Faradic electrical stimulation was applied in an attempt to stimulate neuromuscular pathways to produce muscle contractions in the left hand. Of course, the patients received daily 20 minutes training sessions focusing separately on flexor and extensor digitorum muscles, employing currently accepted parameters that avoid discomfort. The volume was progressively increased every week according to the patients’ status resolving on muscle reactivation and disuse atrophy prevention 6.

The Syrebo C-12 model, a wearable robotic glove, for CPM and active assist in the hand was used throughout the entire treatment period. This device allowed for the practice of skills that involved pick up and release control while engaging intrinsic and extrinsic muscles of the hand. Motor relearning was encouraged through peripheral feedback in addition to regulation of neuroplasticity with the help of the robotic glove. The frequency of the applied protocol involved , co-activation, and co-ordination sessions in 30 minutes daily and five time in a week for four weeks with increased aerobic activities that require active involvement of the patient in order to increase cognitive and motor integration 7 .

Figure 1

The enhancement of robotic rehabilitation with faradic stimulation was helpful because it exploited the advantages of both approaches. Faradic stimulation helped to reopen neuromuscular connections that had previously been severed; the robotic glove supported voluntary control and repeated ‘practice’ in the form of guided motor movement. This was intended to bring about suspensory changes of the central nervous system and, hence, create motor and functional recovery.

At the end of the four-week intervention, the patient demonstrated significant improvements in hand mobility and strength. The MMT score improved from 0/5 to 2/5, indicating the development of slight muscle contraction and movement without gravity. Range of motion assessments showed increased flexibility in the wrist and finger joints, and the patient achieved partial grasping ability, suggesting functional recovery.

Grip strength showed improved ability to hold objects in gravity gravity-eliminated position and dexterity tests indicated enhanced control in finger movements. Throughout the intervention, significant improvements were observed in the range of motion of the wrist and fingers. Wrist flexion increased from 0° at baseline to 30° by the end of four weeks, while wrist extension improved from 0° to 25°. Finger flexion showed a notable recovery, progressing from no movement (0°) at baseline to 60°, allowing for a near-complete fist. Finger extension also improved significantly, increasing from 0° to 40°, demonstrating enhanced ability to open the hand. Additionally, thumb abduction increased from 0° to 25°, indicating restored functionality essential for grasping and precision tasks. These improvements in joint mobility reflect the effectiveness of the intervention in promoting motor recovery and functional independence.

The patient reported increased confidence in using the left hand for basic tasks, such as grasping lightweight objects. He noted improved ability to perform self-care tasks with minimal assistance.

Specific advantages of the robotic -assisted therapy and neuromuscular stimulation have been established. Kwakkel et al. have submitted that the high-repetition therapy administered through a robot provides the desired motor improvement and Manganotti and Amelio have proved that direct electrical stimulation helps muscle strength and saves it from atrophy. Though, relatively little has been written about their functionality when used together for stroke rehabilitation 4.

The present case study lends support to the contention that an amalgamation of these modalities may further improve results of the two therapies. Recent reviews by and Hatem et al. on the issue describe new trends in the simultaneous application of neurostimulation and task-specific training to address the various motor deficits seen in patients with hemiparetic stroke 8. The current case shows that FES improves muscle existing mode, and robotic therapy increases complex movement and rewiring, both of which enable faster progression.

The observed recovery likely involves two key mechanisms:

Robotic therapy involves patients in repeated goal-oriented activities that lead to changes in brain architecture. Training of functional movements enhances the development of other neural connections which assist in replacing the destroyed motor cortex as a result of the stroke. Lee et al. explain that among the major benefits of using robotic devices for training, the more important aspect of motor learning is created by sensory feedback and proprioceptive input. Such feedback enhances control of movement and increases the extent of volitional movements in the patient 9.

Faradic electrical stimulation reproduces motor units recruiting impaired muscles and improves the neuromuscular function for the targeted joint. It helps avoiding muscle wastage and muscles contractions, which in turn helps in coming up with functional motor output. A study conducted by Hara Y, Ogawa S showed that electrical stimulation enhances transport for relearning motor excluding poor connectivity of motor cortex and peripheral nerves. When coordinated with robotic-assisted therapy it plays an important task of converting passive contraction of muscles into functionally useful movement when required 10.

These mechanisms are incorporated to form closed chain rehabilitation protocol in which both the neuroplasticity and the muscle activation are enhanced. As a result of possible stimulating both the nervous system and musculature at the same time, this dual therapy enhances the rehabilitation outcomes of patients with serious post-stroke motor deficits.