Effect of Constraint-Induced Movement Therapy Combined with Neuromuscular Electrical Stimulation on Upper Extremity Function in Chronic Stroke Survivors

The participants will be enrolled in either one of the three groups: Group 1: Constraint-Induced Movement Therapy (CIMT) task practice using a number of repetitions of shaping practice (300 repetitions). The number of participants = 14 stroke patients. Group 2: CIMT task practice using a number of repetitions of shaping practice (300 repetitions) combined with Neuromuscular Electrical Stimulation (NMES). The number of participants = 14 stroke patients. Group 3: Control group that will receive conventional therapy treatment. The number of participants = 14 stroke patients. All treatment protocols will be administered 3 times per week for 4 weeks. Intervention 1: In the CIMT group, the shaping practice of CIMT will perform a number of repetitions of shaping practice in the following tasks: Picking up a cup from the table, taking it to the mouth, and putting it back; writing letters or drawing a circle; picking up an object (a pen or pencil) and transferring from left to right on a table; taking the hand from the lap to the head and sliding it from the front to the back; taking the hand to the nose; and putting and removing shoes. Each of these 6 tasks will be carried out 50 times, which totals 300 repetitions per session. The number of participants = 14 stroke patients. Intervention 2: In the CIMT + NMES group, the shaping practice of CIMT will perform functional tasks similar to the tasks carried out by the CIMT group. Besides that, the NMES will be combined with CIMT tasks. In the NMES, the stimulation will be conducted by the bio-feedback electrical stimulator. Subjects sit with their arms and hands resting at the sides and forearms pronated. The 2 stimulating electrodes shall be placed on the muscle belly of the extensor carpi radialis on the paretic side. The electrical stimulation treatments will be performed for 20 minutes per session. The number of participants = 14 stroke patients. The unaffected upper extremity will be constrained for 90% of the patient’s waking hours. In all cases, the constraint device will be used (a padded mitt or oven mitt) due to its low cost, ready availability, and easy-care requirements. The activities of task practice will be completed by using the affected limb. The researcher and physiotherapists at NASAM will conduct the intervention sessions. The mode of administration will be by groups. A blinded assessor will measure the intervention outcomes for all participants in the feasibility study and the RCT study. The feasibility of interventions will be assessed with regard to patients' acceptance and adherence and the occurrence of adverse effects. 1. Stroke survivor's acceptance will be collected during post-trial assessment with the question “What do you think about this therapy?”. Responses from the survivors will be categorized into positive and negative responses and analyzed descriptively. 2. Adherence rate will be reported in terms of percentages of practice (the number of sessions performed out of the total sessions required). The number of practice sessions performed will be obtained from the participants' logbooks. 3. The occurrence of adverse effects related to exercise such as muscle soreness, cramps, and muscle strain will be monitored (once every week) and during post-trial assessment.