Upper Limb Cross-education in Subacute Stroke
Upper Limb Cross-education in Subacute Stroke
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)