How does cross-education affects muscles of paretic upper extremity in subacute stroke survivors?
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ORIGINAL ARTICLE
How does cross-education affects muscles of paretic upper extremity in subacute stroke survivors? Ozan Volkan Yurdakul 1 Teoman Aydin 1
&
Mehmet Serkan Kilicoglu 1 & Aylin Rezvani 2 & Okan Kucukakkas 1 & Fatma Eren 3 &
Received: 12 January 2020 / Accepted: 30 May 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Introduction This study aimed to evaluate the benefits of adding electromuscular stimulation (EMS) to the flexors of wrist muscles on the nonparetic limb in conventional stroke training to strengthen homologous agonist and antagonist muscles on the paretic side in patients with subacute stroke. Methods The EMS group patients (n = 15) received conventional therapy for 30 sessions for 6 weeks (60 min/session) with 30 min of electrical stimulation to their nonparetic forearm using wrist flexors, with 5 min of pre- and post-warm-up. The transcutaneous electrical nerve stimulation (TENS) group patients (n = 15) received the same conventional rehabilitation training with 30 min of conventional antalgic TENS at a barely sensible level to their nonparetic forearm. The Fugl–Meyer motor function assessment for upper extremity (FMA-UE), functional independence measure (FIM), Brunnstrom staging of recovery for hand, maximum and mean wrist flexion force (flexionmax and flexionmean), and wrist extension force (extensionmax and extensionmean) of paretic untrained limb were evaluated before and after the treatment. Results EMS and TENS group patients improved similarly in terms of FMA-UE, FIM, and Brunnstrom staging for hand recovery. However, flexionmax and flexionmean of the paretic limb increased more in the EMS group than in the TENS group. Extensionmax and extensionmean on the paretic side increased in the EMS group but did not differ in the TENS group. Conclusion Cross-education via EMS may have a beneficial effect as an adjunct to conventional treatment methods. This study is retrospectively registered and is available at www.clinicaltrials.gov (ID: NCT04113369). Keywords Interlimb transfer . Muscle strength . Hemiplegia . Electromuscular stimulation
Introduction Hemiparesis is the leading cause for disability post-stroke, affecting 80–85% of patients with acute stroke [1, 2]. Arm function of stroke patients is often most significantly affected; at 3 months post-stroke, only 20% of the patients have normal * Ozan Volkan Yurdakul [email protected] 1
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Blv. 34093 Fatih, Istanbul, Turkey
2
Department of Physical Medicine and Rehabilitation. Faculty of Medicine, Medipol University, TEM otoyolu. 34214 Bagcilar, Istanbul, Turkey
3
Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, USA
function in their affected arm, and 65% of the patients with chronic stroke have long-term impairment of the upper limb [3, 4]. Resistance training improves muscular strength and functional ability after stroke
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