Progress toward motor recovery with active neuromuscular stimulation: muscle activation pattern evidence after a stroke

Chronic cerebrovascular accident individuals with partial paralysis in an upper extremity typically demonstrate difficulty in voluntarily controlling movement initiation. This study investigated patterns of electromyogram (EMG) activation levels while stroke subjects voluntarily initiated their impaired wrist and finger extensor muscles. Twenty subjects were randomly assigned to either a unilateral movement/stimulation group or a bilateral movement/stimulation group. Participants completed 4 days (6 h over 2 weeks) of active neuromuscular stimulation (i.e., 5 s/trial, 90 trials/day, biphasic waveform) on the wrist and finger extensors according to group assignments. The EMG activation levels were analyzed with a three-factor mixed design Motor recovery protocol x Session block X Trial block (2 X 2 X 3) ANOVA with repeated measures on the second and third factors. This robust analysis revealed higher EMG activation levels for the coupled bilateral movement/stimulation group than the unilateral movement/stimulation group. In addition, higher muscle activation levels were found for the second session block as well as trial blocks 2 and 3. Overall, these findings indicated improved motor capabilities of the impaired muscles as evidenced by the higher voluntary EMG activation levels. (C) 2002 Elsevier Science B.V. All rights reserved.