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.