Is Functional Electrical Stimulation (FES) effective compared to Conventional physiotherapy treatments for improving the motor functions of upper limb and activities of daily living (ADLs) in acute and sub-acute stroke patients?

• Study setting - Neurology and Neuro-surgery Physiotherapy Unit, Teaching Hospital, Anuradhapura. • Randomization - 1:1 randomization using sealed envelopes. • Intervention - Functional Electrical Stimulation. Functional Electrical Stimulation (FES) is the electrical stimulation applied to a muscle during a voluntary movement. FES consists of the application of moderate-intensity and cyclic electrical stimulation over selected muscles to generate functional movements that mimic voluntary contractions and to restore functions that were lost by facilitating motor re-learning. Electrodes are placed over the nerve(s) innervating the muscle to be stimulated and stimulation is delivered. The intensity of the stimulation will determine by which muscles are contracted as well as the strength of their contraction. • Treatment group - Functional electrical stimulation will be performed by the principal investigator over the shoulder flexors (Biceps), elbow extensors (Triceps) and wrist and finger extensors (posterior forearm). Treatment will be continued for 40 minutes a day 3 days a week for 8 weeks. • Control group - sham FES will be performed by the principal investigator over the same muscle groups as in treatment group for 40 minutes a day 3 days a week for 8 weeks. • Both groups will receive conventional physiotherapy program (Standard therapy program) for 30 minutes a day, 3 days a week, for 8 weeks. Standard physiotherapy program will be given to both interventional and control groups. The conventional physiotherapy programme will include positioning, trunk training exercises, active/ passive range of motion exercises, stretching and strengthening exercises, functional task specific repetitive training, gait training and progressive balance training. • Blinding - Both patients and outcome assessors will be blinded to the treatments, and patients will remain unaware of whether they are receiving active or sham Functional Electrical Stimulation.

• Age between 18 to 70 years • Both male and female • Post stroke hemiparesis • First unilateral stroke with upper limb involvement. • Acute and sub-acute stroke patients up to 6-month period from onset • Both hemorrhagic/ischemic stroke patients • Modified Ashworth scale (MAS) score 2 or less than 2 at wrist and elbow. • Sufficient cognitive ability to follow instructions.

• Contraindicated for Functional Electrical stimulation (FES) which include: Poor skin condition (pressure sores, sensitive skin for self-adhesive electrodes) Poorly controlled epilepsy Current pregnancy: Cardiac pacemakers Cancerous tumor: Metal implants: Unhealed fracture. Suspected, diagnosed, or uncontrolled Cardio-vascular conditions: Severe muscle spasticity or contractures. Botulinum toxin

• Presence of psychological or emotional issues depend on medical diagnosis due to current condition or any previous illness. • Presence of previous history of head injury, trauma or concussions. • Any other associated Musculoskeletal or Neurological conditions which might affect upper limb functions. • Numeric Pain Scale >7 (NPS) • Visual defects • Inability to sit in a standard armless chair for at least 40 min • Currently having other treatment options other than medical treatments.