Effects of SBMT Combined With NMES on UL Functions in Post Stroke Patients

May 4, 2026 updated by: Riphah International University

Effects of Synergy-based Motor Therapy Combined With Neuromuscular Electrical Stimulation in Post Stroke Patients

The aim of this study to evaluate the effects of synergy-based motor therapy combined with neuromuscular electric stimulation on upper limb function on post stroke patients

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Stroke is a serious medical condition that affects blood flow of brain due to ischemic stroke or hemorrhagic stroke. It because the long-term disabilities most commonly in older adults. The challenges face after stroke is weakness, loss of functions in upper limb.(1) Patients also feel difficulty in daily life activities like eating, dressing, writing, holding objects. In previous years, many therapeutic approaches have been developed to improve upper limb functions after stroke. There is most promising techniques like synergy-based motor therapy and NMES and these techniques helps patients in different ways. (2) Synergy-based motor therapy (SBMT) is a therapeutic approach designed to address unusual synergy patterns usually seen after stroke. Its purpose is to restore voluntary control and promote separate joint movements by returning motor routes.(3) Neuromuscular Electrical Stimulation (NMES) is a minor that distributes low-existing electrical impulses to stimulate muscle contractions in weak or paralyzed muscles, leading to muscle strength, motor learning and functional recovery.(4) More effective intervention can be offered by mixing SBMT with NMES together by addressing nerve control and muscle activity.

Synergy-based motor therapy is to focuses on retraining the brain to allow natural movements of the arm and hand. This therapy is based on how the brain learns and adapts (neuroplasticity)(5) It helps patients practice specific tasks and movements that target the upper limb joints, like shoulder abduction, elbow extension, and wrist control. Over time, this type of therapy can improve coordination, range of motion, and function of the affected arm.(6) The upper limb plays a vital role in daily living. Even simple actions like buttoning a shirt or brushing teeth require coordination between the hand, wrist, elbow, and shoulder. When stroke disrupts this system, the person becomes dependent on others. Synergy-based motor therapy directly targets the impaired patterns in the upper limb and helps the patient regain voluntary control. It also reduces muscle tightness (spasticity) and increases active participation of the limb in functional tasks.(7) Another important approach in stroke rehabilitation is neuromuscular electrical stimulation (NMES). In NMES, small electrical impulses are sent through the skin to activate the muscles that the brain can no longer control well. This causes the muscles to contract and helps in maintaining muscle strength, preventing muscle wasting, and encouraging active movement.(8) NMES can be especially helpful for patients who are unable to move their arm due to severe weakness in the early phase of recovery.NMES is not just about stimulating muscles; it also sends feedback to the brain, which can help rebuild the brain-muscle connection. It supports the patient's ability to relearn lost skills. Moreover, NMES can reduce pain, improve blood flow, and increase patient motivation by allowing them to see progress even when they cannot move the limb on their own. This makes it a very useful tool in stroke rehabilitation, especially when used in combination with task-specific exercises.(9) Both therapies have shown positive results individually, combining both therapies may offer even better outcome. Synergy based motor therapy works on retraining the brain and correcting the movement patterns while NMES can assist by strengthening the muscles. Most studies have looked these therapies separately and not focused on older adults which have slower recovery than young adults.(10) This research is important because it addresses a gap in the existing literature by focusing on a specific age group and combining the two effective techniques. The findings help physical therapists and rehabilitation professionals develop more effective, evidence-based treatment plan for post stroke patients to improve the quality of life and independence in daily life.(11) Incorporating synergy-based motor therapy and neuromuscular electrical stimulation (NMES) into routine stroke rehabilitation programs may promote long-term benefits such as enhanced motor recovery, improved functional performance, and greater independence in daily activities among post-stroke patients. These interventions work by activating normal muscle synergies, improving neuromuscular recruitment patterns, and facilitating motor relearning through targeted feedback mechanisms. NMES provides sensory and motor stimulation that helps improve voluntary muscle activation, while synergy-based therapy focuses on restoring coordinated limb movements disrupted by cortical damage. Although both techniques have individually demonstrated positive outcomes in upper limb rehabilitation, comparative studies remain limited. Understanding the combined effect of these therapies in older adults with post-stroke hemiparesis is crucial for evidence-based decision making. The findings may assist clinicians in refining post-stroke rehabilitation approaches and designing more tailored intervention protocols for upper limb recovery.

Study Type

Interventional

Enrollment (Estimated)

40

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Pakistan
    • Punjab Province
      • Jhang, Punjab Province, Pakistan, 35200
        • Recruiting
        • District Head Quarter Hospital , Jhang
        • Contact:
        • Sub-Investigator:
          • Jasia Fatima, MS(NMPT)

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • 1) Age :50 to 65 2) Both male and female 3) Ischemic Stroke onset among 3 to 6 months (sub-acute section) 4) Hemiplegia affected upper limb 5) The score of Modified ash worth scale rating <2 for upper limb 6) The score of Mini mental state score >25

Exclusion Criteria:

  • 1) Recurrent stroke or bilateral involvement 2) Cognitive or conversation impairment 3) Presence of pacemaker or contraindications to NMES 4) Uncontrolled comorbid situation (e.g extreme cardiac diseases )

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Synergy-based motor therapy and NMES
Participants will receive synergy-based motor therapy combined with neuromuscular electrical stimulation (NMES) for upper limb rehabilitation following stroke. Treatment will focus on improving motor control, functional movement, and muscle activation.
Behavioral: Synergy-based motor therapy
First do the 5 minutes warm up exercises(passive range of motion exercises for shoulder,elbow ,wrist and then synergy based motor therapy for 25 minutes in which the flexor synergy facilitation ( 10 rep,3 sets) and brushing and tapping for sensory cueing and then 5 minutes of cool down exercises(slow passive movements of upper limb)
Device: Neuromuscular electrical stimulation
NMES applied to wrist extensors .Frequency: 35Hz ,Pulse Width250 ,Duty cycle :10s on /20s off ,Duration : 25 minutes
Other: Conventional therapy
The conventional therapy group will receive standard physiotherapy for the upper limb for 30-45 minutes per session, five days per week for 6-8 weeks. It will include gentle warm-up, range of motion exercises, light strengthening, and simple functional activities like reaching, grasping, and daily task practice. Each session will end with stretching and relaxation. This treatment aims to improve movement, strength, and function without using NMES or synergy-based training.
Active Comparator: Conventional therapy
Participants will receive conventional physiotherapy for upper limb rehabilitation following stroke, including standard exercises aimed at improving strength, range of motion, and functional ability.
Behavioral: Synergy-based motor therapy
First do the 5 minutes warm up exercises(passive range of motion exercises for shoulder,elbow ,wrist and then synergy based motor therapy for 25 minutes in which the flexor synergy facilitation ( 10 rep,3 sets) and brushing and tapping for sensory cueing and then 5 minutes of cool down exercises(slow passive movements of upper limb)
Device: Neuromuscular electrical stimulation
NMES applied to wrist extensors .Frequency: 35Hz ,Pulse Width250 ,Duty cycle :10s on /20s off ,Duration : 25 minutes
Other: Conventional therapy
The conventional therapy group will receive standard physiotherapy for the upper limb for 30-45 minutes per session, five days per week for 6-8 weeks. It will include gentle warm-up, range of motion exercises, light strengthening, and simple functional activities like reaching, grasping, and daily task practice. Each session will end with stretching and relaxation. This treatment aims to improve movement, strength, and function without using NMES or synergy-based training.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Fugl-Meyer Assesssment _Upper Extremity
Time Frame: 8th week
The Fugl-Meyer Assessment for Upper Extremity (FMA-UE) is a standardized tool used to evaluate motor function in the upper limb of post-stroke patients. It assesses movement, coordination, and reflex activity of the shoulder, elbow, forearm, wrist, and hand. The scale includes 33 items, scored on a 3-point scale (0 = cannot perform, 1 = performs partially, 2 = performs fully), with a maximum score of 66 indicating normal function. It helps classify the severity of motor impairment: scores between 0-22 suggest severe, 23-44 moderate, and 45-66 mild impairment. The FMA-UE is based on Brunnstrom's stages of motor recovery and is widely recognized for its high validity and excellent reliability, with inter-rater and intra-rater reliability scores above 0.95. It is considered one of the most reliable clinical tools for evaluating motor recovery in stroke rehabilitation
8th week

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Modified Ashworth Scale (MAS)
Time Frame: 8th week
The Modified Ashworth Scale (MAS) is a clinical tool used to measure spasticity in patients with neurological conditions such as stroke. The scale ranges from 0 to 4, with an additional 1+ grade, where 0 indicates no increase in muscle tone, and 4 indicates the affected part is rigid in flexion or extension. The scores reflect the severity of spasticity: higher scores represent greater resistance and spasticity
8th week

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Riphah International University

Investigators

  • Principal Investigator: Aruba Saeed, Riphah International University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 1, 2026

Primary Completion (Estimated)

July 1, 2026

Study Completion (Estimated)

July 1, 2026

Study Registration Dates

First Submitted

May 4, 2026

First Submitted That Met QC Criteria

May 4, 2026

First Posted (Actual)

May 8, 2026

Study Record Updates

Last Update Posted (Actual)

May 8, 2026

Last Update Submitted That Met QC Criteria

May 4, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REC/RCR&AHS/25/0237

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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