A Top-Down versus Bottom-Up Approach to Lower-Extremity Motor Recovery and Balance Following Acute Stroke: A Pilot Randomized Clinical Trial

Neuromuscular electrical stimulation (NMES) uses electric current to produce contractions of paralyzed or paretic muscles. Mirror therapy (MT) is a cognitively induced intervention that introduces visual illusion of the paretic limb through movements of the healthy limb with external feedback that is communicated with a mirror. Both NMES and MT have been found to be effective adjuvant treatments for motor and functional recovery in stroke rehabilitation. The present study compares the efficacy of NMES and MT for lower-extremity (LE) motor recovery and balance among stroke survivors. We studied 30 stroke patients who were referred for rehabilitation (onset < 3 wk) and used Brunnstrom LE recovery stages 3 and higher. Subjects were randomized into two groups, and each received an eclectic approach for 30 min/d for 6 d to remediate LE recovery. In addition, group A (n = 15) received 30 min of surface NMES training for six major LE paretic muscle groups, and group B (n = 15) received 30 min of MT sessions. NMES had greater change scores compared to those of the MT group, as follows: LE subscale of the Fugl-Meyer Assessment (FMA-LE), 25.12 ± 3.01 vs. 23.31 ± 2.38; Berg Balance Scale (BBS), 35.12 ± 4.61 vs. 34.68 ± 5.42; and Barthel Index (BI), 40.00 ± 10.32 vs. 37.18 ± 7.73. Among groups, no significance was found for FMA-LE (p = 0.09), BBS (p = 0.80), or BI (p = 0.39). We conclude that an eclectic approach is an effective adjunct treatment in very early phases of poststroke rehabilitation, regardless of NMES or MT use.