Effects of Neuromuscular Electrical Stimulation With Neural Mobilization in Stroke Patients

NCT07629908 | Not Yet Recruiting

• 1 other identifier: REC/0235 Fatima Shahid
• Study Type: interventional
• Target: 44
• Locations: 0 countries
• Sites: N/A

Brief Summary

The goal of this clinical trial is to learn if neuromuscular electrical stimulation combined with upper limb neural mobilization works to improve hand grip and upper limb function in post-stroke patients.

Conditions

Stroke; Post Stroke Hand Rehabilitation

Keywords

Post stroke; NMES; Neural mobilization; Hand grip; Upper limb function

Outcome Measures

Primary Outcomes (3)

• Handheld dynamometer

  The standard Jamar hydraulic handgrip dynamometer with reliability (ICC = 0.95-0.98) was used according to established ASHT (American Society of Hand Therapists) protocols for the measurement of hand grip strength. The patient was seated with shoulder adducted, elbow flexed at 90°, forearm neutral, and wrist 0-30° extension. A total of three trials (kg) with a 1-minute rest between trials was done, and the mean of the 3 values was recorded.

  Baseline and 6th week

• Goniometer

  A clinically accepted instrument with high reliability (ICC: 0.85 - 0.99), in accordance with standardised assessment protocols. Each movement was measured across three trails with a 1-minute rest period between trails, and the average of the three readings (in degrees) was used for statistical analysis.

  baseline and 6th week

• Fugl-Meyer Assessment - Upper Extremity

  The scale assesses motor recovery by observing movement patterns that advance from proximal to distal joints and from mass synergistic actions to more selective, isolated movements following a stroke. It consists of 4 sections: shoulder-arm, wrist, hand, and coordination and speed. It comprises 33 test items, each scored on a three-point ordinal scale (0-2) with a maximum achievable score of 66. In stroke patients the scale has revealed high reliability (ICC: 0.993 - 0.997).

  Baseline and 6th week

Study Arms (2)

Control group

ACTIVE COMPARATOR

Participants in the control group received neural mobilization in combination with conventional physical therapy. Conventional rehabilitation consisted of standardized upper limb exercises, including ROM activities, strengthening exercises, stretching and task oriented training.

Other: Conventional physical therapy

Experimental group

EXPERIMENTAL

Participants in the experimental group received neuromuscular electrical stimulation combined with upper limb neural mobilization. NMES was administrated using a frequency range of 35-50 Hz and a pulse duration of 250-300 µsec, with an on-off ratio of 1:3. The stimulation intensity was gradually increased until a visible muscle contraction was achieved. Neural mobilization was performed using standardized techniques targeting the median, radial and ulnar nerves.

Other: Neuromuscular Electrical Stimulation

Interventions

Conventional physical therapy OTHER

Neural mobilization for median, radial, and ulnar nerves. 3 sets of 10 repetitions per nerve for 15 mins with 30 sec rest. Progressed based on tolerance and Range of Motion. Conventional rehabilitation consisted of standardized upper limb exercises, including ROM activities, strengthening exercises, stretching and tsk oriented training. Each treatment session was conducted for 45 minutes.

Also known as: Neural mobilization, Traditional physical therapy

Control group

Neuromuscular Electrical Stimulation OTHER

Neuromuscular Electrical Stimulation (NMES) applied to wrist extensors and finger flexors. Frequency: 35 Hz. Pulse width: 250 µs. Duty cycle: 10s on / 20s off. Intensity: Visible muscle contraction, within patient tolerance. Duration: 30 min Neuromuscular Electrical Stimulation (NMES) + 15 min rest/cool-down. Neural mobilization for median, radial, and ulnar nerves. 3 sets of 10 repetitions per nerve with 30 sec rest.

Also known as: Neural mobilization

Experimental group

Eligibility Criteria

• Age: 45 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Diagnosed with ischemic stroke (duration ≥ 3 months post-stroke)
• Patients with hemiparesis affecting the upper limb have a 15-30 score by the Fugl-Meyer Assessment.
• Medically stable for physical therapy
• Signed informed consent

You may not qualify if:

• Patients with pacemakers or implanted electrical devices
• Upper limb fractures or contractures
• Skin allergies or wounds over the stimulation site
• Previously taking physiotherapy for the last 3 months.

Sponsors & Collaborators

• Riphah International University: lead

Related Publications (11)

• Crema A, Bassolino M, Guanziroli E, Colombo M, Blanke O, Serino A, Micera S, Molteni F. Neuromuscular electrical stimulation restores upper limb sensory-motor functions and body representations in chronic stroke survivors. Med. 2022 Jan 14;3(1):58-74.e10. doi: 10.1016/j.medj.2021.12.001. Epub 2022 Jan 7.

  PMID: 35590144 BACKGROUND

• Baradie RSA. Neurodynamics and mobilization in Stroke Rehabilitation- A Systematic Review. Majmaah Journal of Health Sciences. 2020;5(2).

  BACKGROUND

• Micera S, Caleo M, Chisari C, Hummel FC, Pedrocchi A. Advanced Neurotechnologies for the Restoration of Motor Function. Neuron. 2020 Feb 19;105(4):604-620. doi: 10.1016/j.neuron.2020.01.039.

  PMID: 32078796 BACKGROUND

• Eschle S, Hartmann K, Rieger A, Fischer S, Klima A, Bergmann M. Canine vaccination in Germany: A survey of owner attitudes and compliance. PLoS One. 2020 Aug 27;15(8):e0238371. doi: 10.1371/journal.pone.0238371. eCollection 2020.

  PMID: 32853287 BACKGROUND

• Saxena A, Sehgal S, Jangra MK. Effectiveness of Neurodynamic Mobilization versus Conventional Therapy on Spasticity Reduction and Upper Limb Function in Tetraplegic Patients. Asian Spine J. 2021 Aug;15(4):498-503. doi: 10.31616/asj.2020.0146. Epub 2020 Oct 19.

  PMID: 33059433 BACKGROUND

• Badenhorst. A CASE STUDY TO DETERMINE THE EFFECT OF AN ACTIVITY-BASED NEUROMUSCULAR ELECTRICAL STIMULATION (NMES) PROGRAMME. 2020.

  BACKGROUND

• Crema A, Furfaro I, Raschella F, Rossini M, Zajc J, Wiesener C, Baccinelli W, Proserpio D, Augsten A, Immick N, Becker S, Weber M, Schauer T, Krakow K, Gasperini G, Molteni F, Russold MF, Bulgheroni M, Micera S. Reactive Exercises with Interactive Objects: Interim Analysis of a Randomized Trial on Task-Driven NMES Grasp Rehabilitation for Subacute and Early Chronic Stroke Patients. Sensors (Basel). 2021 Oct 11;21(20):6739. doi: 10.3390/s21206739.

  PMID: 34695957 BACKGROUND

• Chodijah S. THE EFFECT OF NEUROMUSCULAR ELECTRICAL STIMULATION (NMES) AND PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF) IN INCREASING EXTREMITY MUSCLE STRENGTH OF HEMIPARESIS DEXTRA PATIENT: A CASE STUDY. Academic Physiotherapy Conference Proceeding. 2022;1.

  BACKGROUND

• HU Y. Effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia. Chinese Journal of Rehabilitation Theory and Practice. 2024;2.

  BACKGROUND

• Selvaraj. Dynamic Neural Mobilization Versus Proprioceptive Neuromuscular Facilitation on Grip Strength and UpperLimb Function in Sub-Acute Stroke Subjects. Indian Journal of Physiotherapy & Occupational Therapy. 2025;19(1)

  BACKGROUND

• Zamurd D, Baig M. Neurodynamics for motor recovery after Stroke, a Review Article. 2023;17:1008.

  BACKGROUND

MeSH Terms

Conditions

Stroke

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Study Officials

• Hira Jabeen

  Riphah International University

  PRINCIPAL INVESTIGATOR

• Jabeen

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Imran Amjad, Phd

CONTACT

03324390125; imran.amjad@riphah.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 1, 2026
• First Posted: June 5, 2026
• Study Start: June 1, 2026
• Primary Completion: June 1, 2026
• Study Completion (Estimated): August 1, 2026
• Last Updated: June 5, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share