https://doi.org/10.4081/ejtm.2025.14082
Immediate effects of electrical stimulation on serratus anterior muscle activity in people with hemiplegia post-stroke
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 22 August 2025
Upper limb impairment occurs in approximately 80% of stroke survivors, with altered scapular kinematics playing a key role in dysfunction. Serratus anterior weakness post-stroke contributes to abnormal scapular motion, limiting shoulder and arm function. This study explored whether Electrical Stimulation (ES) could immediately enhance serratus anterior activity in individuals with post-stroke hemiplegia. A pre-post intervention design was used involving 19 individuals within three months post-stroke. Surface Electromyography (sEMG) recorded serratus anterior activity during a forward reach task. The Fugl-Meyer Assessment (FMA) was also administered. Participants received 20 minutes of ES targeting the serratus anterior, after which sEMG and FMA were reassessed. Wilcoxon signed rank test compared pre- and post-intervention sEMG values. Statistical analysis showed a significant change in the area under the curve value(p < 0.01) but no significant change in RMS value. There was no change in FMA scale. Electrical stimulation showed significant changes in the muscle activity of the serratus anterior, indicating a reduction in the cost of the muscle work done during the forward reach task.
Downloads
Kazi EN, Ganvir SS. Scapular malalignment in patients with stroke: A narrative. Int J Physiother Res 2021;9:4051–7. DOI: https://doi.org/10.16965/ijpr.2021.192
Donkor ES. Stroke in the 21st century: A snapshot of the burden, epidemiology, and quality of life. Stroke Res Treat 2018;2018:3238165.
Magid-Bernstein J, Girard R, Polster S, et al. Cerebral hemorrhage: Pathophysiology, treatment, and future directions. Circ Res 2022;130:1204–29. DOI: https://doi.org/10.1161/CIRCRESAHA.121.319949
Naviwala AS, Patil S, Kumar A. Immediate effects of Kinesio taping on upper extremity movements in post-stroke hemiplegics. Int J Health Sci Res 2020;10:49–57.
Levangie PK, Norkin CC. Joint structure and function: A comprehensive analysis. 4th ed. Philadelphia: F.A. Davis Co.; 2005.
Jaraczewska E, Long C. Kinesio taping in stroke: Improving functional use of the upper extremity in hemiplegia. Top Stroke Rehabil 2006;13:31–42. DOI: https://doi.org/10.1310/33KA-XYE3-QWJB-WGT6
Kibler WB, Ludewig PM, McClure P, Uhl TL, Sciascia A, editors. Scapular Summit 2009: July 16, 2009, Lexington, Kentucky. J Orthop Sports Phys Ther 2009;39:A1–A3. DOI: https://doi.org/10.2519/jospt.2009.0303
Cailliet R. The shoulder in hemiplegia. 3rd ed. Philadelphia: F.A. Davis Co.; 1980. p. 78–86.
Chaco J, Wolf E. Subluxation of the glenohumeral joint in hemiplegia. Am J Phys Med 1971;50:139–143.
De Baets L, Jaspers E, Janssens L, Van Deun S. Characteristics of neuromuscular control of the scapula after stroke: A first exploration. Front Hum Neurosci 2014;8:933. DOI: https://doi.org/10.3389/fnhum.2014.00933
Kapadia N, Moineau B, Marquez-Chin C, Popovic MR. Feasibility and significance of stimulating interscapular muscles using transcutaneous functional electrical stimulation in able-bodied individuals. J Spinal Cord Med. 2021;44:S185–92. DOI: https://doi.org/10.1080/10790268.2021.1956251
Burkhart SS, Morgan CD, Kibler WB. Shoulder injuries in overhead athletes: The “dead arm” revisited. Clin Sports Med 2000;19:125–58. DOI: https://doi.org/10.1016/S0278-5919(05)70300-8
Kisner C, Colby LA, Borstad J. Therapeutic exercise: Foundations and techniques. 7th ed. Philadelphia: F.A. Davis Co.; 2017.
Park SI, Choi YK, Lee JH, Kim YM. Effects of shoulder stabilization exercise on pain and functional recovery of shoulder impingement syndrome patients. J Phys Ther Sci 2013;25:1359–62. DOI: https://doi.org/10.1589/jpts.25.1359
Kirar B, Pattnaik M, Mohanty P. Effect of bilateral repetitive protraction in antispastic position of suspended upper extremity on motor performance and scapular position in stroke. Adv Neurol Neurosci 2021;4:19–25. DOI: https://doi.org/10.33140/AN.04.03.01
de Kroon JR, IJzerman MJ, Chae J, et al. Relation between stimulation characteristics and clinical outcome in studies using electrical stimulation to improve motor control of the upper extremity in stroke. J Rehabil Med 2005;37:65–74. DOI: https://doi.org/10.1080/16501970410024190
Doucet BM, Lam A, Griffin L. Neuromuscular electrical stimulation for skeletal muscle function. Yale J Biol Med 2012;85:201–15.
Reaz MB, Hussain MS, Mohd-Yasin F. Techniques of EMG signal analysis: Detection, processing, classification and applications. Biol Proced Online 2006;8:11–35. DOI: https://doi.org/10.1251/bpo115
Konrad P. The ABC of EMG: A practical introduction to kinesiological electromyography. Scottsdale, AZ: Noraxon USA Inc.; 2005.
Hesam-Shariati N, Trinh T, Thompson-Butel AG, et al. A longitudinal electromyography study of complex movements in poststroke therapy: Heterogeneous changes despite consistent improvements in clinical assessments. Front Neurol 2017;8:340. DOI: https://doi.org/10.3389/fneur.2017.00340
Hu X, Suresh AK, Rymer WZ, Suresh NL. Assessing altered motor unit recruitment patterns in paretic muscles of stroke survivors using surface electromyography. J Neural Eng 2015;12:066001. DOI: https://doi.org/10.1088/1741-2560/12/6/066001
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.