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Non-Invasive Brain Stimulation Combined with Neuromuscular Electrical Stimulation for Upper Limb Rehabilitation in Stroke Survivors: A Systematic Review

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Abstract

Purpose of Review

To examine the effects of combining non-invasive brain stimulation (NIBS) with neuromuscular electrical stimulation (NMES) on upper limb function in patients with a stroke.

Recent Findings

Of 580 articles, five studies met the eligibility criteria, involving 226 patients (mean age = 58.73 years), 45% of whom were female. Three studies considered "good" quality, one exhibited "excellent" quality, and one considered "poor" quality on the PEDro scale. There is heterogeneous evidence regarding the effects of the combined NIBS and NMES intervention on upper limb function in patients with a stroke.

Summary

The combination of NIBS with NMES might be a safe and well-tolerated intervention for patients with a stroke. However, the initial findings indicate that evidence regarding the effects of the combined NIBS and NMES intervention on upper limb function poststroke was limited. Further studies are strongly needed to understand the effects of the combined NIBS and NMES on upper limb outcomes and to identify the optimal treatment parameters.

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Data Availability

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Acknowledgements

I would like to thank Dr. Qusai Janada and Dr. Tareq Youssef, assistant professors in the physiotherapy department at Middle East University, for their general supervision in search strategy, data extraction, and methodological quality assessment.

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This research did not receive any specific funding from public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Physiotherapy, Middle East University, Amman, Jordan

    Anas R. Alashram

  2. Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy

    Anas R. Alashram

  3. Applied Science Research Center, Applied Science Private University, Amman, Jordan

    Anas R. Alashram

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A.A: writing original draft, Search strategy, Quality assessment, Data extraction The author reviewed the manuscript

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Appendix A: Search strategy in MEDLINE

Appendix A: Search strategy in MEDLINE

(1) Stroke [MeSH].

(2) Cerebrovascular accident.

(3) CVA

(4) 1 OR 2 OR 3

(5) Noninvasive brain stimulation.

(6) transcranial direct current stimulation [MeSH].

(7) repetitive transcranial magnetic stimulation.

(8) Brain stimulation.

(9) rTMS.

(10) tDCs.

(11) Electric stimulation [MeSH].

(12) Electric stimulation therapy [MeSH].

(13) Neuromuscular electrical stimulation.

(14) NMES

(15) 5 OR 6 OR 7 OR 8 OR 9 OR 10 OR 11 OR 12 OR 13 OR 14

(16) Upper extremity [MeSH].

(17) Function.

(18) Disability.

(19) Muscle strength [MeSH].

(20) Motor.

(21) Physical.

(22) Independence.

(23) Range of motion.

(24) Muscle spasticity [MeSH].

(25) 18 OR 19 OR 20 OR 21 OR 22 OR 23 OR 24 OR 25 OR 26 OR 27

(33) 4 AND 15 AND 25

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Alashram, A.R. Non-Invasive Brain Stimulation Combined with Neuromuscular Electrical Stimulation for Upper Limb Rehabilitation in Stroke Survivors: A Systematic Review. Curr Phys Med Rehabil Rep 12, 100–118 (2024). https://doi.org/10.1007/s40141-023-00428-0

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