FES-Assisted Upper Extremity Ergometer Training in Subacute Stroke

Stroke frequently leads to persistent upper extremity motor impairment and reduced aerobic capacity, which negatively affect functional independence and quality of life. In the subacute phase after stroke, rehabilitation interventions that simultaneously target motor recovery and cardiovascular fitness may improve overall functional outcomes.

This study is designed as a prospective, randomized trial conducted at a single center. A total of 24 patients aged 18-85 years with subacute stroke (≤6 months after stroke onset) and unilateral hemiplegia will be included. Eligible participants must be able to follow simple commands, have a Brunnstrom upper extremity stage between 1 and 5, and have a Modified Ashworth Scale score below 3.

Participants will be allocated into two groups using the sealed envelope method. Both groups will receive conventional rehabilitation consisting of range of motion exercises, strengthening exercises, stretching, neurophysiological exercises, balance and coordination training, and functional training, applied for 45 minutes per day, five days per week, for four weeks.

In addition to conventional rehabilitation, the first group will receive upper extremity ergometer training. The second group will receive functional electrical stimulation (FES)-assisted upper extremity ergometer training. In the FES-assisted group, surface electrodes will be placed on selected upper extremity muscles according to individual needs, including wrist extensors with triceps brachii or wrist flexors with biceps brachii. Electrical stimulation will be synchronized with the ergometer cycling movement.

Upper extremity ergometer and FES-assisted ergometer training will be applied for 30 minutes per session, three days per week, for approximately four weeks, resulting in a total of 10 sessions. All interventions will be supervised by trained health care professionals.

Participants will be evaluated at baseline (before the intervention) and at the end of the 10 session intervention period. Primary outcome measures include aerobic capacity assessed by cardiopulmonary exercise testing and upper extremity motor function. Secondary outcome measures include upper extremity strength, sensory function, functional ambulation, functional independence, and activities of daily living.

The findings of this study are expected to provide evidence regarding the effectiveness of adding FES-assisted upper extremity ergometer training to conventional rehabilitation in improving aerobic capacity and upper extremity function in patients with subacute stroke.

Inclusion criteria

• Inclusion Criteria:
• Age between 18 and 85 years
• Diagnosis of subacute stroke (≤6 months after stroke onset)
• Ischemic or hemorrhagic stroke confirmed by imaging
• Unilateral hemiplegia affecting the upper extremity
• Brunnstrom upper extremity motor recovery stage between 1 and 5
• Modified Ashworth Scale score <3 in the affected upper extremity
• Ability to follow simple verbal commands and cooperate with assessments
• Medically stable and able to participate in an exercise-based rehabilitation program
• Voluntary agreement to participate in the study and provision of written informed consent

Exclusion criteria

• Severe cognitive impairment or communication disorder preventing cooperation
• Severe cardiopulmonary disease or other medical conditions contraindicating exercise testing or training
• Uncontrolled hypertension or cardiac arrhythmia
• Severe musculoskeletal disorders of the upper extremity limiting participation in ergometer training
• Presence of implanted electronic devices (e.g., pacemaker) contraindicating functional electrical stimulation
• History of epilepsy or uncontrolled seizures
• Severe spasticity (Modified Ashworth Scale ≥3)
• Participation in another interventional study during the study period