Class IV Laser Therapy And NMES In Stroke Rehabilitation: A Comparative Study Of Upper Limb Motor Control Improvements In Chronic Stroke Patients

Abstract

Background: Stroke is a leading cause of chronic disability, with upper limb motor impairments being among the most persistent and functionally limiting consequences. These deficits often remain even after standard rehabilitation, particularly in patients more than six months post- stroke. Novel interventions like Class IV Laser Therapy and Neuromuscular Electrical Stimulation (NMES) are gaining traction due to their potential to promote neuroplasticity and improve motor outcomes. While Laser Therapy is thought to accelerate tissue repair and reduce inflammation, NMES activates paretic muscles and enhances motor control via electrical stimulation. However, direct comparative data in chronic stroke populations remain scarce.

Objective: The objective of this study was to compare the effectiveness of Class IV Laser Therapy and NMES in improving upper limb motor control in chronic stroke patients, using functional and electrophysiological outcome measures.

Methods: A total of 20 chronic stroke patients (chronicity range: 12–30 months; mean ≈ 19.5 months) were randomly assigned to two intervention groups: Laser Therapy (n=10) and NMES (n=10). Patients ranged in age from 54 to 73 years, with equal distribution by sex (10 males, 10 females). The cohort included 12 ischemic and 8 hemorrhagic stroke cases, with an even mix of right and left hemiparesis. All patients had preserved cognitive function (MMSE ≥ 25), and moderate spasticity (Modified Ashworth Scale mostly 1 to 2+). Fugl-Meyer Assessment for Upper Extremity (FMA-UE) was the primary outcome measure, alongside the Motor Activity Log (MAL) and surface electromyography (EMG). Interventions were administered three times per week for four weeks, with follow-up assessments conducted immediately post- intervention and at 8 weeks.

Results: At baseline, FMA-UE scores ranged from 27 to 35, indicating mild to moderate impairment. Post-intervention, both groups showed significant improvement (p < 0.05). The Laser Therapy group improved by a mean of 10.4 points, while the NMES group showed a mean gain of 9.2 points on the FMA-UE scale. MAL scores improved in both groups, with patients reporting greater use of the affected arm in daily activities. EMG recordings revealed increased muscle activation in all participants; however, the NMES group exhibited slightly higher changes in EMG amplitudes, suggesting more robust muscle recruitment. No serious adverse effects were observed. Mild discomfort was reported during NMES sessions, while Laser Therapy was well tolerated throughout.

Conclusion: Both Class IV Laser Therapy and NMES effectively improved upper limb motor function in chronic stroke patients. Laser Therapy yielded marginally greater functional improvement on clinical scales, while NMES demonstrated stronger effects in terms of muscle activation. These results suggest that either therapy can serve as a valuable adjunct to conventional rehabilitation, depending on therapeutic goals. Future studies should explore combined protocols, larger cohorts, and longer-term outcomes to further define their role in stroke recovery programs.