title: Two coupled motor recovery protocols are better than one: electromyogram-triggered neuromuscular stimulation and bilateral movements.
abstract: OBJECTIVE
  Overcoming chronic hemiparesis from a cerebrovascular accident (CVA) can be challenging for many patients, especially after the first 12 months after the CVA. With the use of established motor control theories, the present study investigated electromyogram (EMG)-triggered neuromuscular stimulation and bilateral coordination training.
  
  
  METHODS
  Twenty-five CVA subjects volunteered to participate in this motor recovery protocol study. Subjects were randomly assigned to 1 of 3 groups: (1) coupled protocol of EMG-triggered stimulation and bilateral movement (n=10); (2) EMG-triggered stimulation and unilateral movement (n=10); or (3) control (n=5). All participants completed 6 hours of rehabilitation during a 2-week period according to group assignments. Motor capabilities of the wrist and fingers were evaluated on the basis of 3 categories of motor tasks in a pretest-posttest control group design.
  
  
  RESULTS
  Significant findings for the (1) number of blocks moved in a functional task, (2) chronometric reaction times to initiate movements, and (3) sustained muscle contraction capability all favored the coupled bilateral movement training and EMG-triggered neuromuscular stimulation protocol group. In addition, the unilateral movement/stimulation group exceeded the control group in the number of blocks moved and rapid onset of muscle contractions.
  
  
  CONCLUSIONS
  This new evidence is convincing in that subjects in the coupled protocol group were able to demonstrate enhanced voluntary motor control across 3 categories of tasks. Chronic hemiparesis decreased considerably in the wrist and fingers as CVA patients expanded their motor repertoire.
authors.affiliation: Motor Behavior Laboratory, University of Florida, Gainesville 32611, USA. jcaura@hhp.ufl.edu
authors.forename: James H
authors.initials: JH
authors.lastname: Cauraugh
authors.forename: Sangbum
authors.initials: S
authors.lastname: Kim
mesh_terms: D001259:Ataxia / Q000209:etiology / Q000534:rehabilitation*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography / Q000379:methods*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009068:Movement; D009119:Muscle Contraction; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D011930:Reaction Time; D020127:Recovery of Function; D013314:Stress, Mechanical; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome