taVNS Combined With TENS on Motor Function in Stroke

The FMA-UE was used to assess motor impairment. It includes 33 items assessing movement, coordination, and reflex actions of the shoulder, elbow, forearm, wrist, and hand joints of the paretic arm. Each item consists of a 3-point scale (0, 1, and 2), with a total maximum score of 66.

The Chinese version of BMET will be used to assess cognitive function. It incorporates tests divided into two main categories: i) executive functioning and processing speed; and ii) orientation and memory. The initial performance of each item is converted to item score (0-2) and the total score (0-16) was used for statistical analysis, where a higher score indicates better general cognitive function.

The jacket test will be used to assess the upper limb proficiency in putting on and removing a long-sleeved jacket. The participants will be required to put on a long-sleeved coat completely, so that it was straight on their shoulders, and then to remove it completely, while maintaining a standing position. The time taken to complete the task was recorded.

The motor activity log (MAL) will be used to assess the ADLs. The MAL has 30 items including object manipulation and upper limb gross activities. Each item is in both quality of movement and amount of movement on a 6-point Likert scale (0-5). The total scale ranges from 0 to 150 with higher score indicate better ADL.

The CUE-T will be used to assess the upper limb function capacity. It consists of 19 unilateral and bilateral upper limb tasks. Depending on the item, scoring is based on performance of the task, the number of repetitions of the task, or time to complete the task. Raw scores are converted to a 5-point scale (0-4). Total score ranges from 0 to 120 with higher score indicate greater functional capacity. Affected side or unaffected side scores can be obtained by adding the score of the unilateral items on each side

The K-Grip hand-hold dynamometer (K-Grip, kinvent biomecanique, Montpellier, France) will be used for hand grip measurement. The participants will be seated in a comfortable chair with arm support and elbow in 90° flexion. Participants will be asked to make a maximal effort for at least 5 s with verbal encouragement. There were three trials for both side and the average value will be used for statistical analysis.

The electronic Jamar pinch gauge will be used to measure the later pinch grip strength. The participants will be seated in a comfortable chair with arm support and elbow in 90° flexion. Participants will be asked to make a maximal effort for at least 5 s with verbal encouragement. There will be three trials for both side and the average value will be used for statistical analysis.

The CUE-Q will be used to assess the self-prospective functional limitation. It consists of 32 for unilateral and bilateral upper limb use, addressing areas of reaching and lifting, pulling, and pushing, wrist actions, and hand and finger actions. The responses are given on a 5-point Likert scale representing self-perceived difficulty in performing the action. Total score ranges from 0 to 160 with higher score indicate lesser functional limitation.

The SIS will be used to assess the quality of life. The SIS comprises 59 items covers eight domains of quality of life and an extra question on stroke recovery. Each item is rated on a 5-point Likert scale in terms of the difficulty in completing each item. The summative scores are generated for each domain, ranging from 0 to 100.

The Chinese version of CIM will be used to assess individuals' perceptions of community integration. It is a 10-item questionnaire with each item rated on a 5-point Likert scale, yielding a total score that ranges from 10 to 50. Higher scores indicate a better degree of perceived community integration.