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NeuroRehabilitation. 2017;40(3):315-323. doi: 10.3233/NRE-161419.

The influence of Task-Related Training combined with Transcutaneous Electrical Nerve Stimulation on paretic upper limb muscle activation in patients with chronic stroke.

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Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea.
Department of Physical Therapy, Gimcheon University, Gimcheon, Republic of Korea.
The Post-Professional DPT Program, Stockton University, New Jersey, USA.
Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Republic of Korea.



This study investigated the efficacy of Task-Related Training (TRT) Combined with Transcutaneous Electrical Nerve Stimulation (TENS) on the improvement of upper limb muscle activation in chronic stroke survivors with mild or moderate paresis.


A single-blind, randomized clinical trial was conducted with 46stroke survivors with chronic paresis. They were randomly allocated two groups: the TRT+TENS group (n = 23) and the TRT+ placebo TENS (TRT+PLBO) group (n = 23). The TRT+TENS group received 30 minutes of high-frequency TENS on wrist and elbow extensors, while the TRT+PLBO group received placebo TENS that was not real ES. Both groups did 30 minutes of TRT after TENS application. Intervention was given five days a week for four weeks. The primary outcomes of upper limb muscle activation were measured by integrated EMG (IEMG), a digital manual muscle tester for muscle strength, active range of motion (AROM) and Fugl-Meyer Assessment of the upper extremity (FMA-UE). The measurements were performed before and after the 4 weeks intervention period.


Both groups demonstrated significant improvements of outcomes in IEMG, AROM, muscle strength and FMA-UE during intervention period. When compared with the TRT+PLBO group, the TRT+TENS group showed significantly greater improvement in muscle activation (wrist extensors, P = 0.045; elbow extensors, P = 0.004), muscle strength (wrist extensors, P = 0.044; elbow extensors, P = 0.012), AROM (wrist extension, P = 0.042; elbow extensors, P = 0.040) and FMA-UE (total, P < 0.001; shoulder/elbow/forearm, P = 0.001; wrist, P = 0.002; coordination, P = 0.008) at the end of intervention.


Our findings indicate that TRT Combined with TENS can improve paretic muscle activity in upper limb paresis, highlighting the benefits of somatosensory stimulation from TENS.


Task–Related Training; Transcutaneous Electrical Nerve Stimulation (TENS); arm motor function

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