Upper Limb Cross-education in Subacute Stroke

How Does Cross-education Affect Muscles of Paretic Upper Extremity in Subacute Stroke Survivors?

This study evaluates how cross-education (unilateral training) affects muscle strength of the paretic limb in acute stroke patients. Half of the hemiplegic patients will receive conventional treatment and transcutaneous electrical nerve stimulation (TENS) to non-paretic side, while other half will receive conventional treatment and electro muscular stimulation (EMS) to non-paretic side.

Cross-education, which means the performance improvement in the untrained homologous muscle after unilateral exercise training, is studied in various orthopedical and neurological conditions affecting the body unilaterally. For those with asymmetrical weakness and immobility after stroke, training the non-paretic side can be utilized to increase the strength of the paretic side and improve functional symmetry. In this study, investigators aim was to examine whether training non-paretic upper extremity wrist flexor muscles by EMS in adjunct to conventional training program, has additional benefits upon the muscle powers of the homologous agonist and antagonist muscles. Investigators will use low frequency antalgic TENS stimulation at barely sensible level, which is considered not to cause muscle strengthening, as a control intervention.

Inclusion Criteria:

• thromboembolic stroke,
• <6 months of stroke,
• right hand dominancy,
• left hemiplegia,
• Brunnstrom stage ≥ 3 of recovery for upper extremity and hand

Exclusion Criteria:

• myopathy, tendinopathy, peripheral neuropathy of the upper extremities,
• auditory, cognitive or speech disorder that enables communication,
• history of fracture or arthrodesis in the upper limb,
• contracture or severe spasticity (Ashworth scale ≥ 2) in forearm muscles,
• severe cardiovascular disorders (heart failure, coronary artery disease, drug resistant hypertension)