Effectiveness of a Novel Contralaterally Controlled Neuromuscular Electrical Stimulation for Restoring Lower Limb Motor Performance and Activities of Daily Living in Stroke Survivors: A Randomized Controlled Trial.

Background: Contralaterally controlled neuromuscular electrical stimulation (CCNMES) is a novel electrical stimulation treatment for stroke; however, reports on the efficacy of CCNMES on lower extremity function after stroke are scarce. Objective: To compare the effects of CCNMES versus NMES on lower extremity function and activities of daily living (ADL) in subacute stroke patients. Methods: Forty-four patients with a history of subacute stroke were randomly assigned to a CCNMES group and a NMES group (n = 22 per group). Twenty-one patients in each group completed the study per protocol, with one subject lost in follow-up in each group. The CCNMES group received CCNMES to the tibialis anterior (TA) and the peroneus longus and brevis muscles to induce ankle dorsiflexion motion, whereas the NMES group received NMES. The stimulus current was a biphasic waveform with a pulse duration of 200 µs and a frequency of 60 Hz. Patients in both groups underwent five 15 min sessions of electrical stimulation per week for three weeks. Indicators of motor function and ADL were measured pre- and posttreatment, including the Fugl-Meyer assessment of the lower extremity (FMA-LE) and modified Barthel index (MBI). Surface electromyography (sEMG) assessments included average electromyography (aEMG), integrated electromyography (iEMG), and root mean square (RMS) of the paretic TA muscle. Results: Values for the FMA-LE, MBI, aEMG, iEMG, and RMS of the affected TA muscle were significantly increased in both groups after treatment (p < 0.01). Patients in the CCNMES group showed significant improvements in all the measurements compared with the NMES group after treatment. Within-group differences in all post- and pretreatment indicators were significantly greater in the CCNMES group than in the NMES group (p < 0.05). Conclusion: CCNMES improved motor function and ADL ability to a greater extent than the conventional NMES in subacute stroke patients.

Noninvasive Brain Stimulation Does Not Improve Neuropathic Pain in Individuals With Spinal Cord Injury: Evidence From a Meta-Analysis of 11 Randomized Controlled Trials.

OBJECTIVE: The aim of the study was to examine the effectiveness of noninvasive brain stimulation on neuropathic pain in individuals with spinal cord injury. METHODS: A meta-analysis on pain intensity, depression, and anxiety levels was conducted to evaluate the effect of noninvasive brain stimulation on neuropathic pain in individuals with spinal cord injury. The authors searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), Embase (OvidSP), PsycINFO (OvidSP), and Physiotherapy Evidence Database (PEDro). Randomized controlled trials comparing noninvasive brain stimulation with sham stimulation were included. RESULTS: Eleven studies were selected. The pooled analysis demonstrated no significant effect of repetitive transcranial magnetic stimulation, transcranial direct current stimulation, or cranial electrotherapy stimulation on neuropathic pain reduction after spinal cord injury. In addition, noninvasive brain stimulation showed no beneficial effect over sham stimulation on the improvement of depression, while it yielded a significant reduction of anxiety levels immediately after treatment. Subgroup analysis showed that only cranial electrotherapy stimulation had a significant effect on the reduction of anxiety levels among the three types of noninvasive brain stimulation. CONCLUSIONS: In individuals with spinal cord injury, no significant effects of noninvasive brain stimulation on neuropathic pain and depression were observed. Cranial electrotherapy stimulation may be beneficial for the management of anxiety. These findings do not support the routine use of noninvasive brain stimulation for neuropathic pain in individuals with spinal cord injury.

Electrical Stimulation in the Treatment of Hemiplegic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: The aim of the study was to determine the effect of electrical stimulation in the treatment of hemiplegic shoulder pain. DESIGN: Eight databases were systematically searched for randomized controlled trials with a treatment duration of at least 2 wks comparing electrical stimulation with sham stimulation or no stimulation for patients with hemiplegic shoulder pain. Shoulder pain on the hemiplegic side after stroke at baseline was required at study selection. The overall effects of electrical stimulation were calculated using a meta-analytic method. RESULTS: Six studies were included. The pooled data indicated that electrical stimulation may have a positive effect for patients with hemiplegic shoulder pain on pain reduction (n = 193, standardized mean difference = -1.89, 95% confidence interval = -3.05 to -0.74) and pain-free external rotation (n = 164, weighted mean difference = 18.92, 95% confidence interval = 7.00 to 30.84). Meta-analysis also showed better recovery of activities of daily living independence in patient groups receiving electrical stimulation (n = 167, weighted mean difference = 8.96, 95% confidence interval = 5.26 to 12.66). CONCLUSIONS: Electrical stimulation may be an effective pain management methodology for hemiplegic shoulders and may contribute to pain-free range of external rotation as well as activities of daily living recovery. However, these results should be interpreted with caution, given the low number of selected studies and risk of potential bias.