title: Repetitive facilitative exercise under continuous electrical stimulation for severe arm impairment after sub-acute stroke: a randomized controlled pilot study.
abstract: OBJECTIVE
  To investigate the effectiveness of repetitive facilitative exercise (RFE) under surface neuromuscular electrical stimulation (NMES) in patients with post-stroke hemiplegia.
  
  
  METHODS
  This randomized, controlled, observer-blinded, pilot trial randomized 27 adults with severe arm impairment [Fugl-Meyer Arm scale (FMA) ≤ 20] due to stroke of 3-13 weeks duration into three groups and provided treatment on a 4-week, 40 minutes/day, 5 days/week schedule. The RFE-under-NMES group were given 100-150 repetitions of standardized movements of shoulder, elbow and wrist joints of their affected arm with concurrent low-amplitude NMES for each corresponding musculature. The RFE group was given the same exercise regimen but without NMES. The control group was treated with a conventional arm rehabilitation programme without NMES. FMA was assessed at baseline and 4 weeks.
  
  
  RESULTS
  All 27 participants (nine in each group) completed the trial. At 4 weeks, the RFE-under-NMES group evidenced significantly greater improvement compared with the control group on the FMA (p = 0.003), but not with the RFE group (p = 0.092). The RFE group showed improvement compared with the control group, but it was not significant (p = 0.199).
  
  
  CONCLUSIONS
  RFE under NMES is feasible in clinical settings and may be more effective than conventional rehabilitation in lessening arm impairment after sub-acute stroke.
authors.affiliation: Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences , Kagoshima , Japan and.
authors.forename: Megumi
authors.initials: M
authors.lastname: Shimodozono
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Noma
authors.forename: Shuji
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Ryuji
authors.initials: R
authors.lastname: Miyata
authors.forename: Seiji
authors.initials: S
authors.lastname: Etoh
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kawahira
mesh_terms: D000368:Aged; D001132:Arm / Q000503:physiopathology*; D004599:Electric Stimulation Therapy / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D020127:Recovery of Function; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome