Stroke motor recovery: active neuromuscular stimulation and repetitive practice schedules

Objective: To investigate progress toward motor recovery in patients with chronic hemiparesis ( mean time since stroke 3.2 years), comparing different types of practice schedules. Design: To increase voluntary control of the upper extremity, active neuromuscular stimulation was administered during blocked and random practice schedules as patients performed three specific movements: wrist/finger extension, elbow joint extension, and shoulder joint abduction. Methods: 34 stroke subjects volunteered to participate and were randomly assigned to one of three treatment groups: blocked practice ( the same movement was repetitively performed on successive trials) combined with active neuromuscular stimulation; random practice ( different movements on successive trials) along with active stimulation; or no active stimulation assistance control group. Subjects completed two days of 90 minute training for each of two weeks with at least 24 hours of rest between sessions. A session was three sets of 30 successful active neuromuscular stimulation trials with the three movements executed 10 times/set. Results: Mixed design analyses on three categories of behavioural measures indicated motor improvements for the blocked and random practice/stimulation groups in comparison with the control group during the post-test period, with a larger number of blocks moved, faster premotor and motor reaction times, and less variability in the sustained muscular contraction task. Conclusions: Upper extremity rehabilitation intervention of active stimulation and blocked practice performed as well as stimulation/random practice. Moreover, these purposeful voluntary movement findings support and extend sensorimotor integration theory to both practice schedules.