***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 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 — Paresis of the upper extremity after stroke is not effectively solved by existing therapies . We investigated whether mental imagery training combined with electromyogram-triggered electric stimulation improved motor function of the paretic upper extremity in patients with chronic stroke and induced cortical changes . Methods — Fourteen subjects with chronic stroke ( ≥12 months ) were r and omly allocated to receive mental imagery training combined with electromyogram-triggered electric stimulation ( n=7 ) or generalized functional electric stimulation ( n=7 ) on the forearm extensor muscles of the paretic extremity in 2 20-minute daily sessions 5 days a week for 4 weeks . The upper extremity component of the Fugl-Meyer Motor Assessment , the Motor Activity Log , the modified Barthel Index , and 18F-fluorodeoxyglucose brain positron emission tomography were measured before and after the intervention . Results — The group receiving mental imagery training combined with electromyogram-triggered electric stimulation exhibited significant improvements in the upper extremity component of the Fugl-Meyer Motor Assessment after intervention ( median , 7 ; interquartile range , 5–8 ; P<0.05 ) , but the group receiving functional electric stimulation did not ( median , 0 ; interquartile range , 0–3 ) . Differences in score changes between the 2 groups were significant . The mental imagery training combined with electromyogram-triggered electric stimulation group showed significantly increased metabolism in the contralesional supplementary motor , pre central , and post central gyri ( Puncorrected<0.001 ) after the intervention , but the functional electric stimulation group showed no significant differences . Conclusions — Mental imagery training combined with electromyogram-triggered electric stimulation improved motor function of the paretic extremity in patients with chronic stroke . The intervention increased metabolism in the contralesional motor – sensory cortex . Clinical Trial Registration — URL : https://e-irb.khmccri.or.kr/eirb/receipt/index.html?code=02&status=5 . Unique identifier : KHUHMDIRB 1008 - 02 Background Effective poststroke motor rehabilitation depends on repeated limb practice with voluntary efforts . An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robot arm was design ed for the multi-joint physical training on the elbow , the wrist , and the fingers . Objectives To investigate the training effects of the device-assisted approach on subacute stroke patients and to compare the effects with those achieved by the traditional physical treatments . Method This study was a pilot r and omized controlled trial with a 3-month follow-up . Subacute stroke participants were r and omly assigned into two groups , and then received 20-session upper limb training with the EMG-driven NMES-robotic arm ( NMES-robot group , n = 14 ) or the time-matched traditional therapy ( the control , n = 10 ) . For the evaluation of the training effects , clinical assessment s including Fugl-Meyer Assessment ( FMA ) , Modified Ashworth Score ( MAS ) , Action Research Arm Test ( ARAT ) , and Function Independence Measurement ( FIM ) were conducted before , after the rehabilitation training , and 3 months later . Session-by-session EMG parameters in the NMES-robot group , including normalized co-contraction Indexes ( CI ) and EMG activation level of target muscles , were used to monitor the progress in muscular coordination patterns . Results Significant improvements were obtained in FMA ( full score and shoulder/elbow ) , ARAT , and FIM [ P < 0.001 , effect sizes ( EFs ) > 0.279 ] for both groups . Significant improvement in FMA wrist/h and was only observed in the NMES-robot group ( P < 0.001 , EFs = 0.435 ) after the treatments . Significant reduction in MAS wrist was observed in the NMES-robot group after the training ( P < 0.05 , EFs = 0.145 ) and the effects were maintained for 3 months . MAS scores in the control group were elevated following training ( P < 0.05 , EFs > 0.24 ) , and remained at an elevated level when assessed 3 months later . The EMG parameters indicated a release of muscle co-contraction in the muscle pairs of biceps brachii and flexor carpi radialis and biceps brachii and triceps brachii , as well as a reduction of muscle activation level in the wrist flexor in the NMES-robot group . Conclusion The NMES-robot-assisted training was effective for early stroke upper limb rehabilitation and promoted independence in the daily living comparable to the traditional physical therapy . It could achieve higher motor outcomes at the distal joints and more effective release in muscle tones than the traditional therapy . Clinical Trial Registration Clinical Trials.gov , identifier NCT02117089 ; date of registration : April 10 , 2014 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 Motor Activity Log ( MAL ) , goniometric measurements of active wrist and metacarpophalangeal joint extension , surface EMG potentials , grip strength , and the modified Ashworth scale in a blinded manner . Data were obtained before and at the end of the treatment . Participants were similar in all clinical and demographic features ( P>0.05 ) . All groups were comparable with respect to UE-FMA , MAL , self-care FIM , wrist and finger flexor spasticity , active range of motion ( ROM ) , grip strength , and surface EMG potentials before treatment ( P>0.05 ) . The active ROM , grip strength , FMA , FIM , surface EMG potentials , and MAL : amount of use were significantly improved in the EMG-triggered NMES group compared with the controls ( P<0.05 ) . The active wrist extension ROM and FMA scores were significantly improved in the passive NMES group compared with the controls ( P<0.05 ) . There were no statistically significant differences between active and passive NMES groups in any of the parameters evaluated at the end of the treatment ( P>0.05 ) . Both active and passive NMES as adjuvant therapy in the neurophysiologic exercise program effectively enhanced the UE motor and functional recovery of stroke survivors . Vergleich der Wirksamkeit der elektromyographisch (EMG)-getriggerten ( aktiven ) neuromuskulären Elektrostimulation ( NMES ) und passiven NMES zur Verbesserung der motorischen und funktionellen Erholung der oberen Extremitäten bei Schlaganfallpatienten in der subakuten und chronischen Phase . Insgesamt 31 einseitig gelähmte Patienten wurden r and omisiert den aktiven NMES- ( n=11 ) , passiven NMES- ( n=10 ) und Kontrollgruppen ( Sham-Stimulation ) ( n=10 ) zugeordnet . Jede Therapie wurde fünfmal pro Woche jeweils 45 Minuten lang über drei Wochen hinweg angew and t. Alle Patienten unterzogen sich fünfmal pro Woche jeweils 45 Minuten lang über drei Wochen hinweg dem gleichen neurophysiologischen Übungsprogramm . Die Beurteilung der Patienten erfolgte anh and der Komponente “ obere Extremitäten ” des motorischen Funktionstests nach Fugl-Meyer ( UE-FMA ) , der Selbstversorgungskomponente des funktionalen Selbständigkeitsindexes ( Selbstversorgung FIM ) , des Motor Activity Log ( MAL ) , der goniometrischen  Messung der aktiven H and gelenk- und Fingergrundgelenkextension , der Oberflächen-EMG-Potenziale , der Griffstärke und der modifizierten Ashworth-Skala in verblindeter Form . Date n wurden vor und nach Abschluss der Beh and lung erfasst . Die Teilnehmer schnitten bei allen klinischen und demographischen Merkmalen ähnlich ab ( P<0.05 ) . Alle Gruppen waren vergleichbar hinsichtlich UE-FMA , MAL , Selbstversorgungs-FIM , Spastizität der H and gelenks- und Fingerbeuger , aktiver Bewegungsamplitude ( ROM ) , Griffstärke und Oberflächen-EMG-Potenziale vor der Beh and lung ( P>0.05 ) . Aktive ROM , Griffstärke , FMA , FIM , Oberflächen-EMG-Potenziale und MAL : Das Ausmaß der Anwendung war in der EMG-getriggerten NMES-Gruppe verglichen mit den Teilnehmern der Kontrollgruppe signifikant verbessert ( P<0.05 ) . Die ROM- und FMA-Scores der aktiven H and gelenkextension waren in der passiven NMES-Gruppe verglichen mit der Kontrollgruppe signifikant verbessert ( P<0.05 ) . Es lagen keine statistisch signifikanten Unterschiede zwischen den aktiven und passiven NMES-Gruppen bei den zu Ende der Beh and lung beurteilten Parametern vor ( P>0.05 ) . Die aktive und passive NMES als Begleittherapie des neurophysiologischen Übungsprogramms verbesserte die motorische und funktionelle Genesung der oberen Extremitäten von Überlebenden eines Schlaganfalls effektiv . El objetivo de este estudio fue comparar la eficacia de la estimulación el 
    Output:
    
The meta- analysis showed that EMG-NMES has a robust short-term effect on improving UL motor impairment in the Body Structure and Function domain .
No evidence was found in favor of EMG-NMES for the Activity and Participation domain .
EMG-NMES had a stronger effect for each ICF domain in chronic ( ≥3 months ) compared to acute/subacute phases .
Conclusion .
EMG-NMES is effective in the short term in improving UL impairment in individuals with chronic stroke