The aim of this study to evaluate the effects of synergy-based motor therapy combined with neuromuscular electric stimulation on upper limb function on post stroke patients

Stroke is a serious medical condition that affects blood flow of brain due to ischemic stroke or hemorrhagic stroke. It because the long-term disabilities most commonly in older adults. The challenges face after stroke is weakness, loss of functions in upper limb.(1) Patients also feel difficulty in daily life activities like eating, dressing, writing, holding objects. In previous years, many therapeutic approaches have been developed to improve upper limb functions after stroke. There is most promising techniques like synergy-based motor therapy and NMES and these techniques helps patients in different ways. (2) Synergy-based motor therapy (SBMT) is a therapeutic approach designed to address unusual synergy patterns usually seen after stroke. Its purpose is to restore voluntary control and promote separate joint movements by returning motor routes.(3) Neuromuscular Electrical Stimulation (NMES) is a minor that distributes low-existing electrical impulses to stimulate muscle contractions in weak or paralyzed muscles, leading to muscle strength, motor learning and functional recovery.(4) More effective intervention can be offered by mixing SBMT with NMES together by addressing nerve control and muscle activity.

Synergy-based motor therapy is to focuses on retraining the brain to allow natural movements of the arm and hand. This therapy is based on how the brain learns and adapts (neuroplasticity)(5) It helps patients practice specific tasks and movements that target the upper limb joints, like shoulder abduction, elbow extension, and wrist control. Over time, this type of therapy can improve coordination, range of motion, and function of the affected arm.(6) The upper limb plays a vital role in daily living. Even simple actions like buttoning a shirt or brushing teeth require coordination between the hand, wrist, elbow, and shoulder. When stroke disrupts this system, the person becomes dependent on others. Synergy-based motor therapy directly targets the impaired patterns in the upper limb and helps the patient regain voluntary control. It also reduces muscle tightness (spasticity) and increases active participation of the limb in functional tasks.(7) Another important approach in stroke rehabilitation is neuromuscular electrical stimulation (NMES). In NMES, small electrical impulses are sent through the skin to activate the muscles that the brain can no longer control well. This causes the muscles to contract and helps in maintaining muscle strength, preventing muscle wasting, and encouraging active movement.(8) NMES can be especially helpful for patients who are unable to move their arm due to severe weakness in the early phase of recovery.NMES is not just about stimulating muscles; it also sends feedback to the brain, which can help rebuild the brain-muscle connection. It supports the patient's ability to relearn lost skills. Moreover, NMES can reduce pain, improve blood flow, and increase patient motivation by allowing them to see progress even when they cannot move the limb on their own. This makes it a very useful tool in stroke rehabilitation, especially when used in combination with task-specific exercises.(9) Both therapies have shown positive results individually, combining both therapies may offer even better outcome. Synergy based motor therapy works on retraining the brain and correcting the movement patterns while NMES can assist by strengthening the muscles. Most studies have looked these therapies separately and not focused on older adults which have slower recovery than young adults.(10) This research is important because it addresses a gap in the existing literature by focusing on a specific age group and combining the two effective techniques. The findings help physical therapists and rehabilitation professionals develop more effective, evidence-based treatment plan for post stroke patients to improve the quality of life and independence in daily life.(11) Incorporating synergy-based motor therapy and neuromuscular electrical stimulation (NMES) into routine stroke rehabilitation programs may promote long-term benefits such as enhanced motor recovery, improved functional performance, and greater independence in daily activities among post-stroke patients. These interventions work by activating normal muscle synergies, improving neuromuscular recruitment patterns, and facilitating motor relearning through targeted feedback mechanisms. NMES provides sensory and motor stimulation that helps improve voluntary muscle activation, while synergy-based therapy focuses on restoring coordinated limb movements disrupted by cortical damage. Although both techniques have individually demonstrated positive outcomes in upper limb rehabilitation, comparative studies remain limited. Understanding the combined effect of these therapies in older adults with post-stroke hemiparesis is crucial for evidence-based decision making. The findings may assist clinicians in refining post-stroke rehabilitation approaches and designing more tailored intervention protocols for upper limb recovery.

Inclusion Criteria:

• 1) Age :50 to 65 2) Both male and female 3) Ischemic Stroke onset among 3 to 6 months (sub-acute section) 4) Hemiplegia affected upper limb 5) The score of Modified ash worth scale rating <2 for upper limb 6) The score of Mini mental state score >25

Exclusion Criteria:

• 1) Recurrent stroke or bilateral involvement 2) Cognitive or conversation impairment 3) Presence of pacemaker or contraindications to NMES 4) Uncontrolled comorbid situation (e.g extreme cardiac diseases )

Randomized for RCT