Neuromuscular Electrical Stimulation in Stroke Rehabilitation: Current Evidence, Clinical Applications, and Future Directions

##article.abstract##

Stroke remains one of the leading causes of long-term disability worldwide and continues to place a significant physical,
emotional, and economic burden on individuals, their families, and healthcare systems. Although advances in emergency
stroke care and medical management have improved survival rates, many stroke survivors continue to experience long-
term impairments such as muscle weakness, impaired motor control, spasticity, balance deficits, gait abnormalities, and
limitations in performing activities of daily living. These persistent impairments emphasize the importance of
comprehensive rehabilitation aimed at restoring functional independence and improving quality of life.
Conventional physiotherapy remains the cornerstone of stroke rehabilitation and focuses on improving movement through
strengthening exercises, balance training, gait re-education, task-oriented practice, and functional mobility training.
However, recovery is often incomplete, particularly in individuals with moderate to severe neurological deficits.
Consequently, several adjunctive rehabilitation approaches have been introduced to enhance motor recovery and promote
neuroplasticity. Among these, neuromuscular electrical stimulation (NMES) has gained increasing attention because of its
ability to facilitate muscle contraction, improve voluntary motor control, reduce muscle atrophy, and support functional
recovery.
The purpose of this narrative review is to summarize the current evidence regarding the role of NMES in stroke
rehabilitation, describe its physiological mechanisms, discuss its clinical applications, and highlight future research
directions. A comprehensive literature search was conducted using PubMed, Scopus, PEDro, and Google Scholar, focusing
primarily on studies published between 2015 and 2026. Randomized controlled trials, systematic reviews, meta-analyses,
and clinical practice guidelines involving adult stroke survivors were reviewed to provide a comprehensive overview of
the available evidence.
Current literature indicates that NMES, particularly when combined with conventional physiotherapy and task-specific
training, can improve upper and lower limb motor function, muscle strength, gait performance, balance, and functional
independence in appropriately selected stroke survivors. Evidence suggests that early application of NMES may further
enhance recovery by promoting neuroplasticity and improving neuromuscular activation, although beneficial effects have
also been reported in individuals with chronic stroke. Nevertheless, considerable variability exists in stimulation
parameters, treatment duration, patient selection, and outcome measures, making it difficult to establish standardized
clinical protocols.
Overall, NMES should be considered a valuable adjunct to conventional physiotherapy rather than a replacement for it.
When incorporated into individualized rehabilitation programs, it has the potential to enhance functional recovery and
improve long-term outcomes after stroke. Future multicenter randomized controlled trials with standardized treatment
protocols, larger sample sizes, and extended follow-up periods are needed to determine optimal stimulation parameters
and strengthen the evidence supporting its routine clinical use.