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Aim: Repetitive facilitative exercise (RFE) is a developed approach to the rehabilitation of hemiplegia. RFE can be integrated with neuromuscular electrical stimulation (NMES), direct application of vibratory stimulation (DAVS) and repetitive transcranial magnetic stimulation (rTMS). The aims of the present study were to retrospectively compare the effects of RFE and NMES, DAVS with those of RFE and rTMS, and to determine the maximal effect of the combination of RFE with NMES, DAVS, rTMS and pharmacological treatments in stroke patients., Subjects and Methods: Thirty-three stroke patients were enrolled and divided into three groups: 15 who received RFE with rTMS (4 min) (TMS4 alone), 9 who received RFE with NMES, DAVS (NMES, DAVS alone) and 9 who received RFE with NMES, DAVS and rTMS (10 min) (rTMS10 + NMES, DAVS). The subjects performed the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) before and after the 2-week session. The 18 patients in the NMES, DAVS alone and rTMS10 + NMES, DAVS group underwent the intervention for 4 weeks., Result: There were no significant differences in the increases in the FMA, ARAT scores in the three groups. The FMA or ARAT scores in the NMES, DAVS alone and the rTMS10 + NMES, DAVS group were increased significantly. The FMA and ARAT scores were significantly improved after 4 weeks in the NMES, DAVS alone group., Discussion: RFE with NMES, DAVS may be more effective than RFE with rTMS for the recovery of upper-limb function. Patients who received RFE with NMES, DAVS and pharmacological treatments showed significant functional recovery.

Objective: To investigate the impact of stroke on health status and the effects of repetitive facilitation exercises (RFEs) for convalescent patients after stroke., Methods: The study was a prospective observational study of patients enrolled in an RFE programme. Between April 2008 and March 2012, 468 patients with stroke were enrolled in an intensive, comprehensive RFE programme. Patients participated in this interdisciplinary programme for 12 weeks, for an average of 5 hours per week. Before and immediately after the programme, several measures of rehabilitation outcomes and health-related quality-of-life were evaluated., Results: At baseline, most patients (95.4%) had modified Rankin scale scores of 3-5. Their health-related quality-of-life was significantly impaired, with physical and mental component summary scores on the Short Form 36-item questionnaire (SF-36) of 30.7 and 35.8, respectively. After the RFE programme, all outcome measures improved significantly., Conclusions: The results demonstrate that convalescent patients after stroke may benefit substantially from RFE programmes in stroke rehabilitation centres, even when patients have impaired health status or high levels of healthcare utilization. Thus, an RFE programme is a simple yet highly effective means to improve rehabilitation outcomes and health-related quality-of-life, with a relatively low dropout rate.

Objective: To investigate the effectiveness of repetitive facilitative exercise (RFE) under surface neuromuscular electrical stimulation (NMES) in patients with post-stroke hemiplegia., Methods: This randomized, controlled, observer-blinded, pilot trial randomized 27 adults with severe arm impairment [Fugl-Meyer Arm scale (FMA) ≤ 20] due to stroke of 3-13 weeks duration into three groups and provided treatment on a 4-week, 40 minutes/day, 5 days/week schedule. The RFE-under-NMES group were given 100-150 repetitions of standardized movements of shoulder, elbow and wrist joints of their affected arm with concurrent low-amplitude NMES for each corresponding musculature. The RFE group was given the same exercise regimen but without NMES. The control group was treated with a conventional arm rehabilitation programme without NMES. FMA was assessed at baseline and 4 weeks., Results: All 27 participants (nine in each group) completed the trial. At 4 weeks, the RFE-under-NMES group evidenced significantly greater improvement compared with the control group on the FMA (p = 0.003), but not with the RFE group (p = 0.092). The RFE group showed improvement compared with the control group, but it was not significant (p = 0.199)., Conclusions: RFE under NMES is feasible in clinical settings and may be more effective than conventional rehabilitation in lessening arm impairment after sub-acute stroke.

A stroke patient with right hemiplegia and mirror movement underwent transcranial magnetic stimulation (TMS) and somatosensory-evoked potential (SEP) testing. The motor-evoked potentials (MEPs) of both abductor pollicis brevis muscles after stimulating the unaffected right hemisphere showed similar latencies, and were potentially produced by corticospinal tracts from the same motor cortex. N(20) responses of SEPs were recorded at C(4)' after contralateral stimulation of the unaffected left median nerve, but not stimulation of the affected right median nerve. The mirror movements and motor recovery might have utilized an ipsilateral motor pathway between the unaffected hemisphere and the affected hand.

Objective: To study the effects on the hemiplegic upper limb of repetitive facilitation exercises (RFEs) using a novel facilitation technique, in which the patient's intention to move the hemiplegic upper limb or finger was followed by realization of the movement using multiple sensory stimulations., Methods: Twenty-three stroke patients were enrolled in a cross-over study in which 2-week RFE sessions (100 repetitions each of five-to-eight types of facilitation exercise per day) were alternated with 2-week conventional rehabilitation (CR) sessions, for a total of four sessions. Treatments were begun with the 2-week RFE session in one group and the 2-week CR session in the second group., Results: After the first 2-week RFE session, both groups showed improvements in the Brunnstrom stages of the upper limb and the hand, in contrast to the small improvements observed during the first CR session. The Simple Test for Evaluating Hand Function (STEF) score, which evaluates the ability of manipulating objects, in both groups improved during both sessions. After the second 2-week RFE and CR sessions, both groups showed little further improvement except in the STEF score., Conclusion: The novel RFEs promoted the functional recovery of the hemiplegic upper limb and hand to a greater extent than the CR sessions.

Objective: To investigate whether the direct application of vibratory stimuli inhibits spasticity and improves motor function in the hemiplegic upper limbs of post-stroke patients., Design: Prospective pilot study., Setting: University hospital rehabilitation centre., Subjects: Fourteen post-stroke patients (mean age = 57.3 years; SD = 19.1 years)., Interventions: A hand and forearm stimulation device and an upper-arm stimulation device, consisting of vibrators, a wooden frame and a cloth strap, applied to the upper limbs of subjects., Main Measures: The modified Ashworth scale (MAS) score, F-wave parameters and motor-function parameters (finger tapping, active range of motion and the simple test for evaluating hand function)., Results: Subjects showed significant and potentially durable improvements in MAS score (p < 0.01), F-wave parameters (p < 0.01) and motor-function parameters (p < 0.05). The MAS score, F-wave parameters and motor-function parameters dropped below the baseline values after vibratory stimulation. The MAS score and F-wave parameters remained significantly below the baseline 30 minutes after stimulation., Conclusions: The direct application of vibratory stimuli is an effective non-pharmacological anti-spastic treatment that could facilitate stroke rehabilitation. These results provide good evidence of potential short-term benefits of anti-spastic vibratory therapy in post-stroke patients in terms of decreased muscle tonus and improved motor function.