Previous studies have suggested that repetitive movement therapy mediated by transcutaneous neuromuscular electrical stimulation (NMES) facilitates motor relearning in upper limb hemiparesis. Motor relearning is defined as """"""""the recovery of previously learned motor skills that have been lost following localized damage to the CMS."""""""" Two types of NMES have been reported in the literature. Cyclic NMES activates the paretic muscles to provide full range of motion (ROM) at a given joint. The subject is a passive participant and does not provide any cognitive input or attempt to assist the NMES during treatment. EMG triggered NMES is similar to cyclic NMES except that a cognitive element is introduced by triggering the NMES by subject's own volitionally activated EMG signal. Thus, the NMES provides full ROM """"""""time-locked"""""""" to the cognitive intent to do the same. While previous studies have suggested that NMES facilitates motor relearning in upper limb hemiparesis, there are significant gaps in the scientific literature that prevent the clinical implementation of this promising technique. In order to address these gaps, a multi-center, randomized clinical trial among acute stroke survivors is proposed. The paretic wrist and finger extensors will be treated with sensory stimulation (control), cyclic NMES or EMG triggered NMES for 8-wks and followed for 6-mos. Outcome measures will include motor impairment, upper limb specific activity limitation and EMG activation patterns. The following specific aims will be addressed: 1. Assess the effect of NMES on upper limb motor impairment. 2. Assess the effect of NMES on upper limb activity limitation. 3. Assess the effect of NMES on central motor processing. 4. Assess the effect of adding cognitive input during NMES therapy.
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