***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: It has been proposed that somatosensory stimulation in the form of electromyographically triggered neuromuscular electrical stimulation ( NMES ) to the peripheral nerve can influence functional measures of motor performance in subjects with stroke and can additionally produce changes in cortical excitability . Using a controlled , double-blind design , we studied the effects of intensive ( 60 h/3 weeks ) treatment at home with NMES compared with a sham treatment , applied to the extensor muscles of the hemiplegic forearm to facilitate h and opening in 16 chronic stroke subjects . We investigated improvement in functional use of the h and and change in cortical activation as measured by functional magnetic resonance imaging ( fMRI ) . Following treatment , subjects improved on measures of grasp and release of objects ( Box and Block Test and Jebsen Taylor H and Function Test [ JTHFT ] : small objects , stacking , heavy cans ) , isometric finger extension strength , and self-rated Motor Activity Log ( MAL ) : Amount of Use and How Well score . The sham subjects did not improve on any grasp and release measure or self-rated scale , but did improve on isometric finger extension strength . Importantly , however , following crossover , these subjects improved further in the measure of strength , grasp and release ( Box and Block [ JTHFT ] : page turning ) , and self-rated MAL : Amount of Use score and How Well score . Using fMRI and a finger-tracking task , an index of cortical intensity in the ipsilateral somatosensory cortex increased significantly from pre-test to post-test following treatment . Cortical activation , as measured by voxel count , did not change . These findings suggest that NMES may have an important role in stimulating cortical sensory areas allowing for improved motor function BACKGROUND AND PURPOSE It has been suggested that cyclic neuromuscular electrical stimulation ( ES ) may enhance motor recovery after stroke . We have investigated the effects of ES of the wrist extensors on impairment of wrist function and on upper-limb disability in patients being rehabilitated after acute stroke . METHODS We recruited 60 hemiparetic patients ( mean age , 68 years ) 2 to 4 weeks after stroke into a r and omized , controlled , parallel-group study comparing st and ard rehabilitation treatment with st and ard treatment plus ES of wrist extensors ( 3 times 30 minutes daily for 8 weeks ) . Isometric strength of wrist extensors was measured using a device built for that purpose . Upper-limb disability was assessed with use of the  Action Research Arm Test ( ARAT ) . Observations were continued for 32 weeks ( 24 weeks after the finish of ES or the control intervention phase ) . RESULTS The change in isometric strength of wrist extensors ( at an angle of 0 degrees extension ) was significantly greater in the ES group than the control group at both 8 and 32 weeks ( P=0.004 , P=0.014 by Mann Whitney U test ) . At week 8 the grasp and grip subscores of the ARAT increased significantly in the ES group compared with that in the control group ( P=0.013 and P=0.02 , respectively ) ; a similar trend was seen for the total ARAT score ( P=0.11 ) . In the subgroup of 33 patients with some residual wrist extensor strength at study entry ( moment at 0 degrees extension > 0 ) , the ARAT total score had increased at week 8 by a mean of 21.1 ( SD , 12.7 ) in the ES group compared with 10.3 ( SD , 9.0 ) in the control group ( P=0.024 , Mann Whitney U test ) ; however , at 32 weeks the differences between these 2 subgroups were no longer statistically significant . CONCLUSIONS ES of the wrist extensors enhances the recovery of isometric wrist extensor strength in hemiparetic stroke patients .  Upper-limb disability was reduced after 8 weeks of ES therapy , with benefits most apparent in those with some residual motor function at the wrist . However , it is not clear how long the improvements in upper-limb disability are maintained after ES is discontinued To determine the effectiveness of mirror therapy and electromyography (EMG)-triggered neuromuscular stimulation on improvement of functions of the upper extremity in patients with subacute stroke in comparison with conventional therapy as well as to evaluate the advantage of each treatment over another , we conducted a prospect i ve , r and omized , and controlled trial involving 24 patients with ischemic stroke . The mean age and mean time since stroke of the patients were 58.79±11.49 years and 5.25±2.25 months . Patients were assigned r and omly to a mirror therapy group ( MT group , n=9 ) , which consisted of therapy with a mirror box 5 days/week , 30 min/day , for 3 weeks , an electrostimulation group ( ES group , n=7 ) , which consisted of therapy with EMG-triggered stimulation ( EMG-stim ) of similar duration and frequency of treatment as the MT group , and a control group ( n=8 ) . All the groups received conventional physiotherapy for the same period as the MT group . Patients in the MT group practice d their therapy at home after supervised sessions . The Fugl-Meyer scores of the upper extremity , grip force , wrist extension , and Box and Block Test were evaluated at baseline , after treatment , and at 3 months after the treatment . All of these measures were evaluated by a blinded research er . We found that there was no significant improvement in wrist extension range and grip force in control group . The MT and EMG-stim were effective in increasing the Fugl-Meyer motor scale for upper extremity ( MT group : P<0.01 ) , increasing wrist extension range , grip force , and h and dexterity determined by the Box and Block Test ( MT group and ES group P<0.05 ) . Furthermore , h and skills were increased significantly in the MT group compared with the ES group at the follow-up assessment ( P<0.05 ) . This pilot study suggested that MT was more efficient in improving motor performance than physiotherapy alone . Also , MT may be more useful in improving the h and skills compared with  EMG-stim . We assume that this difference might be related to the feasibility of maintenance of MT at home Background and Purpose — Surface neuromuscular electrical stimulation ( sNMES ) after stroke aims to improve upper limb function and reduce shoulder pain , but current evidence of effectiveness is inconclusive . We have undertaken a r and omized controlled trial to evaluate sNMES to the shoulder after acute stroke . Methods — One hundred seventy-six patients , within 10 days of stroke onset , were r and omized to receive sNMES or placebo  in addition to stroke unit care . The primary outcome measure was upper limb function measured by the Action Research Arm Test ( ARAT ) 3 months after stroke . Secondary outcome measures included other measures of upper limb function , upper limb impairment , pain , disability , and global health status . Outcome assessment s were blinded . Results — There was no difference in arm function between groups in terms of the primary outcome measure . The median ARAT at 3 months was 50 in the intervention group and 55.5 in the control group ( P=0.068 ) . Significant differences were seen at 3 months in favor of the control group for other measures of arm function and impairment : grasp and gross movement subsections of the ARAT , Frenchay Arm Test , and the arm subsection of the Motricity Index . Secondary analysis suggested that these differences were most marked in subjects with severe initial upper limb weakness . Conclusions — A 4-week program of sNMES to the shoulder after acute stroke does not improve functional outcome and may worsen arm function in severely impaired stroke patients . “ Routine ” use of sNMES to the proximal affected upper limb after acute stroke can not be recommended Background and Purpose — Severe upper limb paresis is a major contributor to disability after stroke . This study investigated the efficacy of a new nonrobotic training device , the Sensorimotor Active Rehabilitation Training ( SMART ) Arm , that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension , permitting stroke survivors with severe paresis to practice a constrained reaching task . Methods — A single-blind , r and omized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis . Thirty-three participants completed the study , of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation , 13 received training using the SMART Arm alone , and 10 received no intervention ( control ) . Training consisted of 12 1-hour sessions over 4 weeks . The primary outcome measure was “ upper arm function , ” item 6 of the Motor Assessment Scale . Secondary outcome measures included impairment measures ; triceps muscle strength , reaching force , modified Ashworth scale ; and activity measures : reaching distance and Motor Assessment Scale . Assessment s were administered before ( 0 weeks ) and after training ( 4 weeks ) and at 2 months follow-up ( 12 weeks ) . Results — Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up . There was no significant difference between these 2 groups . There was no change in the control group . Conclusions — Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis , highlighting the benefits of intensive task-oriented practice , even in the context of severe paresis Background and Purpose — A sensory-based intervention called peripheral nerve stimulation can enhance outcomes of motor training for stroke survivors with mild-to-moderate hemiparesis . Further research is needed to establish whether this paired intervention can have benefit in cases of severe impairment ( almost no active movement ) . Methods — Subjects with chronic , severe poststroke hemiparesis ( n=36 ) were r and omized to receive 10 daily sessions of either active or sham stimulation ( 2 hours ) immediately preceding intensive task-oriented training ( 4 hours ) . Upper extremity movement function was assessed using Fugl – Meyer Assessment ( primary outcome measure ) , Wolf Motor Function Test , and Action Research Arm Test at baseline , immediately post intervention and at 1-month follow-up . Results — Statistically significant difference between groups favored the active stimulation group on Fugl – Meyer at postintervention ( 95 % confidence interval [ CI ] , 1.1–6.9 ; P=0.008 ) and 1-month follow-up ( 95 % CI , 0.6–8.3 ; P=0.025 ) , Wolf Motor Function Test at postintervention ( 95 % CI , −0.21 to −0.02 ; P=0.020 ) , and Action Research Arm Test at postintervention ( 95 % CI , 0.8–7.3 ; P=0.015 ) and 1-month follow-up ( 95 % CI , 0.6–8.4 ; P=0.025 ) . Only the active stimulation condition was associated with ( 1 ) statistically significant within-group benefit on all outcomes at 1-month follow-up and ( 2 ) improvement exceeding minimal detectable change , as well as minimal clinical ly significant difference , on ≥1 outcomes at ≥1 time points after intervention . Conclusions — After stroke , active peripheral nerve stimulation paired with intensive task – oriented training can effect significant improvement in severely impaired upper extremity movement function . Further confirmatory studies that consider a larger group , as well as longer follow-up , are needed . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT02633215 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 h and . Methods This was a r and omized , double-blind , sham-controlled study . Thirty-nine individuals with chronic stroke were r and omly 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 h and function domain of the SIS . For other outcome measures , both groups improved significantly after the interventions , but no group differences were found . Conclusion RT + ES induced significant benefits in reducing wrist flexor spasticity and in h and movement quality in patients with chronic stroke . Trial registration Clinical Trials.gov . To compare the efficacy of electromyography (EMG)-triggered ( active ) neuromuscular electrical stimulation ( NMES ) and passive NMES in enhancing the upper extremity ( UE ) motor and functional recovery of subacute and chronic stage stroke patients . Thirty-one hemiplegic patients were r and omly assigned to active NMES ( n=11 ) , passive NMES ( n=10 ) , and control ( sham stimulation ) ( n=10 ) groups . Each treatment regimen was applied five times per week for 45 min for 3 weeks . All of the patients performed the same neurophysiologic exercise program for 45 min five times per week for 3 weeks . Patients were assessed by the UE component of the Fugl-Meyer Motor Assessment ( UE-FMA ) , the self-care component of the Functional Independence Measure ( self-care FIM ) , the 
    Output:
    
Comparisons between three types of electrical stimulation ( sensory , cyclic , and electromyography-triggered electrical stimulation ) groups revealed no significant differences in the body function and activity .
Conclusion : Electrical stimulation therapy can effectively improve the arm function in stroke patients