Comparison of the effectiveness of active and passive neuromuscular electrical stimulation of hemiplegic upper extremities: a randomized, controlled trial

To compare the efficacy of electromyography (EMG)triggered (active) neuromuscular electrical stimulation (NMES) and passive NMES in enhancing the upper extremity (UE) motor and functional recovery of subacute and chronic stage stroke patients. Thirty-one hemiplegic patients were randomly assigned to active NMES (n=11), passive NMES (n=10), and control (sham stimulation) (n=10) groups. Each treatment regimen was applied five times per week for 45 min for 3 weeks. All of the patients performed the same neurophysiologic exercise program for 45 min five times per week for 3 weeks. Patients were assessed by the UE component of the Fugl-Meyer Motor Assessment (UE-FMA), the self-care component of the Functional Independence Measure (self-care FIM), the Motor Activity Log (MAL), goniometric measurements of active wrist and metacarpophalangeal joint extension, surface EMG potentials, grip strength, and the modified Ashworth scale in a blinded manner. Data were obtained before and at the end of the treatment. Participants were similar in all clinical and demographic features (P> 0.05). All groups were comparable with respect to UE-FMA, MAL, self-care FIM, wrist and finger flexor spasticity, active range of motion (ROM), grip strength, and surface EMG potentials before treatment (P > 0.05). The active ROM, grip strength, FMA, FIM, surface EMG potentials, and MAL: amount of use were significantly improved in the EMG-triggered NMES group compared with the controls (P< 0.05). The active wrist extension ROM and FMA scores were significantly improved in the passive NMES group compared with the controls (P < 0.05). There were no statistically significant differences between active and passive NMES groups in any of the parameters evaluated at the end of the treatment (P > 0.05). Both active and passive NMES as adjuvant therapy in the neurophysiologic exercise program effectively enhanced the UE motor and functional recovery of stroke survivors.