***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 Background and Purpose — The effectiveness of functional electrical stimulation ( FES ) has been investigated in chronic hemiplegia . The present study examines whether FES , given during acute stroke , was more effective in promoting motor recovery of the lower extremity and walking ability than st and ard rehabilitation alone . Methods — Forty-six subjects , 70.9±8.0 years old and 9.2±4.1 days after stroke , were assigned r and omly to 1 of 3 groups receiving st and ard rehabilitation with FES or placebo stimulation or alone ( control ) . FES was applied 30 minutes and placebo stimulation 60 minutes , 5 days per week for 3 weeks . Outcome measurements included composite spasticity score , maximum isometric voluntary contraction of ankle dorsi-flexors and planter-flexors , and walking ability . They were recorded before treatment , weekly during the 3-week treatment , and at week 8 after stroke . Results — No significant differences were found in the baseline measurements . After 3 weeks of treatment , there was a significant reduction in the percentage of composite spasticity score , and a significant improvement in the ankle dorsiflexion torque , accompanied by an increase in agonist electromyogram and a reduction in electromyogram cocontraction ratio in the FES group , when compared with the other 2 groups ( P<0.05 ) . All subjects in the FES group were able to walk after treatment , and 84.6 % of them returned home , in comparison with the placebo ( 53.3 % ) and control ( 46.2 % , P<0.05 ) groups . Conclusions — Fifteen sessions of FES , applied to subjects with acute stroke plus st and ard rehabilitation , improved their motor and walking ability to the degree that more subjects were able to return to home Positional feedback ( PF ) and electrical stimulation were combined in a new treatment modality for facilitating wrist extension in stroke patients . Thirty adult hemiparetic patients lacking normal voluntary wrist extension were r and omly placed in control and study groups . The control group received conventional therapy while the study group received positional feedback stimulation training ( PFST ) in addition to conventional treatment . At the end of the 4-week program , study patients showed a 280 % increase in isometric extension torque when the wrist was positioned in 30 degrees of extension and 70 % increase when positioned in 30 degrees of flexion . Control patients showed no significant changes in torque . Study patients made an average 200 % gain in selective range of motion over their starting levels while controls made only a 50 % increase . Treatment using automated PFST equipment allows controlled repetitive isotonic exercise and facilitation of wrist extension without continuous one-on-one therapist/patient supervision Objective : To investigate the therapeutic effect of electrical stimulation on plantarflexor spasticity in stroke patients . Design : A r and omized controlled clinical trial study . Setting : Rehabilitation clinic of Semnan University of Medical Sciences . Subjects : Forty stroke patients ( aged from 42 to 65 years ) with ankle plantarflexor spasticity . Intervention : Fifteen minutes of inhibitory Bobath techniques were applied to one experimental group and a combination of 9 minutes of electrical stimulation on the dorsiflexor muscles and inhibitory Bobath techniques was applied to another group for 20 sessions daily . Main measures : Passive ankle joint dorsiflexion range of motion , dorsiflexion strength test , plantarflexor muscle tone by Modified Ashworth Scale and soleus muscle H-reflex . Results : The mean change of passive ankle joint dorsiflexion in the combination therapy group was 11.4 ( SD 4.79 ) degrees versus 6.1 ( SD 3.09 ) degrees , which was significantly higher ( P = 0.001 ) . The mean change of plantarflexor muscle tonicity measured by the Modified Ashworth Scale in the combination therapy group was -1.6 ( SD 0.5 ) versus -1.1 ( SD 0.31 ) in the Bobath group ( P = 0.001 ) . Dorsiflexor muscle strength was also increased significantly ( P = 0.04 ) in the combination therapy group ( 0.7 ± 0.37 ) compared with the Bobath group ( 0.4 ± 0.23 ) . However , no significant change in the amplitude of H-reflex was found between combination therapy ( -0.41 ± 0.29 ) and Bobath ( -0.3 ± 0.28 ) groups . Conclusion : Therapy combining Bobath inhibitory technique and electrical stimulation may help to reduce spasticity effectively in stroke patients Positional feedback stimulation training and cyclical electrical stimulation were used in combination as a treatment for facilitating knee extension in hemiparetic patients . Forty adult hemiparetic patients who demonstrated minimal active control of their quadriceps femoris muscles were r and omly assigned to control or study groups . The control patients received a program of physical therapy , and the study patients received the positional feedback stimulation training in addition to their therapy program . The stimulation training provided the patient with immediate auditory and visual feedback of his changing joint angle while he voluntarily extended his knee . When the patient reached a near maximal extension effort , electrical stimulation of the quadriceps femoris muscle was automatically triggered , completing the patient 's available range of motion in extension . The stimulation training was supplemented with two hours of cyclical electrical stimulation daily . At the end of four weeks , analysis revealed a statistically significant increase in knee extension torque and active synergistic range of motion in the study group . No change was noted in their ability to extend their knees using isolated quadriceps femoris muscle control . This study suggests that positional feedback stimulation training is effective when used to augment a facilitation program for improving knee extension control in hemiparetic patients Purpose . This study examined the association between impaired physical function and participation in  community ambulation  following stroke . We hypothesised that participation would be significantly less following stroke , and that physical impairments would be associated with participation . Method . Using a case – control design 30 survivors of stroke aged 45 and older and 30 controls provided health status information and a self-report of participation in community ambulation  ( number of trips and walking-related activities ( WRA ) reported prospect ively over a 12-day period ) . The association of physical impairments ( strength , range of motion , sensation , muscle tone , vision , and activity limitations ( gait speed and performance on complex walking tasks ) ) with level of participation was analysed using negative binomial regression and goodness of fit . Results . Participants included 30 individuals with and 30 without stroke , average age 68 years , majority were Caucasian women . Average time  since stroke was 40 months . Participation in survivors of stroke was characterised by fewer trips and WRA and lower satisfaction ( p < 0.001 ) . Usual gait speed , balance , muscle strength and muscle length were impaired ( p < 0.001 ) in stroke vs. controls , and associated with number of trips and WRA ( p < 0.05 ) . However , these factors explained less than very little of the variance in participation . Conclusions . While individual factors were associated with level of participation , results failed to accurately predict participation in community ambulation following stroke . Other factors , such as depression , cognition and self-efficacy may be stronger determinants of participation We investigated the effect of electromyography (EMG)-triggered neuromuscular electrical stimulation ( NMES ; EMG-stim ) on functional recovery of the hemiparetic h and and the related cortical activation pattern in chronic stroke patients . We enrolled 14 stroke patients , who were r and omly assigned to the EMG-stim ( n=7 ) or the control groups ( n=7 ) . The EMG-stim was applied to the wrist extensor of the EMG-stim group for two sessions ( 30 min/session ) a day , five times per week for 10 weeks . Four functional tests ( box and block , strength , the accuracy index , and the on/offset time of muscle contraction ) and functional MRI ( fMRI ) were performed before and after treatment . fMRI was measured at 1.5 T in parallel with timed finger flexion-extension movements at a fixed rate . Following treatment , the EMG-stim group showed a significant improvement in all functional tests . The main cortical activation change with such functional improvement was shifted from the ipsilateral sensorimotor cortex ( SMC ) to the contralateral SMC . We demonstrated that 10-week EMG-stim can induce functional recovery and change of cortical activation pattern in the hemiparetic h and of chronic stroke patients OBJECTIVE To investigate whether treatment with surface neuromuscular electrical stimulation to the wrist extensors improves recovery of arm function in severely disabled patients with stroke . DESIGN Single blinded r and omized controlled trial . SETTING Acute stroke unit and stroke rehabilitation wards of a university hospital . PARTICIPANTS Patients with no upper limb function ( Action Research Arm Test [ ARAT ] score 0 ) ( N=90 ; mean age ± SD , 74±11y ; 49 % men ) were recruited to the study within 6 weeks of stroke . Only 67 participants were alive at the end of the study and data from 66 of these people were analyzed . INTERVENTIONS Participants were r and omized to surface neuromuscular electrical stimulation using surface electrical stimulators for 30 minutes , twice in a working day for 6 weeks in addition to st and ardized upper limb therapy or just st and ardized upper limb therapy . MAIN OUTCOME MEASURE The primary outcome measure was the ARAT score . Assessment s were made at baseline and at 6 , 12 , 24 , and 36 weeks after recruitment . RESULTS There were statistically significant improvements in measures of wrist extensor ( mean difference 0.5 ; 95 % confidence interval [ CI ] , 0.0 - 1.0 ) and grip strength ( mean difference 0.9 ; 95 % CI , 0.1 - 1.7 ) over the treatment period . Arm function ( ARAT score ) was not significantly different between the groups over the treatment period at 6 weeks ( mean difference 1.9 ; 95 % CI , -2. 
    Output:
    
Cyclical electrical stimulation  increases strength and improves activity after stroke .
These benefits were maintained beyond the intervention period with a small-to-moderate effect size .
The sustained effect on activity suggests that the benefits were incorporated into daily life .