Comparison of Motor Relearning Program and Electric Muscle Stimulation in Subacute Stroke Patients (MORE-EMS)

Stroke frequently results in upper limb motor impairment, reduced functional independence, and diminished quality of life. Despite advances in stroke rehabilitation, recovery of upper extremity function remains challenging. The Motor Relearning Program (MRP) is a task-oriented rehabilitation approach that promotes neuroplasticity through repetitive practice of meaningful functional activities. Electrical Muscle Stimulation (EMS) has been proposed as an adjunctive intervention to facilitate voluntary muscle activation, improve neuromuscular recruitment, and enhance functional recovery.

This study is designed as a single-center, single-blinded, randomized controlled trial conducted at the University of Lahore Teaching Hospital. A total of 36 participants with subacute stroke who meet the eligibility criteria will be recruited and randomly allocated into two equal groups using the sealed envelope randomization technique.

Participants in Group A will receive a structured Motor Relearning Program combined with Electrical Muscle Stimulation. The intervention will include repetitive task-oriented upper limb activities such as opening and closing bottle lids, lifting and drinking from a glass, arranging puzzles, reaching in different directions, transferring small objects, turning door handles, and turning book pages. EMS will be applied to the affected upper limb muscles, including the deltoid, biceps brachii, triceps brachii, wrist flexors and extensors, and finger flexors and extensors, using surface electrodes for 10 minutes during each treatment session.

Participants in Group B will receive the identical Motor Relearning Program without Electrical Muscle Stimulation. Both groups will receive treatment for 1 hour per day, 5 days per week, for 6 consecutive weeks, with progression of task difficulty according to individual performance.

Outcome assessments will be performed at baseline and after completion of the 6-week intervention. The primary outcome measures are the Upper Extremity Fugl-Meyer Assessment (UEFMA) and the Modified Ashworth Scale (MAS). The secondary outcome measure is the Motor Evaluation Scale for Upper Extremity in Stroke (MESUPES). These validated outcome measures will be used to evaluate motor recovery, upper limb function, and muscle tone.

The study aims to determine whether the addition of Electrical Muscle Stimulation to a Motor Relearning Program produces superior improvements in upper limb motor function compared with the Motor Relearning Program alone in individuals with subacute stroke. The results may contribute evidence to support the development of effective rehabilitation strategies for upper limb recovery following stroke.