Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies

This type of research would not be necessary if our fucking failures of stroke associations kept an up-to-date database of all effective stroke interventions.

 Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies

Saba Anwer 1 , Asim Waris 1 , Syed Omer Gilani 1 , Javaid Iqbal 1 , Nusratnaaz Shaikh 2 , Amit N. Pujari 3,4 and Imran Khan Niazi 2,5,6, * 1 School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; sanwer.bmes19smme@student.nust.edu.pk (S.A.); asim.waris@smme.nust.edu.pk (A.W.); omer@smme.nust.edu.pk (S.O.G.); j.iqbal@ceme.nust.edu.pk (J.I.) 2 Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand; nusrat.shaikh@aut.ac.nz 3 School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK; amit.pujari@ieee.org 4 School of Engineering, University of Aberdeen, Aberdeen AB24 3FX, UK 5 Center of Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand 6 Center for Sensory-Motor Interaction, Department of Health Science & Technology, Aalborg University, 9000 Alborg, Denmark * Correspondence: imran.niazi@nzchiro.co.nz 

Abstract: 

Stroke has been one of the leading causes of disability worldwide and is still a social health issue. Keeping in view the importance of physical rehabilitation of stroke patients, an analytical review has been compiled in which different therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR. This literature review mainly focuses on the randomized controlled studies, reviews, and statistical meta-analyses associated with motor rehabilitation after stroke. Moreover, with the increasing prevalence rate and the adverse socio-economic consequences of stroke, a statistical analysis covering its economic factors such as treatment, medication and post-stroke care services, and risk factors (modifiable and non-modifiable) have also been discussed. This review suggests that if the prevalence rate of the disease remains persistent, a considerable increase in the stroke population is expected by 2025, causing a substantial economic burden on society, as the survival rate of stroke is high compared to other diseases. Compared to all the other therapies, VR has now emerged as the modern approach towards rehabilitation motor activity of impaired limbs. A range of randomized controlled studies and experimental trials were reviewed to analyse the effectiveness of VR as a rehabilitative treatment with considerable satisfactory results. However, more clinical controlled trials are required to establish a strong evidence base for VR to be widely accepted as a preferred rehabilitation therapy for stroke.

Revolutionary study finds optimal FES settings for enhancing muscle recovery training

 Why are we doing FES anyway, nothing has been done to stop the spasticity? There obviously is some electrical signal that causes spasticity. Why not use this FES to disrupt that signal? Then you would be much more likely to get recovery going.

Revolutionary study finds optimal FES settings for enhancing muscle recovery training

Peer-Reviewed Publication

Beijing Institute of Technology Press Co., Ltd

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Credit: Cyborg and Bionic Systems

At present, stroke has become one of the most serious neurological diseases, which is usually accompanied by movement disorders and cognitive impairment. In recent years, the number of stroke patients has increased annually . Most stroke patients are accompanied by movement disorders, which seriously affect the normal life of patients. A groundbreaking study conducted by Shihao Sun and colleagues, recently published in the Cyborg Bionic Systems journal, has introduced innovative findings in the realm of Functional Electrical Stimulation (FES), particularly its application in muscle recovery and fatigue management.

Functional electrical stimulation (FES) technology is a new type of treatment, which is through the simulation of the nerve on the muscle issued by the electrical signals for rehabilitation training.

Functional Electrical Stimulation has been a beacon of hope for patients suffering from severe neurological disorders such as stroke, which often leaves individuals with significant movement and cognitive impairments. This new research primarily focuses on optimizing the parameters of FES to enhance muscle recovery without causing additional muscle fatigue, a common setback in previous applications.

The study meticulously analyzed the effects of FES parameter settings on muscle health, establishing a crucial relationship between current amplitude and the optimal stimulation time. This relationship is key to preventing muscles from entering an excessive fatigue state, thereby promoting more effective recovery.

In a detailed experiment involving ten subjects undergoing dumbbell weightlifting training, the research team, led by Sun and Guizhi Xu from Hebei University of Technology, China, monitored the subjects' muscle responses via surface electromyography (sEMG). This technique helped them craft a nuanced understanding of how muscles react under different levels of electrical stimulation.

Their findings suggest that the most significant parameter in FES is the current amplitude, which, when optimized, can prevent muscles from over-fatigue.This breakthrough is depicted in a linear curve developed during the study, demonstrating a direct relationship between current amplitude and maximum safe stimulation time. This curve is anticipated to be a valuable tool for clinicians and therapists focusing on rehabilitation through FES.

Moreover, the research explored the effects of varying the frequency and pulse width of the FES, uncovering that these adjustments could significantly impact muscle fatigue rates and recovery times. This has important implications for the customization of FES treatments to individual patient needs, potentially leading to more personalized and effective rehabilitation strategies.

By integrating a complex array of biomedical engineering techniques, including wavelet transform and RMS normalization, the team was able to provide robust scientific insights that pave the way for the next generation of FES devices. These devices could offer more adjustable and patient-specific settings, reducing the risk of muscle damage and enhancing the overall effectiveness of recovery therapies.

This study not only marks a significant advancement in the use of Functional Electrical Stimulation for muscle recovery but also highlights the potential for future technologies to be more adaptable to the physiological conditions of different patients, ensuring safer and more effective recovery processes.

As the research moves forward, further studies will likely focus on refining these parameters and exploring additional ways to harness the power of FES in medical rehabilitation. The ultimate goal is to provide stroke survivors and individuals with neurological impairments a more effective path to regain muscle function and improve their quality of life.

The paper, "Function Electrical Stimulation Effect on Muscle Fatigue Based on Fatigue Characteristic Curves of Dumbbell Weightlifting Training" was published in the journal Cyborg and Bionic Systems on Jun 6, 2024, at DOI: https://doi.org/10.34133/cbsystems.0124

Soft robotics and functional electrical stimulation advances for restoring hand function in people with SCI: a narrative review, clinical guidelines and future directions

Yes, this is for spinal cord injury but what can your doctor use from this to get your hand recovered? 

Do you prefer your  doctor incompetence NOT KNOWING? OR NOT DOING?

Soft robotics and functional electrical stimulation advances for restoring hand function in people with SCI: a narrative review, clinical guidelines and future directions

• Lucas R. L. Cardoso,
• Vanesa Bochkezanian,
• Arturo Forner-Cordero,
• Alejandro Melendez-Calderon &
• Antonio P. L. Bo 

Journal of NeuroEngineering and Rehabilitation volume 19, Article number: 66 (2022) Cite this article

• Metrics details

Abstract

Background

Recovery of hand function is crucial for the independence of people with spinal cord injury (SCI). Wearable devices based on soft robotics (SR) or functional electrical stimulation (FES) have been employed to assist the recovery of hand function both during activities of daily living (ADLs) and during therapy. However, the implementation of these wearable devices has not been compiled in a review focusing on the functional outcomes they can activate/elicit/stimulate/potentiate. This narrative review aims at providing a guide both for engineers to help in the development of new technologies and for clinicians to serve as clinical guidelines based on the available technology in order to assist and/or recover hand function in people with SCI.

Methods

A literature search was performed in Scopus, Pubmed and IEEE Xplore for articles involving SR devices or FES systems designed for hand therapy or assistance, published since 2010. Only studies that reported functional outcomes from individuals with SCI were selected. The final collections of both groups (SR and FES) were analysed based on the technical aspects and reported functional outcomes.

Results

A total of 37 out of 1101 articles were selected, 12 regarding SR and 25 involving FES devices. Most studies were limited to research prototypes, designed either for assistance or therapy. From an engineering perspective, technological improvements for home-based use such as portability, donning/doffing and the time spent with calibration were identified. From the clinician point of view, the most suitable technical features (e.g., user intent detection) and assessment tools should be determined according to the particular patient condition. A wide range of functional assessment tests were adopted, moreover, most studies used non-standardized tests.

Conclusion

SR and FES wearable devices are promising technologies to support hand function recovery in subjects with SCI. Technical improvements in aspects such as the user intent detection, portability or calibration as well as consistent assessment of functional outcomes were the main identified limitations. These limitations seem to be be preventing the translation into clinical practice of these technological devices created in the laboratory.

Background

Spinal cord injury (SCI) often leads to motor and sensory deficits, in addition to other complications, such as autonomic dysfunction, respiratory problems and urinary incontinence [1]. Among these complications, one of the major therapeutic priorities of people with tetraplegia is the recovery of arm and hand function since they are essential to independently perform most of the activities of daily living (ADLs) [2,3,4].

The rehabilitation of arm, hand and finger-related functional abilities after SCI can follow different approaches. One of them is through invasive procedures, like nerve and tendon transfer, in which preserved working nerves (tendons) are surgically re-directed to proximal non-functioning motor pathways [5]. Although this technique has the potential to produce relevant functional outcomes, it may demand long training time for adaptation post-surgery [5].

Another alternative to recover hand function after SCI are activity-based therapies. These comprise several training protocols and techniques, usually delivered under the supervision of physical or occupational therapist, and have the potential to increase range of motion, decrease pain and spasticity or recover lost functional movements, relying on the principles of neuroplasticity [6]. When the patient’s limb is activated, combining volitional control and external assistance, sensory afferent input is produced, which triggers a series of neurorestoration processes (e.g., synapse formation, remyelination, neural reorganization and repair), either in supraspinal or in spinal structures [6,7,8]. However, due to the high number of repetitions required to enhance neuroplastic adaptations, this type of intervention can be time-consuming and costly [7, 9, 10]. To potentially reduce treatment cost and time, and improve functional outcomes, activity-based therapies can be supported by technological hand neuroprostheses. In addition to therapeutical purposes, these engineering features have been employed as assistive devices, increasing the user’s independence and augmenting the overall practicing time.

Functional electrical stimulation (FES) is one of the technologies used to build neuroprostheses to support activity-based training after SCI. During a conventional FES therapy, subjects are encouraged to voluntary activate their muscles to perform a certain task while the FES system stimulates the muscles using superficial or implanted electrodes [11, 12]. According to this approach, purposeful movements are produced in parallel to a combination of cortical activation (due to the voluntary attempt) and peripheral stimulation. The FES produces additional afferent information thus enhancing the practice-induced brain and spinal plasticity [13,14,15]. A common method used to trigger electrical stimulation is through a push-button. However, a more intuitive system detects user intent via physiological signals, e.g., electroencephalography (EEG) or electromyography (EMG), which increases usability and learning outcomes, by pairing stimulation with movement intention [16]. Despite promising results as a therapeutical tool [17], FES devices are limited in generating high accuracy control and muscle selectivity [18]. In this respect, implanted systems [19] or superficial multi-pad electrode matrices [20, 21] can yield better outcomes but they still have many obstacles, such as the limitations of its use in case of lower motor neuron damage [22, 23] or in people with cervical injury without any volitional control of the hand. [14].

Robotic systems are also employed to support activity-based therapy for hands after SCI. Typically, these are non-portable devices that are able to assist end-user’s hand in a clinical setting, throughout repeatable and predictable movement patterns [24]. However, most of these devices are bulky and are built using rigid links, which hampers the biomimetics of the human hand [25], and possibly limits the potential outcomes of the therapy [26]. In this sense, neuroprostheses based on Soft Robotics (SR) devices have emerged as a specific category of robotic rehabilitation systems, relying on soft actuators (usually back-drivable) and flexible links, increasing comfort and flexibility to adjust to the contours of the human body [25, 27,28,29]. SR devices developed for hand function are also intended to be lightweight and portable, possibly for home-rehabilitation use, which is important to increase end-user adherence to treatment and also to meet assistance needs in ADLs. The underlying neuroplastic process associated to the use of SR tools is the same as observed in conventional activity-based therapies, since they also provide mechanical assistance for the movement execution. However, they are intended to increase the user engagement (by supporting activities in a daily basis) and consequently increase the number of repetitions (practice time), for a more affordable cost compared to the constant supervision of a physiatrist [28].

Noticeably, FES and SR have complementary features which encourages protocols combining both technologies. In a recent review, Dunkelberger and colleagues described a hybrid muscle stimulation and robotic assistance that was used for upper limb movement in people with SCI [30]. Even if the review did not focus on hand function or in SR, the authors concluded that the combination of FES and SR was promising, but argued that technological advances (e.g., improve tunability, reduce size and weight or detect user intent in an intuitive and unobtrusive way), both in FES and robotics, should be achieved to be fully integrated in an efficient hybrid system [30].

The present narrative review aims to identify the effects of FES, SR and their combination in the recovery of hand function in people with SCI. Therefore, this review summarizes the most recent research articles that presented any hand functional outcomes in people with SCI, using neuroprostheses based on FES and/or SR, either for assistance or therapy purposes. Results from this review will inform engineers on the next steps to develop these technologies and will allow clinicians to use this information as easy-to-use clinical guidelines.

More at link.

Patient-specific functional electrical stimulation strategy based on muscle synergy and walking posture analysis for gait rehabilitation of stroke patients

Now write this up as a proposed protocol and distribute this to all 10 million yearly stroke survivors  now and into the future.

Your responsibility since we have fucking failures of stroke associations that can't even mange to do this simple thing for survivors. But then most stroke associations are not for survivors, they are to remove money from them and supposedly train doctors.

 Patient-specific functional electrical stimulation strategy based on muscle synergy and walking posture analysis for gait rehabilitation of stroke patients

Junghwan Lim1,*, Taehyun Lim2,*,

Jungeun Lee1 , Junhyuk Sim1

,
Hyungjun Chang1
, Bumchul Yoon2 and
Hoeryong Jung1

Abstract

Objective: 

To evaluate a novel multi-channel functional electrical stimulation (FES) rehabilitation
method based on the evaluation of patient-specific walking dysfunction.
Methods:  

This study investigated a novel multi-channel FES-based rehabilitation method that
analysed the patient’s muscle synergy and walking posture. A patient-specific FES profile was
produced in the pre-evaluation stage by comparing the muscle synergy and walking posture of the
patient with those of healthy control subjects. During the rehabilitation phase, this profile was
used to determine an appropriate FES pulse width and amplitude for stimulating the patient’s
muscles as they walked across a flat surface.
Results: 

Two stroke patients with hemiplegic symptoms participated in a clinical evaluation of
the proposed method involving a 4-week course of rehabilitation. An evaluation of the rehabilitation results based on a comparison of the pre- and post-rehabilitation muscle synergy and
walking posture revealed that the rehabilitation enhanced the muscle synergy similarity between
the patients and healthy control subjects and their quantitative walking performance, as measured
by a 10-m walk test and walking speed, by up to 23.38% and 30.00%, respectively.
Conclusion: 

These results indicated that the proposed rehabilitation method improved walking
ability by improving muscle coordination and adequately supporting weakened muscles in stroke
patients.
Keywords
Stroke rehabilitation, functional electrical stimulation, muscle synergy
Date received: 17 November 2020; accepted: 20 April 2021

Introduction

Walking impairment is a major concern for stroke patients because it significantly contributes to functional disability and can lead to disruption in their quality of life.^1–3Generally, strokes result in muscle weakness and spasticity of the paretic limb that can lead to disruptions in interlimb coordination control. Although the terms ‘muscle weakness’ and ‘coordination’ technically describe different phenomena, they are used interchangeably in this context because
most stroke patients exhibit muscle weakness and coordination problems simultaneously.⁴ Foot drop is associated with not only problems in terms of ankle muscle coordination but also weakness of the tibialis anterior muscle, which is noticeable relative to weaknesses in other muscles of the paretic limb.⁵ Because the impaired walking patterns of stroke patients such as circumduction and steppage gait are caused by a combination of coordination problems and muscle weakness, these should be considered together in constructing an effective rehabilitation strategy. Coordinated walking patterns are performed either through motor modules or muscle synergies.^1,6 A muscle synergy represents a system of commands from the central nervous system (CNS) to several muscles that coordinate a single action. In
healthy individuals, walking typically involves four muscle synergies – weight acceptance (WA), push off (PO), foot clearance (FC) and leg deceleration (LD).^1,7–10 Absent or weakened muscle synergies can be used to identify a patient’s muscle coordination problem. In previous studies, it has been found that stroke patients exhibit a reduced number of synergies on their paretic side as a result of the merging of motor modules; this implies that a non-functional muscle co-contraction is reflected in walking dysfunction.^7,8,11 Recent studies have proposed the use of muscle synergy, along with conventional indices such as cadence, walking speed and walking posture, as an effective measure for assessing a patient’s overall walking performance.^12–14 A combination of functional electrical stimulation (FES) and walking rehabilitation is an effective intervention for stroke patients.^15–17 FES can effectively enhance motor learning and CNS plasticity, and single- or dual-channel FES can be applied
to the dorsiflexor muscles in the walking rehabilitation process to prevent foot drop during the swing phase.^2,3,6,18 Recently, rehabilitation methods applying multichannel FES based on muscle synergy analysis have been proposed as a solution to muscle coordination problems caused by CNS damage.^1,8,19 Although these methods improve muscle coordination in the lower extremities through the simultaneous electrical stimulation of multiple muscles on he paretic side, they cannot be used to individually strengthen single weakened muscles (such as the tibialis anterior muscle in the case of foot drop) because they only modulate the FES pulse width. Thus, the muscle weakening cannot be
directly elevated through these rehabilitation methods. This current report proposes a novel
multi-channel FES rehabilitation method based on the evaluation of patient-specific walking dysfunction. The proposed method utilizes muscle synergy and walking posture analysis to produce an FES profile that addresses the muscle coordination and weakness problems simultaneously by modulating both the FES pulse width and amplitude. The pulse width modulation adapts the approach used under existing methods to address muscle synergy dysfunction,1 while the amplitude modulation
addresses walking posture dysfunction by strongly contracting individual weakened muscles. Since the higher amplitude of electrical stimulation causes the larger muscle contraction,^20–23 the strength of muscle contraction can be controlled effectively by amplitude modulation. In the literature, it has been shown that amplitude modulation can be used effectively for improving the muscle strength in the stroke rehabilitation.^24,25 The proposed rehabilitation method was validated through clinical
evaluations of two stroke patients. The rehabilitation results were presented by comparing pre- and post-evaluation of the walking dysfunction of the two patients.

A novel functional electrical stimulation treatment for recovery of hand function in hemiplegia: 12-week pilot study

 WHOM very specifically is going to do the followup research that will get this to persist. I want an EXACT name. Leaders assign concrete goals and expect completion of those goals. The stroke medical world has NO LEADERS, which is why nothing in stroke is ever solved.

A novel functional electrical stimulation treatment for recovery of hand function in hemiplegia: 12-week pilot study

2008, Neurorehabilitation and Neural Repair
 Jayme S. Knutson, PhD
,
Terri Z. Hisel, OTR/L
,
Mary Y. Harley, OTR/L
, and
John Chae, MD
Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio (JSK,JC); Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center,Cleveland, Ohio (TZH, MYH, JC); and Department of Physical Medicine and Rehabilitation, CaseWestern Reserve University, Cleveland, Ohio (JC)

Abstract

Background—
Loss of finger extension is common after stroke and can severely limit hand function. Contralaterally controlled functional electrical stimulation (CCFES) is a new treatment aimed at restoring volitional finger and thumb extension. A previous pilot study showed reductions in hand impairment after 6 weeks of CCFES, but the effect did not persist after end of treatment.
Objective—
This study aimed to evaluate the feasibility of achieving greater and more persistent gains with CCFES by increasing the treatment period to 12 weeks.
Methods—
CCFES uses neuromuscular electrical stimulation to open the paretic hand in direct proportion to the degree of volitional opening of the unimpaired contralateral hand, which isdetected by an instrumented glove. Three subjects with chronic hemiplegia participated in a 12-week CCFES treatment, which consisted of daily CCFES-assisted active repetitive hand-opening exercises and twice weekly functional task practice with CCFES.
Results—
Maximum voluntary finger extension increased by 101° and 68° for subjects 1 and 2,respectively, but subject 3 had no improvement in finger extension. Box and Block score increasedby 6, 15, and 7 blocks, and upper extremity Fugl-Meyer score increased by 11, 15, and 7 points forsubjects 1, 2, and 3, respectively. The finger extension gains declined at the 1-month and 3-monthfollow-up for subjects 1 and 2, but the gains in Box and Block and Fugl-Meyer scores persisted at follow-up.
Conclusions—
Greater reductions in hand impairment were achieved by extending the treatment period. The effect and its longevity may be related to baseline impairment level.
Keywords
Stroke
;
 Hemiplegia
;
Contralaterally controlled functional electrical stimulation
;
 Rehabilitation
;
 Medical device
Loss of hand function is one of the most frequently persisting consequences of stroke and isoften characterized by inability to open the hand.
1
,
2
 Although routine occupational therapy is beneficial, it remains limited in its effectiveness in restoring full independent use of the impaired upper extremity and consequently many stroke survivors never regain the function of their affected hand.
© 2009 The American Society of Neurorehabilitation Address correspondence to Jayme S. Knutson, PhD, Cleveland FES Center, MetroHealth Medical Center, 2500 MetroHealth Drive,Hamann 601, Cleveland, OH 44109. jsk12@case.edu..
 

A Robotic System with EMG-Triggered Functional Eletrical Stimulation for Restoring Arm Functions in Stroke Survivors

 Good luck getting this in your stroke hospital. You probably will need to fire the board of directors first so you can set correct goals for the stroke department. 100% recovery for all.

A Robotic System with EMG-Triggered Functional Eletrical Stimulation for Restoring Arm Functions in Stroke Survivors

Show all authors

Emilia Ambrosini, PhD, Giulio Gasperini, MD, Johannes Zajc, PhD, ...

First Published March 3, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/1545968321997769

Article information

 

Abstract

Background

Robotic systems combined with Functional Electrical Stimulation (FES) showed promising results on upper-limb motor recovery after stroke, but adequately-sized randomized controlled trials (RCTs) are still missing.

Objective

To evaluate whether arm training supported by RETRAINER, a passive exoskeleton integrated with electromyograph-triggered functional electrical stimulation, is superior to advanced conventional therapy (ACT) of equal intensity in the recovery of arm functions, dexterity, strength, activities of daily living, and quality of life after stroke.

Methods

A single-blind RCT recruiting 72 patients was conducted. Patients, randomly allocated to 2 groups, were trained for 9 weeks, 3 times per week: the experimental group performed task-oriented exercises assisted by RETRAINER for 30 minutes plus ACT (60 minutes), whereas the control group performed only ACT (90 minutes). Patients were assessed before, soon after, and 1 month after the end of the intervention. Outcome measures were as follows: Action Research Arm Test (ARAT), Motricity Index, Motor Activity Log, Box and Blocks Test (BBT), Stroke Specific Quality of Life Scale (SSQoL), and Muscle Research Council.

Results

All outcomes but SSQoL significantly improved over time in both groups (P < .001); a significant interaction effect in favor of the experimental group was found for ARAT and BBT. ARAT showed a between-group change of 11.5 points (P = .010) at the end of the intervention, which increased to 13.6 points 1 month after. Patients considered RETRAINER moderately usable (System Usability Score of 61.5 ± 22.8).

Conclusions

Hybrid robotic systems, allowing to perform personalized, intensive, and task-oriented training, with an enriched sensory feedback, was superior to ACT in improving arm functions and dexterity after stroke.

Keywords stroke, rehabilitation, randomized controlled trial, arm, exoskeleton, functional electrical stimulation

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Improving Hand Function in Stroke Survivors: A Pilot Study of Contralaterally Controlled Functional Electric Stimulation in Chronic Hemiplegia

14 years. But further research is needed to get results to continue past 3 months.

Do you prefer your  incompetence NOT KNOWING? OR NOT DOING?

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will ream me out for making them look bad by being truthful , I look forward to that day.

Improving Hand Function in Stroke Survivors: A Pilot Study of Contralaterally Controlled Functional Electric Stimulation in Chronic Hemiplegia

Volume 88, Issue 4, April 2007, Pages 513-520

Author links open overlay panelJayme S.KnutsonPhD^a

Mary Y.HarleyOT^cTerri Z.HiselOT^cJohnChaeMD^abc

https://doi.org/10.1016/j.apmr.2007.01.003Get rights and content

Abstract

Knutson JS, Harley MY, Hisel TZ, Chae J. Improving hand function in stroke survivors: a pilot study of contralaterally controlled functional electric stimulation in chronic hemiplegia.

Objective

To assess the feasibility of a new stroke rehabilitation therapy for the hemiparetic hand.

Design

Case series. Pre- and postintervention assessment with 1- and 3-month follow-ups.

Setting

Clinical research laboratory of a large public hospital.

Participants

Three subjects with chronic (>6mo postcerebrovascular accident) upper-extremity hemiplegia.

Intervention

Subjects used an electric stimulator to cause the paretic hand extensor muscles to contract and thereby open the hand. Subjects controlled the intensity of the stimulation, and thus the degree of hand opening, by volitionally opening the unimpaired contralateral hand, which was detected by an instrumented glove. For 6 weeks, subjects used the stimulator to perform active repetitive hand-opening exercises 2 hours daily at home and functional tasks 1.5 hours twice a week in the laboratory.

Main Outcome Measures

Maximum voluntary finger extension, maximum voluntary isometric finger-extension moment, finger-movement control, and box and block test (BBT) score at pre- and posttreatment and at 1 month and 3 months posttreatment.

Results

Maximum voluntary finger extension increased from baseline to end of treatment and from the end of treatment to 1-month follow-up in 2 subjects. Maximum voluntary isometric finger-extension moment, finger-movement control, and BBT score increased from baseline to the end of treatment and from the end of treatment to 1-month follow-up in all 3 subjects. The improvements generally declined at 3 months.

Conclusions

The results suggest a positive effect on motor impairment, meriting further investigation of the intervention.

 

 

 

 

Feasibility and preliminary efficacy of gait training assisted by multichannel functional electrical stimulation in early stroke rehabilitation: A pilot randomized controlled trial

Your feasibility definition is totally wrong, you should be measuring the feasibility of getting recovery done.

 Feasibility and preliminary efficacy of gait training assisted by multichannel functional electrical stimulation in early stroke rehabilitation: A pilot randomized controlled trial

Neurorehabilitation and Neural Repair (NNR) , Volume 35(2) , Pgs. 131-144.

NARIC Accession Number: J85575.  What's this?
ISSN: 1545-9683.
Author(s): van Bloemendaal, Maijke ; Bus, Sicco A. ; Nollet, Frans ; Geurts, Alexander C. H.; Beelen, Anita.
Publication Year: 2021.
Number of Pages: 14.
Abstract: 

Study evaluated the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by multichannel functional electrical stimulation (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of gait symmetry and walking capacity in patients starting in the subacute phase after stroke. Forty inpatient participants (≤31 days after stroke) were randomized to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday. Feasibility was determined by adherence (≥75 percent of sessions) and satisfaction with gait training (score ≥7 out of 10). Primary outcome for efficacy was step length symmetry. Secondary outcomes included other spatiotemporal gait parameters and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect post intervention and at 3-month follow-up. Thirty-seven participants completed the study protocol (19 experimental group participants). Feasibility was confirmed by good adherence (90 percent of the participants) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome. The findings suggest that MFES gait training is feasible early after stroke, but MFES efficacy for improving step length symmetry, other spatiotemporal gait parameters, or walking capacity could not be demonstrated.
Descriptor Terms: AMBULATION, ELECTRICAL STIMULATION, FEASIBILITY STUDIES, INTERVENTION, MOBILITY TRAINING, MUSCLES, NERVES, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: van Bloemendaal, Maijke , Bus, Sicco A. , Nollet, Frans , Geurts, Alexander C. H., Beelen, Anita. (2021). Feasibility and preliminary efficacy of gait training assisted by multichannel functional electrical stimulation in early stroke rehabilitation: A pilot randomized controlled trial.  Neurorehabilitation and Neural Repair (NNR) , 35(2), Pgs. 131-144. Retrieved 3/19/2021, from REHABDATA database.

A Robotic System with EMG-Triggered Functional Eletrical Stimulation for Restoring Arm Functions in Stroke Survivors

But you don't tell us how many 100% recovered OR give us protocols. Useless.

A Robotic System with EMG-Triggered Functional Eletrical Stimulation for Restoring Arm Functions in Stroke Survivors

Show all authors

Emilia Ambrosini, PhD, Giulio Gasperini, MD, Johannes Zajc, PhD, ...

First Published March 3, 2021 Research Article 

https://doi.org/10.1177/1545968321997769

Article information

   

Abstract

Background

Robotic systems combined with Functional Electrical Stimulation (FES) showed promising results on upper-limb motor recovery after stroke, but adequately-sized randomized controlled trials (RCTs) are still missing.

Objective

To evaluate whether arm training supported by RETRAINER, a passive exoskeleton integrated with electromyograph-triggered functional electrical stimulation, is superior to advanced conventional therapy (ACT) of equal intensity in the recovery of arm functions, dexterity, strength, activities of daily living, and quality of life after stroke.

Methods

A single-blind RCT recruiting 72 patients was conducted. Patients, randomly allocated to 2 groups, were trained for 9 weeks, 3 times per week: the experimental group performed task-oriented exercises(What are they?) assisted by RETRAINER for 30 minutes plus ACT (60 minutes), whereas the control group performed only ACT (90 minutes). Patients were assessed before, soon after, and 1 month after the end of the intervention. Outcome measures were as follows: Action Research Arm Test (ARAT), Motricity Index, Motor Activity Log, Box and Blocks Test (BBT), Stroke Specific Quality of Life Scale (SSQoL), and Muscle Research Council.

Results

All outcomes but SSQoL significantly improved over time in both groups (P < .001); a significant interaction effect in favor of the experimental group was found for ARAT and BBT. ARAT showed a between-group change of 11.5 points (P = .010) at the end of the intervention, which increased to 13.6 points 1 month after. Patients considered RETRAINER moderately usable (System Usability Score of 61.5 ± 22.8).

Conclusions

Hybrid robotic systems, allowing to perform personalized, intensive, and task-oriented training, with an enriched sensory feedback, was superior to ACT in improving arm functions and dexterity after stroke.

Keywords stroke, rehabilitation, randomized controlled trial, arm, exoskeleton, functional electrical stimulation

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A Novel Functional Electrical Stimulation Treatment for Recovery of Hand Function in Hemiplegia: 12-Week Pilot Study

12 YEARS! Why isn't this in your hospital? Is everyone in your hospital completely fucking incompetent? 

Where is the protocol located? Survivors want to know.

A Novel Functional Electrical Stimulation Treatment for Recovery of Hand Function in Hemiplegia: 12-Week Pilot Study

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Jayme S. Knutson, PhD, Terri Z. Hisel, OTR/L, Mary Y. Harley, OTR/L, ...

First Published September 15, 2008 Research Article Find in PubMed

https://doi.org/10.1177/1545968308317577

Article information

 

Abstract

Background. 

Loss of finger extension is common after stroke and can severely limit hand function. Contralaterally controlled functional electrical stimulation (CCFES) is a new treatment aimed at restoring volitional finger and thumb extension. A previous pilot study showed reductions in hand impairment after 6 weeks of CCFES, but the effect did not persist after end of treatment. 

Objective. 

This study aimed to evaluate the feasibility of achieving greater and more persistent gains with CCFES by increasing the treatment period to 12 weeks.  

Methods. 

CCFES uses neuromuscular electrical stimulation to open the paretic hand in direct proportion to the degree of volitional opening of the unimpaired contralateral hand, which is detected by an instrumented glove. Three subjects with chronic hemiplegia participated in a 12-week CCFES treatment, which consisted of daily CCFES-assisted active repetitive hand-opening exercises and twice weekly functional task practice with CCFES.  

Results. 

Maximum voluntary finger extension increased by 101° and 68° for subjects 1 and 2, respectively, but subject 3 had no improvement in finger extension. Box and Block score increased by 6, 15, and 7 blocks, and upper extremity Fugl-Meyer score increased by 11, 15, and 7 points for subjects 1, 2, and 3, respectively. The finger extension gains declined at the 1-month and 3-month follow-up for subjects 1 and 2, but the gains in Box and Block and Fugl-Meyer scores persisted at follow-up.  

Conclusions. Greater reductions in hand impairment were achieved by extending the treatment period. The effect and its longevity may be related to baseline impairment level.

 

Rehabilitation of Reaching and Grasping Function in Severe Hemiplegic Patients Using Functional Electrical Stimulation Therapy

 Did anything here get to your stroke hospital in the past 12 years?

Do you prefer your hospital  incompetence NOT KNOWING? OR NOT DOING?

Rehabilitation of Reaching and Grasping Function in Severe Hemiplegic Patients Using Functional Electrical Stimulation Therapy

Randomized Controlled Trial

. Nov-Dec 2008;22(6):706-14.

doi: 10.1177/1545968308317436.

 

T Adam Thrasher  ¹ , Vera Zivanovic, William McIlroy, Milos R Popovic

Affiliations

• PMID: 18971385
• DOI: 10.1177/1545968308317436

Abstract

Objective: The aim of this study was to establish the efficacy of a therapeutic intervention based on functional electrical stimulation (FES) therapy to improve reaching and grasping function after severe hemiplegia due to stroke.

Methods: A total of 21 subjects with acute stroke were randomized into 2 groups, FES plus conventional occupational and physiotherapy (FES group) or only conventional therapy (control group) 5 days a week for 12 to 16 weeks. A third group of 7 subjects with chronic hemiplegia (at least 5 months poststroke) received only FES therapy (chronic group) and pre-post training changes were compared. FES was applied to proximal and then distal muscle groups during specific motor tasks. At baseline and at the end of treatment, grasping function was assessed using the Rehabilitation Engineering Laboratory Hand Function Test, along with more standard measures of rehabilitation outcome.

Results: The FES group improved significantly more than the control group in terms of object manipulation, palmar grip torque, pinch grip pulling force, Barthel Index, Upper Extremity Fugl-Meyer scores, and Upper Extremity Chedoke-McMaster Stages of Motor Recovery. The chronic stroke subjects demonstrated improvements in most categories, but the changes were not statistically significant.

Conclusions: FES therapy with upper extremity training may be an efficacious intervention in the rehabilitation of reaching and grasping function during acute stroke rehabilitation.