Neuromuscular Electrical Stimulation (NMES) in Stroke-diagnosed Individuals
Neuromuscular Electrical Stimulation (NMES) in Stroke-diagnosed Individuals
Specific clinical tools and treatment variables have a key role on the results to be
 obtained. Therefore, there is a need for well-planned studies on the effect of Neuromuscular
 Electrical Stimulation (NMES) on stroke patients. Although NMES is frequently used in
 patients with stroke, scientific evidence regarding back extensor muscle stimulation,
 functional capacity, balance and mobility efficiency in this patient group is not sufficient.
 This study was planned to compare controlled individuals with neurological rehabilitation.
 According to the definition of World Health Organization (WHO) stroke; It is a rapidly
 developing clinical condition due to local or general impairment of brain functions, without
 apparent cause other than vascular causes. In the world, the loss of disability and labor
 force is known as the first and the second cause of deaths.

 Post-stroke intensive care and rehabilitation processes vary between countries. For example,
 in Australia, $ 2.14 billion is spent each year for the treatment of stroke-diagnosed
 individuals, while US $ 65 million is spent annually. For these reasons, it is very important
 to choose low-cost, effective and evidence-based physiotherapy approaches for people with
 stroke. Hemiparesis, which is characterized by a loss of power on one side of the body, is
 the most common neurological loss after stroke. Patients with hemiparetic stroke often have
 impaired balance, mobility and functional capacity. This results in a high economic burden
 and social problem in this person. Among the functional problems after stroke; impaired
 balance, abnormal walking pattern with abnormal asymmetry, abnormal body and spinal movement
 can be shown. The most important problem is the loss of mobility; bed activities include
 sitting and standing. The most important goal of stroke rehabilitation is the recovery of
 mobility and balance. Changes in walking pattern and balance abilities occur due to motor
 control loss, spasticity, muscle weakness, joint motion deficit, abnormal movement patterns
 and sensory dysfunction. In addition to neurophysiological treatment techniques such as
 Bobath, conventional exercise programs, Brunnstrom and proprioceptive neuromuscular
 parasilication, with the aim of improving the quality of movement and maintaining the balance
 in rehabilitation of stroke-diagnosed patients, electrical stimulation is also used.Although
 the importance of back extensor muscle strength is documented in the literature, it is
 observed that studies focusing on back extensor muscle strength in limb rehabilitation are
 limited.

 Control disorders in the posterior extensor muscles after stroke are found to be
 significantly associated with balance, gait and upper extremity dysfunctions.

 Based on this idea, our study was planned to examine the effect of NMEs application on
 functional capacity, balance and mobility in stroke individuals.
Our study will be carried out in Fırat University Training and Research Hospital. Individuals
 who are diagnosed with stroke by the Physical Medicine and Rehabilitation Specialist and who
 are directed to the physiotherapy program will be included. 20 hemiparesis patients who
 underwent stimulation and conventional physiotherapy and rehabilitation of the back
 extensors, will constitute 20 volunteer patients who only provided conventional physiotherapy
 and rehabilitation applications. 20 cases were included in the study and 20 cases as control
 group. All cases will be informed and approved before they start working.

 Inclusion Criteria

 1. Having a chart of hemiplegia or hemiparesis due to the first story of cerebrovascular
 accident (SVO)

 2. At least 3 months after SVO

 3. Mini-mental State Examination (MMSE) value ≥ 15

 4. Being in the 30 to 80 age range

 5. Back extensor muscle spasticity value <4 according to modified Ashworth Scale

 Criteria for Inclusion of Patients in the Study

 1. Ataxia, dystonia, dyskinesia

 2. The presence of lower motor neuron or peripheral nerve lesion

 3. Degraded deep senses

 4. Detection disorder and dementia

 5. Skin and peripheral circulatory disorder

 6. History of CVO, bilateral hemiplegia

 As demographic characteristics; age, gender, body weight, height of the patients, the hand
 (dominant hemisphere), occupation and educational status, as a history of the disease; It
 will be noted whether the patient has undergone SVO or transient ischemic attack. Our
 neurological evaluation form; Reflexes, sensory defects, cranial nerve lesion, visual
 disturbances, speech problem and type will be recorded.

 All patients will be evaluated after treatment (TS). Spasticity will be graded from 0 to 5
 according to the Modified Ashworth Scale.

 Postural Assesment of Stroke Scale (PASS), Short Form-36, Adapted Patient Evaluation and
 Conference System, Stroke Rehabilitation Assesment of Movement (STREAM), Brunel Balance
 Assessment (BBA), Functional Ambulation Scale(FAS) and Mini-Mental State Examination (MMSE)
 surveys and scales will be used.

 Stimulation program, symmetrical biphasic waveform, 50 Hz frequency, 400 μs width flow
 characteristics are used and the duration of treatment should be 30 min.

 The current density will be adjusted to give full contraction of the back extensor muscle at
 each warning. It will be adjusted separately in each session without any discomfort or pain.
 In cases where contraction is reduced, the intensity of the current will be increased to
 achieve the same quality contraction. However, the target muscles outside the muscles will
 spread to the muscles strong enough to be created.

 Statistical analysis of the study will be done with Statistical Package for Social Sciences
 (SPSS) Version IBM Statistic 20. Mann Whitney U test will be used for the differences between
 the two groups. Comparisons between the pre-treatment and post-treatment values of the
 patients will be done by Wilcoxon Signed Rank test in dependent groups.

 The obtained values will be expressed as mean ± standard deviation (SD). The differences
 below p <0.05 would be considered significant.
Inclusion Criteria:

 1. Having a chart of hemiplegia or hemiparesis due to the first story of cerebrovascular
 accident (SVO)

 2. At least 3 months after SVO

 3. Mini-mental State Examination (MMSE) value ≥ 15

 4. Being in the 30 to 80 age range

 5. Back extensor muscle spasticity value <4 according to modified Ashworth Scale

 Exclusion Criteria:

 1. Ataxia, dystonia, dyskinesia

 2. The presence of lower motor neuron or peripheral nerve lesion

 3. Degraded deep senses

 4. Detection disorder and dementia

 5. Skin and peripheral circulatory disorder

 6. History of CVO, bilateral hemiplegia