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Alon G, Levitt AF, McCarthy PA: Functional electrical stimulation (FES) may modify the poor prognosis of stroke survivors with severe motor loss of the upper extremity: a preliminary study. Am J Phys Med Rehabil 2008;87:627–636.This nonblinded, block-randomized clinical trial tested the hypothesis that task-oriented functional electrical stimulation (FES) can enhance the recovery of upper-extremity volitional motor control and functional ability in patients with poor prognosis.Ischemic stroke survivors (FES + exercise group, n = 13, 17.4 ± 7.6 days after stroke, and exercise-only group n = 13, 23.8 ± 10.9 days after stroke) trained with task-specific exercises, 30 min, twice each day. The FES group practiced the exercises combined with FES that enabled opening and closing of the paretic hand and continued with FES without exercises for up to 90 mins of additional time twice a day. Both groups trained for 12 wks. Volitional motor control (modified Fugl–Meyer [mF-M]), hand function (Box & Blocks [B&B], and Jebsen–Taylor light object lift [J-T]) were video recorded for both upper extremities at baseline and at 4, 8, and 12 wks.Mean mF-M score of the FES group (24 ± 13.7) was significantly better (P = 0.05) at 12 wks compared with the control group that scored 14.2 ± 10.6 points. The B&B mean score did not reach statistical significance (P = 0.058) in favor of the FES group (10.5 ± 2.4 blocks) over the control group (2.5 ± 4.9 blocks). The J-T task time did not differ between groups. Eight (FES) compared with three (control) patients regained the ability to transfer five or more blocks (P = 0.051), and six (FES) compared with two (control) completed the J-T task in 30 secs or less after 12 wks of training (P = 0.09).FES + exercise as used in this preliminary study is likely to minimize motor loss, but it may not significantly enhance the ability to use the upper extremity after ischemic stroke. Anecdotally, more patients may regain some functional ability after training with FES compared with training without FES. Patients with severe motor loss may require prolonged task-specific FES training.