BACKGROUND: The purpose was to determine the cumulative longitudinal effects of upper extremity distributed practice with variable treatment protocols involving EMG-triggered neuromuscular stimulation and coupled bilateral movements. METHODS: Sixteen chronic stroke subjects were randomly selected to complete 5 effective upper extremity treatment protocols over 12 months. The subjects were randomly assigned to 1 of 2 treatment orders. Consistent across the orders and protocols, the participants completed 90 min of training per day for 4 days during separate 2-week rehabilitation periods. RESULTS: Data for the 5 primary outcome measures were analyzed in separate mixed design ANOVAs (treatment order x test session: 2x6). The analyses revealed distinct cumulative treatment evidence later in training in comparison to the baseline motor capabilities: (1) higher number of blocks moved; (2) higher percentage of blocks moved by the impaired hand; (3) faster motor reaction time (peripheral component), and (4) faster total reaction time. CONCLUSIONS: These chronic stroke patients displayed robust cumulative motor improvement effects from the longitudinally distributed practice of active neuromuscular stimulation and coupled bilateral movements.

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