Neuromuscular Stimulation Research Articles

Short-term microcurrent electrical neuromuscular stimulation to improve muscle function in the elderly: A randomized, double-blinded, sham-controlled clinical trial.

Background:Microcurrent electrical neuromuscular stimulation (MENS) has been suggested to improve muscle function and restore damaged muscle. However, current evidence is insufficient to determine the effectiveness of this therapy in age-dependent muscle weakness. Therefore, a prospective, randomized, double-blinded, sham-controlled clinical trial was designed to evaluate the effects of short-term MENS on muscle function in the elderly.Methods:A total of 38 healthy elderly participants aged 65 years and above were enrolled and randomly divided into 2 stimulation groups: real or sham MENS group. Real or sham MENS were applied to the 8 anatomical points of the dominant arm and leg during the course of 40 minutes. We performed muscle function tests at baseline and after the intervention: the handgrip strength tests (HGS, kg), the root mean square values (RMS, μV), and the single leg heel-rise tests (HRT) to determine changes in the strength, activity, and endurance of the elderly muscle, respectively.Results:In the real MENS group, the mean values of the HGS and the number of plantar flexions were significantly increased, but the RMS value of the electromyography signal was significantly decreased after the real intervention (P < .05). However, the sham MENS group showed a significant decrease in the number of plantar flexions and the total time for HRT after the sham stimulation (P < .05). The mean difference in the RMS value was significantly lower, but the number of plantar flexions and the total time for HRT was significantly higher in the real MENS group than in the sham MENS group (P < .05).Conclusion:The findings suggest that short-term application of MENS may play a partial role in enhancing physical activities of the elderly, as it can improve some muscle function.

A muscle-driven approach to restore stepping with an exoskeleton for individuals with paraplegia

BackgroundFunctional neuromuscular stimulation, lower limb orthosis, powered lower limb exoskeleton, and hybrid neuroprosthesis (HNP) technologies can restore stepping in individuals with paraplegia due to spinal cord injury (SCI). However, a self-contained muscle-driven controllable exoskeleton approach based on an implanted neural stimulator to restore walking has not been previously demonstrated, which could potentially result in system use outside the laboratory and viable for long term use or clinical testing. In this work, we designed and evaluated an untethered muscle-driven controllable exoskeleton to restore stepping in three individuals with paralysis from SCI.MethodsThe self-contained HNP combined neural stimulation to activate the paralyzed muscles and generate joint torques for limb movements with a controllable lower limb exoskeleton to stabilize and support the user. An onboard controller processed exoskeleton sensor signals, determined appropriate exoskeletal constraints and stimulation commands for a finite state machine (FSM), and transmitted data over Bluetooth to an off-board computer for real-time monitoring and data recording. The FSM coordinated stimulation and exoskeletal constraints to enable functions, selected with a wireless finger switch user interface, for standing up, standing, stepping, or sitting down. In the stepping function, the FSM used a sensor-based gait event detector to determine transitions between gait phases of double stance, early swing, late swing, and weight acceptance.ResultsThe HNP restored stepping in three individuals with motor complete paralysis due to SCI. The controller appropriately coordinated stimulation and exoskeletal constraints using the sensor-based FSM for subjects with different stimulation systems. The average range of motion at hip and knee joints during walking were 8.5°–20.8° and 14.0°–43.6°, respectively. Walking speeds varied from 0.03 to 0.06 m/s, and cadences from 10 to 20 steps/min.ConclusionsA self-contained muscle-driven exoskeleton was a feasible intervention to restore stepping in individuals with paraplegia due to SCI. The untethered hybrid system was capable of adjusting to different individuals’ needs to appropriately coordinate exoskeletal constraints with muscle activation using a sensor-driven FSM for stepping. Further improvements for out-of-the-laboratory use should include implantation of plantar flexor muscles to improve walking speed and power assist as needed at the hips and knees to maintain walking as muscles fatigue.

Accelerated life-test methods and results for implantable electronic devices with adhesive encapsulation.

We have developed and applied new methods to estimate the functional life of miniature, implantable, wireless electronic devices that rely on non-hermetic, adhesive encapsulants such as epoxy. A comb pattern board with a high density of interdigitated electrodes (IDE) could be used to detect incipient failure from water vapor condensation. Inductive coupling of an RF magnetic field was used to provide DC bias and to detect deterioration of an encapsulated comb pattern. Diodes in the implant converted part of the received energy into DC bias on the comb pattern. The capacitance of the comb pattern forms a resonant circuit with the inductor by which the implant receives power. Any moisture affects both the resonant frequency and the Q-factor of the resonance of the circuitry, which was detected wirelessly by its effects on the coupling between two orthogonal RF coils placed around the device. Various defects were introduced into the comb pattern devices to demonstrate sensitivity to failures and to correlate these signals with visual inspection of failures. Optimized encapsulation procedures were validated in accelerated life tests of both comb patterns and a functional neuromuscular stimulator under development. Strong adhesive bonding between epoxy and electronic circuitry proved to be necessary and sufficient to predict 1 year packaging reliability of 99.97% for the neuromuscular stimulator.

Effect of neuromuscular stimulation and individualized rehabilitation on muscle strength in Intensive Care Unit survivors: A randomized trial

PurposeIntensive Care Unit (ICU) survivors experience muscle weakness leading to restrictions in functional ability. Neuromuscular electrical stimulation (NMES) has been an alternative to exercise in critically ill patients. The aim of our study was to investigate its effects along with individualized rehabilitation on muscle strength of ICU survivors. Material and methodsFollowing ICU discharge, 128 patients (age: 53±16years) were randomly assigned to daily NMES sessions and individualized rehabilitation (NMES group) or to control group. Muscle strength was assessed by the Medical Research Council (MRC) score and hand grip at hospital discharge. Secondary outcomes were functional ability and hospital length of stay. ResultsMRC, handgrip, functional status and hospital length of stay did not differ at hospital discharge between groups (p>0.05). ΔMRC% one and two weeks after ICU discharge tended to be higher in NMES group, while it was significant higher in NMES group of patients with ICU-acquired weakness at two weeks (p=0.05). ConclusionsNMES and personalized physiotherapy in ICU survivors did not result in greater improvement of muscle strength and functional status at hospital discharge. However, in patients with ICU-aw NMES may be effective. The potential benefits of rehabilitation strategies should be explored in larger number of patients in future studies.Clinical trial registration: www.Clinicaltrials.gov: NCT01717833

Effects of Home-based Telesupervising Rehabilitation on Physical Function for Stroke Survivors with Hemiplegia: A Randomized Controlled Trial.

The aims of this work were to evaluate the effects of home-based telesupervising rehabilitation on physical function for stroke survivors with hemiplegia and to determine if the rehabilitation therapy can relieve the burden on caregivers. This study is a randomized, controlled, assessor-blinded trial. Stroke survivors were randomly assigned to either home-based telesupervising rehabilitation group or conventional rehabilitation group to receive physical exercise and electromyography-triggered neuromuscular stimulation. Modified Barthel Index, Berg Balance Scale, modified Rankin Scale, Caregiver Strain Index, root mean square of extensor carpi radialis longus and tibialis anterior muscle were measured at 3 time points: baseline, postintervention (12 weeks), and 12-week follow-up (24 weeks). Both the home-based telerehabilitation and conventional rehabilitation groups demonstrated significant effects within groups over the 3 time points in increasing Modified Barthel Index, Berg Balance Scale, and root mean square value of extensor carpi radialis longus and tibialis anterior, as well as decreasing Caregiver Strain Index (P < 0.001), but none of the between-group differences was significant. For modified Rankin Scale, the percentage of participants of grades 0 and 1 in 2 groups increased over time without significant difference between the groups. Home-based telesupervising rehabilitation is most likely as effective as the conventional outpatient rehabilitation for improving functional recovery in stroke survivors and could ease the burden of caregivers as conventional rehabilitation.

The Contribution of Neuromuscular Stimulation in Elucidating Muscle Plasticity Revisited.

Studies carried out during the past 45 years on the effects of chronic low-frequency stimulation on skeletal muscle have revealed a multiplicity of adaptive changes of muscle fibres in response to increased activity. As reflected by induced changes in the metabolic properties, protein profiles of the contractile machinery and elements of the Ca2+-regulatory system, all essential components of the muscle fibre undergo pronounced changes in their properties that ultimately lead to their reversible transformation from fast-to-slow phenotype. The chronic low-frequency stimulation experiment thus allows exploring many aspects of the plasticity of mammalian skeletal muscle. Moreover it offers the possibility of elucidating molecular mechanisms that remodel phenotypic properties of a differentiated post-mitotic cell during adaptation to altered functional demands. The understanding of the adaptive potential of muscle can be taken advantage of for repairing muscle damage in various muscle diseases. In addition it can be used to prevent muscle wasting during inactivity and aging. Indeed, pioneering studies are still the sound grounds for the many current applications of Functional Electrical Stimulation and for the related research activities that are still proposed and funded.

Exercise Training Versus Neuromuscular Stimulation in Severe COPD

Exercise Training Versus Neuromuscular Stimulation in Severe COPD

Decoding Lower Limb Muscle Activity and Kinematics from Cortical Neural Spike Trains during Monkey Performing Stand and Squat Movements

Extensive literatures have shown approaches for decoding upper limb kinematics or muscle activity using multichannel cortical spike recordings toward brain machine interface (BMI) applications. However, similar topics regarding lower limb remain relatively scarce. We previously reported a system for training monkeys to perform visually guided stand and squat tasks. The current study, as a follow-up extension, investigates whether lower limb kinematics and muscle activity characterized by electromyography (EMG) signals during monkey performing stand/squat movements can be accurately decoded from neural spike trains in primary motor cortex (M1). Two monkeys were used in this study. Subdermal intramuscular EMG electrodes were implanted to 8 right leg/thigh muscles. With ample data collected from neurons from a large brain area, we performed a spike triggered average (SpTA) analysis and got a series of density contours which revealed the spatial distributions of different muscle-innervating neurons corresponding to each given muscle. Based on the guidance of these results, we identified the locations optimal for chronic electrode implantation and subsequently carried on chronic neural data recordings. A recursive Bayesian estimation framework was proposed for decoding EMG signals together with kinematics from M1 spike trains. Two specific algorithms were implemented: a standard Kalman filter and an unscented Kalman filter. For the latter one, an artificial neural network was incorporated to deal with the nonlinearity in neural tuning. High correlation coefficient and signal to noise ratio between the predicted and the actual data were achieved for both EMG signals and kinematics on both monkeys. Higher decoding accuracy and faster convergence rate could be achieved with the unscented Kalman filter. These results demonstrate that lower limb EMG signals and kinematics during monkey stand/squat can be accurately decoded from a group of M1 neurons with the proposed algorithms. Our findings provide new insights for extending current BMI design concepts and techniques on upper limbs to lower limb circumstances. Brain controlled exoskeleton, prostheses or neuromuscular electrical stimulators for lower limbs are expected to be developed, which enables the subject to manipulate complex biomechatronic devices with mind in more harmonized manner.

Upper limb vibration prototype with sports and rehabilitation applications: development, evaluation and preliminary study.

Vibration stimulation as an exercise intervention has been studied increasingly for its potential benefits and applications in sports and rehabilitation. Vibratory exercise devices should be capable of generating highly precise and repeatable vibrations and should be capable of generating a range of vibration amplitudes and frequencies in order to provide different training protocols. Many devices used to exercise the upper body provide limited variations to exercise regimes mostly due to the fact that only vibration frequency can be controlled. The authors present an upper limb vibration exercise device with a novel actuator system and design which attempts to address these limitations. Preliminary results show that this device is capable of generating highly precise and repeatable vibrations with independent control over amplitude and frequency. Furthermore, the results also show that this solution provides a higher neuromuscular stimulation (i.e. electromyography activity) when compared with a control condition. The portability of this device is an advantage, and though in its current configuration it may not be suitable for applications requiring higher amplitude levels the technology is scalable.

Strengthening of Quadriceps by Neuromuscular Magnetic Stimulation in Healthy Subjects

BackgroundQuadriceps muscle strengthening is one of the rehabilitation strategies for improving walking in some people with gait impairments, and neuromuscular electrical stimulation (NMES) has been used for that reason. The strengthening effect of neuromuscular magnetic stimulation (NMMS) on the quadriceps has been demonstrated in various conditions, but not specifically for gait training. The purpose of this study was to determine whether the effect of NMMS is clinically applicable. ObjectiveTo determine the effect of NMMS on quadriceps muscle strength, cross-sectional area (CSA) and thickness in healthy subjects. DesignSingle-blind, prospective, case-control study. SettingTertiary academic hospital setting. ParticipantsA total of 40 healthy volunteers were randomly assigned to an NMMS (n = 20) or control group (n = 20). InterventionsFifteen minutes of quadriceps NMMS of at maximum tolerable intensity, 3 times per week for 5 weeks. Main Outcome MeasurementsAt baseline and after the intervention, the CSA and thicknesses of the rectus femoris and vastus intermedius were measured by ultrasound. Isometric and isokinetic maximal and average peak torques of the dominant side knee extensors were also measured at pre- and postintervention. ResultsThere were no between-group differences in strength, CSA, or muscle thickness at baseline. Isometric maximum and average peak torque of NMMS group were increased significantly after 5 weeks of intervention (P < .001). The isokinetic maximum and average peak torque of NMMS group were increased significantly at both angle velocities of 60°/sec and 120°/sec after 5 weeks of intervention (P < .001). However, neither group showed a significant difference in cross-sectional area or thickness after training. ConclusionNMMS can be a useful strengthening method for large skeletal muscles such as the quadriceps. Level of EvidenceII

Hybrid Assistive Neuromuscular Dynamic Stimulation Therapy: A New Strategy for Improving Upper Extremity Function in Patients with Hemiparesis following Stroke.

Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) therapy is one of the neurorehabilitation therapeutic approaches that facilitates the use of the paretic upper extremity (UE) in daily life by combining closed-loop electromyography- (EMG-) controlled neuromuscular electrical stimulation (NMES) with a wrist-hand splint. This closed-loop EMG-controlled NMES can change its stimulation intensity in direct proportion to the changes in voluntary generated EMG amplitudes recorded with surface electrodes placed on the target muscle. The stimulation was applied to the paretic finger extensors. Patients wore a wrist-hand splint and carried a portable stimulator in an arm holder for 8 hours during the daytime. The system was active for 8 hours, and patients were instructed to use their paretic hand as much as possible. HANDS therapy was conducted for 3 weeks. The patients were also instructed to practice bimanual activities in their daily lives. Paretic upper extremity motor function improved after 3 weeks of HANDS therapy. Functional improvement of upper extremity motor function and spasticity with HANDS therapy is based on the disinhibition of the affected hemisphere and modulation of reciprocal inhibition. HANDS therapy may offer a promising option for the management of the paretic UE in patients with stroke.

The role of the neurophysiological methods in the assessment of the effectiveness of the rehabilitation of sensorimotor disturbances associated with the lesions of the central nervous system at the spinal cord level

The objective of the present study was the evaluation and comparison of the effectiveness of the differential approaches to the neurorehabilitation of the somatosensory disturbances in the patients presenting with the spinal cord lesions. A total of 68 patients with spinal cord lesions were enrolled in the study, including 38 suffering from vascular myelopathy, 18 with the consequences of extramedullar meningioma surgery, 12 with the sequelae of acute transverse myelitis. The control groups was comprised of were 55 subjects. All the participants of the study underwent rehabilitation which included robotized mechanotherapy, stabilography, neuro-muscular stimulation, kinesiotherapy, physical therapy, ergotherapy, massage, etc. Transcranial magnetic stimulation (TMS) and evaluation of somatosensory evoked potentials (SSEP) were carried out before and after the therapy. In those patients who received personalized therapy, significant changes of TMS parameters (central motor conduction time at rest and in facilitation probe), but not SSEP ones were registered. Moreover, the patients who had undergone personalized therapy exhibited better clinical results than in the absence of such treatment. The results of the study gave evidence that neurorehabilitation had produced the more pronounced beneficial influence as regards the correction of motor disturbances even though the disturbances of the somatosensory functions proved to be more resistant to therapy. The data obtained suggest that taking into consideration the afferent deficit has to be mandatory for the purpose of planning the neurorehabilitative treatment of the patients suffering from sensorimotor disturbances associated with the lesions of the central nervous system at the spinal cord level. TMS and SSEP have to be utilized as the tools for the objective evaluation of the effectiveness of the neurorehabilitation process in such patients.

The comparative assessment of the vocal function in the professional voice users and non-occupational voice users in the late adulthood

The objective of the present study was to evaluate the clinical and functional condition of the voice apparatus in the elderly patients and to elaborate recommendations for the prevention of disturbances of the vocal function in the professional voice users. This comprehensive study involved 95 patients including the active professional voice users (n=48) and 45 non-occupational voice users at the age from 61 to 82 years with the employment history varying from 32 to 51 years. The study was designed to obtain the voice characteristics by means of the subjective auditory assessment, microlaryngoscopy, video laryngostroboscopy, determination of maximum phonation time (MPT), and computer-assisted acoustic analysis of the voice with the use of the MDVP Kay Pentaxy system. The level of anxiety of the patients was estimated based on the results of the HADS questionnaire study. It is concluded that the majority of the disturbances of the vocal function in the professional voice users have the functional nature. It is concluded that the method of neuro-muscular electrophonopedic stimulation (NMEPS) of laryngeal muscles is the method of choice for the diagnostics of the vocal function of the voice users in the late adulthood. It is recommended that the professional vocal load for such subjects should not exceed 12-14 hours per week. Rational psychotherapy must constitute an important component of the system of measures intended to support the working capacity of the voice users belonging to this age group.

Low Frequency Neuromuscular Stimulation Effect on Ergoreflex Activity in Advanced Heart Failure

Background: Heart failure is a syndrome characterized by cardiac dysfunction with either left ventricular dilation or hypertrophy causing cardinal manifestations of dyspnea, fatigue and exercise intolerance. Objectives: To determine the effect of low frequency neuromuscular stimulation on ergoreflex activity in advanced heart failure. Methods: Thirty patients of with advanced heart failure were included in this study with mean age of 60 years. They received eight weeks (four times a week) of increasing amplitude low frequency neuromuscular stimulation on Quadriceps and calf muscles after thorough assessment of ergoreflex, ejection fraction and assessment of disability via Minnesota Living with Heart Failure Questionnaire. Results: Statistical significant alteration of ergo reflex contribution associated with decreased disability without any statistically significant changes in ejection fraction. The percentages of changes in minute ventilation (VE) and carbon dioxide production (VCO2 ) and maximum oxygen consumption (VO2 ) were 37.83%, -36.38% and 25.46% respectively. These changes were associated with improved functional, emotional and psychological status of the patients with a decline of Minnesota Living with Heart Failure Questionnaire score by -29.87%. Conclusion: Low frequency neuromuscular stimulation altered ergoreflex contribution leading to higher functional levels.

Effect of Combination Microcurrent Electrical Neuromuscular Stimulation and Hyperbaric Oxygen Therapy on the Regeneration of Injured Skeletal Muscle in Mice

Effect of Combination Microcurrent Electrical Neuromuscular Stimulation and Hyperbaric Oxygen Therapy on the Regeneration of Injured Skeletal Muscle in Mice

Regenerated Sciatic Nerve Axons Stimulated through a Chronically Implanted Macro-Sieve Electrode.

Sieve electrodes provide a chronic interface for stimulating peripheral nerve axons. Yet, successful utilization requires robust axonal regeneration through the implanted electrode. The present study determined the effect of large transit zones in enhancing axonal regeneration and revealed an intimate neural interface with an implanted sieve electrode. Fabrication of the polyimide sieve electrodes employed sacrificial photolithography. The manufactured macro-sieve electrode (MSE) contained nine large transit zones with areas of ~0.285 mm2 surrounded by eight Pt-Ir metallized electrode sites. Prior to implantation, saline, or glial derived neurotropic factor (GDNF) was injected into nerve guidance silicone-conduits with or without a MSE. The MSE assembly or a nerve guidance conduit was implanted between transected ends of the sciatic nerve in adult male Lewis rats. At 3 months post-operation, fiber counts were similar through both implant types. Likewise, stimulation of nerves regenerated through a MSE or an open silicone conduit evoked comparable muscle forces. These results showed that nerve regeneration was comparable through MSE transit zones and an open conduit. GDNF had a minimal positive effect on the quality and morphology of fibers regenerating through the MSE; thus, the MSE may reduce reliance on GDNF to augment axonal regeneration. Selective stimulation of several individual muscles was achieved through monopolar stimulation of individual electrodes sites suggesting that the MSE might be an optimal platform for functional neuromuscular stimulation.

Clinical observation study of Chinese massage combined with low-frequency pulse electrical stimulation therapy in treatment of milk siltation breasts

Objective To observe the traditional Chinese medicine massage in breasts joint French PHENIX-USB4 neuromuscular stimulation electrical stimulation therapy treatment of postpartum milk siltation, and provide the basis for clinical. Methods 120 patients with a diagnosis of milk deposition were selected according to random number table method, who were divided into control group and observation group, with 60 cases in each group.The patients in the control group were administrated with the traditional hot compress and breast massage technique treatment, and the patients in the observation group were administrated with low frequency pulse electrical stimulation treatment based on that in the control group, the clinical efficacy of the two groups were compared. Results The therapy efficacy rate of the observation group was 100.0%, which was significantly higher than 80.0%of control group(χ2=16.51, P 0.78). The case of mild pain in the observation group was significantly more than that in the control group (χ2=40.98, P<0.05). The cases of moderate pain and severe pain in the observation group were significantly less than those in the control group (χ2=4.48, 10.21, all P<0.05); After treatment of milk deposition for 1 day, 2 days and 3 days, the milk siltation in the observation group were significantly lighter than those in the control group (χ2=31.58, 23.52, 37.33, all P<0.05). Conclusion Breast massage of traditional Chinese medicine combined with low-frequency pulse electrical stimulation of acupuncture treatment of postpartum maternal milk deposition has the very good curative effect, the treatment is relatively simple, which is easy to operate, safe, noninvasive, relatively low incidence of adverse reactions, it can enhance the confidence of breastfeeding, and is worth of clinical promotion. Key words: Low frequency pulsed electrical stimulation; Points; Analgesia; TCM massage; Milk siltation

Demonstration of 2-mm-Thick Microcontrolled Injectable Stimulators Based on Rectification of High Frequency Current Bursts.

Existing implantable stimulators use powering approaches that result in stiff and bulky systems or result in systems incapable of producing the current magnitudes required for neuromuscular stimulation. This hampers their use in neuroprostheses for paralysis. We previously demonstrated an electrical stimulation method based on electronic rectification of high frequency (HF) current bursts. The implants act as rectifiers of HF current that flows through the tissues by galvanic coupling, transforming this current into low frequency current capable of performing neuromuscular stimulation. Here we developed 2 mm thick, semi-rigid, injectable and addressable stimulators made of off-the-shelf components and based on this method. The devices were tested in vitro to illustrate how they are powered by galvanic coupling. In addition they were tried in an animal model to demonstrate their ability to perform controlled electrical stimulation. The implants were deployed by injection into two antagonist muscles of an anesthetized rabbit and were addressed resulting in independent isometric contractions. Low frequency currents of 2 mA were delivered by the implants. The HF currents are safe in terms of unwanted electrostimulation and tissue heating according to standards. This indicates that the proposed electrical stimulation method will allow unprecedented levels of miniaturization for neuroprostheses.

Effectiveness of transcutaneous eletrical neuromuscular stimulation along with exercisces manoeuver in Dysphagia: case series

Effectiveness of transcutaneous eletrical neuromuscular stimulation along with exercisces manoeuver in Dysphagia: case series

A new therapeutic application ofbrain-machine interface (BMI) training followed by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy forpatients with severe hemiparetic stroke: A proof of concept study.

Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy improved paretic upper extremity motor function in patients with severe to moderate hemiparesis. We hypothesized that brain machine interface (BMI) training would be able to increase paretic finger muscle activity enough to apply HANDS therapy in patients with severe hemiparesis, whose finger extensor was absent. The aim of this study was to assess the efficacy of BMI training followed by HANDS therapy in patients with severe hemiparesis. Twenty-nine patients with chronic stroke who could not extend their paretic fingers were participated this study. We applied BMI training for 10 days at 40 min per day. The BMI detected the patients' motor imagery of paretic finger extension with event-related desynchronization (ERD) over the affected primary sensorimotor cortex, recorded with electroencephalography. Patients wore a motor-driven orthosis, which extended their paretic fingers and was triggered with ERD. When muscle activity in their paretic fingers was detected with surface electrodes after 10 days of BMI training, we applied HANDS therapy for the following 3 weeks. In HANDS therapy, participants received closed-loop, electromyogram-controlled, neuromuscular electrical stimulation (NMES) combined with a wrist-hand splint for 3 weeks at 8 hours a day. Before BMI training, after BMI training, after HANDS therapy and 3month after HANDS therapy, we assessed Fugl-Meyer Assessment upper extremity motor score (FMA) and the Motor Activity Log14-Amount of Use (MAL-AOU) score. After 10 days of BMI training, finger extensor activity had appeared in 21 patients. Eighteen of 21 patients then participated in 3 weeks of HANDS therapy. We found a statistically significant improvement in the FMA and the MAL-AOU scores after the BMI training, and further improvement was seen after the HANDS therapy. Combining BMI training with HANDS therapy could be an effective therapeutic strategy for severe UE paralysis after stroke.