title: Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: a double-blinded randomized controlled trial.
abstract: BACKGROUND
  Robot-assisted therapy (RT) is a widely used intervention approach to enhance motor recovery in patients after stroke, but its effects on functional improvement remained uncertain. Neuromuscular electrical stimulation (NMES) is one potential adjuvant intervention approach to RT that could directly activate the stimulated muscles and improve functional use of the paretic hand.
  
  
  METHODS
  This was a randomized, double-blind, sham-controlled study. Thirty-nine individuals with chronic stroke were randomly assigned to the RT combined with NMES (RT + ES) or to RT with sham stimulation (RT + Sham) groups. The participants completed the intervention 90 to 100 minutes/day, 5 days/week for 4 weeks. The outcome measures included the upper extremity Fugl-Meyer Assessment (UE-FMA), modified Ashworth scale (MAS), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Stroke Impact Scale 3.0 (SIS). All outcome measures were assessed before and after intervention, and the UE-FMA, MAL, and SIS were reassessed at 3 months of follow-up.
  
  
  RESULTS
  Compared with the RT + Sham group, the RT + ES group demonstrated greater improvements in wrist flexor MAS score, WMFT quality of movement, and the hand function domain of the SIS. For other outcome measures, both groups improved significantly after the interventions, but no group differences were found.
  
  
  CONCLUSIONS
  RT + ES induced significant benefits in reducing wrist flexor spasticity and in hand movement quality in patients with chronic stroke.
  
  
  BACKGROUND
  ClinicalTrials.gov. NCT01655446.
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Rd, Taoyuan, Taiwan.|Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ya-yun
authors.initials: YY
authors.lastname: Lee
authors.affiliation: School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.|Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Keh-chung
authors.initials: KC
authors.lastname: Lin
authors.affiliation: School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Hsiao-ju
authors.initials: HJ
authors.lastname: Cheng
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Rd, Taoyuan, Taiwan. cywu@mail.cgu.edu.tw.|Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan. cywu@mail.cgu.edu.tw.
authors.forename: Ching-yi
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Rd, Taoyuan, Taiwan.|Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yu-wei
authors.initials: YW
authors.lastname: Hsieh
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan.|School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chih-kuang
authors.initials: CK
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D000071939:Stroke Rehabilitation; D014955:Wrist Joint / Q000503:physiopathology