the NMES group ( P < 0.05). It may indicate that NMES can effectively improve the recruitment of muscle fibers ( 17 ), but CCFES is more effective in activating the number and synchronization of motor units during muscle contraction, which is consistent with the previous results of Huang et al ( 18 ) in the upper extremity study. After the 3-week intervention, the functional scores of the two groups, except for the 10-meter walking test, were significantly improved in both groups ( P < 0.05).…”

The efficacy of contralaterally controlled functional electrical stimulation compared to conventional neuromuscular electrical stimulation for recovery of limb function following a stroke: a systematic review and meta-analysis

“…In our analysis, however, the hand CCFES and the intensive CCFES group were not included. Regarding the nature of the contralateral sensor, six studies have used a bend angle sensor ( 30–32 , 35 , 36 , 43 ), and nine studies used an EMGB ( 33 , 34 , 37–42 , 44 ). For the classification of stroke phases, participants within the first 2 weeks post-stroke were regarded as acute, 3–24 weeks were subacute, and more than 24 weeks were chronic ( 46 ).…”

“…For the classification of stroke phases, participants within the first 2 weeks post-stroke were regarded as acute, 3–24 weeks were subacute, and more than 24 weeks were chronic ( 46 ). Therefore, one study assessed participants in the acute phase ( 40 ), one in the acute/subacute ( 34 ), nine studies investigated subacute participants ( 30 , 33 , 35–39 , 41 , 42 ), one in the subacute/chronic ( 32 ), and finally, four studies examined chronic individuals ( 31 , 43–45 ). The duration of therapy differed between the included studies.…”

“…The duration of therapy differed between the included studies. The therapy program’s duration ranged from 2 weeks ( 40 ), 3 weeks ( 33 , 35 , 36 , 41 , 42 ), 4 weeks ( 34 , 37 , 39 , 41 , 44 ) 6 weeks ( 30 , 43 ), and 12 weeks ( 31 , 32 ). Six studies ( 30–32 , 38 , 43 , 45 ) followed up with the participants after the treatment, with the follow-up period ranging from 1–6 months.…”

Effect of constraint-induced movement therapy combined with neuromuscular electrical stimulation on upper extremity function in stroke survivors: A protocol for systematic review

“…[17,18] Neuromuscular electrical stimulation (NMES) is widely used in stroke rehabilitation for motor impairments by improving and assisting volitional movements. [19] Given the common motor impairments following stroke, NMES-based interventions aimed at improving motor function and quality of life should ideally be able to contract weak muscles along the affected limb to address paresis, facilitate individual joint control and coordination to restore fractionated movements and reduce abnormal synergistic patterns and hypertonia. [20] Several studies have indicated that NMES significantly affects limb rehabilitation in patients with stroke.…”