title: Neuromuscular electric stimulation enhances endothelial vascular control and hemodynamic function in paretic upper extremities of patients with stroke.
abstract: OBJECTIVE
  To investigate the effects of neuromuscular electric stimulation (NMES) on endothelial vascular control and hemodynamic function in patients in rehabilitation after acute stroke.
  
  
  METHODS
  Before-after trial.
  
  
  METHODS
  Inpatients in a tertiary hospital.
  
  
  METHODS
  Sixteen stroke patients (11 women, 5 men) with a mean age of 60.6+/-19.5 years.
  
  
  METHODS
  All patients received NMES for paretic wrist extensor and flexor muscles 30 minutes daily, 5 days a week, for 4 weeks. The nonparetic upper extremities, which served as controls, did not receive NMES.
  
  
  METHODS
  Laser Doppler perfusion testing was conducted to measure cutaneous microcirculatory responses to transdermal iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), as specific endothelium-dependent and -independent vasodilators, respectively. Arterial and venous hemodynamic function was also measured by impedance plethysmography.
  
  
  RESULTS
  Before NMES treatment, the venous capacity and compliance of the paretic extremities did not differ significantly from those of the nonparetic extremities. However, hyperemic arterial inflow, ACh-induced cutaneous perfusion, and the ratio of ACh- to SNP-induced cutaneous perfusion were lower in the paretic than in the nonparetic extremities. After NMES treatment, hyperemic arterial inflow and venous outflow increased by 21.5% and 57.2%, respectively, in the paretic extremities (P<.05). ACh-induced cutaneous perfusion and the ratio of ACh- to SNP-induced cutaneous perfusion were also significantly enhanced in the paretic extremities. In contrast, hyperemic arterial inflow decreased by 39.6% in the nonparetic extremities (P<.05), and endothelium-dependent cutaneous vasodilation also decreased significantly.
  
  
  CONCLUSIONS
  NMES therapy may enhance the hyperemic arterial response and endothelium-dependent dilation in skin vasculature in the paretic upper extremities of patients with stroke.
authors.affiliation: Graduate Institute of Rehabilitation Sciences and Center for Gerontological Research, Chang-Gung University, Tao-Yuan, Taipei, Taiwan 10016.
authors.forename: Jong-Shyan
authors.initials: JS
authors.lastname: Wang
authors.forename: Ssu-Yuan
authors.initials: SY
authors.lastname: Chen
authors.forename: Ching
authors.initials: C
authors.lastname: Lan
authors.forename: May-Kuen
authors.initials: MK
authors.lastname: Wong
authors.forename: Jin-Shin
authors.initials: JS
authors.lastname: Lai
mesh_terms: D000109:Acetylcholine / Q000494:pharmacology; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000534:rehabilitation; D002544:Cerebral Infarction / Q000534:rehabilitation; D004599:Electric Stimulation Therapy; D004730:Endothelium, Vascular / Q000187:drug effects; D005260:Female; D005296:Ferrous Compounds; D006439:Hemodynamics; D006801:Humans; D007478:Iontophoresis; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009599:Nitroprusside / Q000494:pharmacology; D010291:Paresis / Q000534:rehabilitation*; D000071939:Stroke Rehabilitation; D034941:Upper Extremity; D014664:Vasodilation; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D005296:Ferrous Compounds; D014665:Vasodilator Agents; D009599:Nitroprusside; C020748:ferrous sulfate; D000109:Acetylcholine