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Rikhof CJH, Leerskov KS, Prange-Lasonder GB, Prinsen EC, Spaich EG, Dosen S, Struijk LNSA, Buurke JH, Rietman JS. Combining robotics and functional electrical stimulation for assist-as-needed support of leg movements in stroke patients: A feasibility study. Med Eng Phys 2024; 130:104216. [PMID: 39160022 DOI: 10.1016/j.medengphy.2024.104216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/05/2024] [Accepted: 07/31/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE Rehabilitation technology can be used to provide intensive training in the early phases after stroke. The current study aims to assess the feasibility of combining robotics and functional electrical stimulation (FES), with an assist-as-needed approach to support actively-initiated leg movements in (sub-)acute stroke patients. METHOD Nine subacute stroke patients performed repetitions of ankle dorsiflexion and/or knee extension movements, with and without assistance. The assist-as-needed algorithm determined the amount and type of support needed per repetition. The number of repetitions and range of motion with and without assistance were compared with descriptive statistics. Fatigue scores were obtained using the visual analogue scale (score 0-10). RESULTS Support was required in 44 % of the repetitions for ankle dorsiflexion and in 5 % of the repetitions of knee extension, The median fatigue score was 2.0 (IQR: 0.2) and 4.0 (IQR: 1.5) for knee and ankle, respectively, indicating mild to moderate perceived fatigue. CONCLUSION This study demonstrated the feasibility of assist-as-needed assistance through combined robotic and FES support of leg movements in stroke patients. It proved particularly useful for ankle dorsiflexion. Future research should focus on implementing this approach in a clinical setting, to assess clinical applicability and potential effects on leg function.
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Affiliation(s)
- Cindy J H Rikhof
- Roessingh Research and Development, Roessinghsbleekweg 33b 7522AH, Enschede, The Netherlands; University of Twente, Department of Biomechanical Engineering, Faculty of Engineering Technology, Drienerlolaan 5 7522NB, Enschede, The Netherlands.
| | - Kasper S Leerskov
- Aalborg University, The neurorehabilitation Robotics and Engineering group, Center for Rehabilitation in Robotics, Department of Health Science and Technology, Gistrup 9260, Denmark
| | - Gerdienke B Prange-Lasonder
- Roessingh Research and Development, Roessinghsbleekweg 33b 7522AH, Enschede, The Netherlands; University of Twente, Department of Biomechanical Engineering, Faculty of Engineering Technology, Drienerlolaan 5 7522NB, Enschede, The Netherlands
| | - Erik C Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b 7522AH, Enschede, The Netherlands; University of Twente, Department of Biomechanical Engineering, Faculty of Engineering Technology, Drienerlolaan 5 7522NB, Enschede, The Netherlands
| | - Erika G Spaich
- Aalborg University, Neurorehabilitation Systems group, Department of Health Science and Technology 9260, Aalborg Gistrup, Denmark
| | - Strahinja Dosen
- Aalborg University, Neurorehabilitation Systems group, Department of Health Science and Technology 9260, Aalborg Gistrup, Denmark
| | - Lotte N S Andreasen Struijk
- Aalborg University, The neurorehabilitation Robotics and Engineering group, Center for Rehabilitation in Robotics, Department of Health Science and Technology, Gistrup 9260, Denmark
| | - Jaap H Buurke
- Roessingh Research and Development, Roessinghsbleekweg 33b 7522AH, Enschede, The Netherlands; University of Twente, Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, Drienerlolaan 5 7522NB, Enschede, The Netherlands
| | - Johan S Rietman
- Roessingh Research and Development, Roessinghsbleekweg 33b 7522AH, Enschede, The Netherlands; University of Twente, Department of Biomechanical Engineering, Faculty of Engineering Technology, Drienerlolaan 5 7522NB, Enschede, The Netherlands
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Frazão M, Figueiredo TDG, Cipriano G. Should We Use the Functional Electrical Stimulation-Cycling Exercise in Clinical Practice? Physiological and Clinical Effects Systematic Review With Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)01057-8. [PMID: 38914190 DOI: 10.1016/j.apmr.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVE To examine the evidence regarding functional electrical stimulation cycling's (FES-cycling's) physiological and clinical effects. DATA SOURCES The study was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses protocol. PubMed, Embase, Cochrane Review, CINAHL, Scopus, Sport Discus, and Web of Science databases were used. STUDY SELECTION Randomized controlled trials involving FES-cycling were included. Studies that did not involve FES-cycling in the intervention group or without the control group were excluded. Two reviewers screened titles and abstracts and then conducted a blinded full-text evaluation. A third reviewer resolved the discrepancies. DATA EXTRACTION Meta-analysis was performed using inverse variance for continuous data, with effects measured using the mean difference and random effects analysis models. A 95% confidence interval was adopted. The significance level was set at P<.05, and trends were declared at P=.05 to ≤.10. The I2 method was used for heterogeneity analysis. The minimal clinically important difference was calculated. Methodological quality was assessed using the risk of bias tool for randomized trials. The Grading of Recommendations Assessment, Development, and Evaluation method was used for the quality of the evidence analysis. DATA SYNTHESIS A total of 52 studies were included. Metabolic, cardiocirculatory, ventilatory, and peripheral muscle oxygen extraction variables presented statistical (P<.05) and clinically important differences favoring FES-cycling, with moderate-to-high certainty of evidence. It also presented statistical (P<.05) and clinically important improvements in cardiorespiratory fitness, leg and total body lean mass, power, physical fitness in intensive care (moderate-to-high certainty of evidence), and torque (low certainty of evidence). It presented a trend (P=.05 to ≤.10) of improvement in muscle volume, spasticity, and mobility (low-to-moderate certainty of evidence). It showed no difference (P>.10) in 6-minute walking distance, muscle cross-sectional area, bone density, and length of intensive care unit stay (low-to-moderate certainty of evidence). CONCLUSIONS FES-cycling exercise is a more intense stimulus modality than other comparative therapeutic modalities and presented clinically important improvement in several clinical outcomes.
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Affiliation(s)
- Murillo Frazão
- Lauro Wanderley University Hospital - UFPB/EBSERH, João Pessoa-PB; Postgraduate Program in Health Sciences and Technologies, University of Brasília - UnB, Brasília.
| | | | - Gerson Cipriano
- Postgraduate Program in Health Sciences and Technologies, University of Brasília - UnB, Brasília
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Ringsten M, Ivanic B, Iwarsson S, Lexell EM. Interventions to improve outdoor mobility among people living with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1407. [PMID: 38882933 PMCID: PMC11177337 DOI: 10.1002/cl2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence. Main Results The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors’ Conclusions Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.
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Affiliation(s)
- Martin Ringsten
- Cochrane Sweden, Research and Development Skåne University Hospital Lund Sweden
- Department of Health Sciences Lund University Lund Sweden
| | | | | | - Eva Månsson Lexell
- Department of Health Sciences Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Medicine and Geriatrics Skåne University Hospital Lund-Malmö Sweden
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Rikhof CJH, Feenstra Y, Fleuren JFM, Buurke JH, Prinsen EC, Rietman JS, Prange-Lasonder GB. Robot-assisted support combined with electrical stimulation for the lower extremity in stroke patients: a systematic review. J Neural Eng 2024; 21:021001. [PMID: 38527367 DOI: 10.1088/1741-2552/ad377c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/25/2024] [Indexed: 03/27/2024]
Abstract
Objective. The incidence of stroke rising, leading to an increased demand for rehabilitation services. Literature has consistently shown that early and intensive rehabilitation is beneficial for stroke patients. Robot-assisted devices have been extensively studied in this context, as they have the potential to increase the frequency of therapy sessions and thereby the intensity. Robot-assisted systems can be combined with electrical stimulation (ES) to further enhance muscle activation and patient compliance. The objective of this study was to review the effectiveness of ES combined with all types of robot-assisted technology for lower extremity rehabilitation in stroke patients.Approach. A thorough search of peer-reviewed articles was conducted. The quality of the included studies was assessed using a modified version of the Downs and Black checklist. Relevant information regarding the interventions, devices, study populations, and more was extracted from the selected articles.Main results. A total of 26 articles were included in the review, with 23 of them scoring at least fair on the methodological quality. The analyzed devices could be categorized into two main groups: cycling combined with ES and robots combined with ES. Overall, all the studies demonstrated improvements in body function and structure, as well as activity level, as per the International Classification of Functioning, Disability, and Health model. Half of the studies in this review showed superiority of training with the combination of robot and ES over robot training alone or over conventional treatment.Significance. The combination of robot-assisted technology with ES is gaining increasing interest in stroke rehabilitation. However, the studies identified in this review present challenges in terms of comparability due to variations in outcome measures and intervention protocols. Future research should focus on actively involving and engaging patients in executing movements and strive for standardization in outcome values and intervention protocols.
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Affiliation(s)
- C J H Rikhof
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - Y Feenstra
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - J F M Fleuren
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - J H Buurke
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomedical Signals and systems, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - E C Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - J S Rietman
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - G B Prange-Lasonder
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
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Debeuf R, De Vlieger D, Defour A, Feyen K, Guida S, Cuypers L, Firouzi M, Tassenoy A, Swinnen E, Beckwée D, Leemans L. Electrotherapy in stroke rehabilitation can improve lower limb muscle characteristics: a systematic review and meta-analysis. Disabil Rehabil 2024:1-17. [PMID: 38557249 DOI: 10.1080/09638288.2024.2334444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This review assesses the effect of electrotherapy (e.g. functional electrical stimulation (FES), motor and sensor therapeutic electrical stimulation (TES)) on muscle strength and skeletal muscle characteristics in individuals post-stroke compared to conventional or sham therapy. METHODS A systematic literature search was conducted in MEDLINE, SCOPUS, and Web of Science, focusing on randomized controlled trials investigating the effect of electrotherapy. Data of interest was extracted from eligible studies, and risk of bias was assessed. RESULTS In total, 23 studies (933 people post-stroke) were included, of which 17, which mainly focus on patients in a chronic stage of stroke recovery and the implementation of FES, were incorporated in the meta-analysis. A significant increase in muscle strength was found favoring electrotherapy over conventional therapy (SMD 0.63, 95% CI 0.34-0.91, I2 = 37%, p = 0.07) and over sham therapy (SMD 0.44, 95% CI 0.20-0.68, I2 = 38%, p = 0.08). Three studies investigated the effect on muscle thickness and found a significant increase in favor of electrostimulation when compared to conventional therapy (MD 0.11 cm, 95% CI 0.06-0.16, I2 = 0%, p = 0.50). CONCLUSION Current evidence suggests electrotherapy in combination with physiotherapy has positive effects on lower limb muscle strength and skeletal muscle characteristics in patients recovering from stroke.
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Affiliation(s)
- Ruben Debeuf
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Daan De Vlieger
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Arne Defour
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Karen Feyen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefania Guida
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Lotte Cuypers
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mahyar Firouzi
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Brain, Body and Cognition, Department of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - An Tassenoy
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - David Beckwée
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Lynn Leemans
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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Galvão WR, Castro Silva LK, Formiga MF, Thé GAP, Faria CDCDM, Viana RT, Lima LAO. Cycling using functional electrical stimulation therapy to improve motor function and activity in post-stroke individuals in early subacute phase: a systematic review with meta-analysis. Biomed Eng Online 2024; 23:1. [PMID: 38167021 PMCID: PMC10762955 DOI: 10.1186/s12938-023-01195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Stroke necessitates interventions to rehabilitate individuals with disabilities, and the application of functional electrical stimulation therapy (FEST) has demonstrated potential in this regard. This study aimed to analyze the efficacy and effectiveness of cycling using FEST to improve motor function and lower limb activity in post-stroke individuals. METHODS We performed a systematic review according to the recommendations of the PRISMA checklist, searching MEDLINE, Cochrane, EMBASE, LILACS, and PEDro databases by July 2022, without any date or language limitations. Studies were selected using the following terms: stroke, electrical stimulation therapy, cycling, and clinical trials. Randomized or quasi-randomized clinical trials that investigated the effectiveness of cycling using FEST combined with exercise programs and cycling using FEST alone for motor function and activity in subacute post-stroke individuals were included. The quality of included trials was assessed using the PEDro scores. Outcome data were extracted from eligible studies and combined in random-effects meta-analyses. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS Five randomized clinical trials involving 187 participants were included. Moderate-quality evidence indicates that cycling using FEST combined with exercise programs promotes relevant benefits in trunk control (MD 9 points, 95% CI 0.36-17.64) and walking distance (MD 94.84 m, 95% CI 39.63-150.05, I = 0%), the other outcomes had similar benefits. Cycling using FEST alone compared to exercise programs promotes similar benefits in strength, balance, walking speed, walking distance, and activities of daily living. CONCLUSION This systematic review provides low- to moderate-quality evidence that cycling using FEST may be an effective strategy to consider in improving motor function and activity outcomes for post-stroke individuals in the early subacute phase. REVIEW REGISTRATION PROSPERO (CRD42022345282).
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Affiliation(s)
- Wagner Rodrigues Galvão
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, Brazil.
| | | | - Magno Ferreira Formiga
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Ramon Távora Viana
- Department of Physiotherapy, Federal University of Ceará, Fortaleza, Brazil
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Hwang S, Song CS. Rehabilitative effects of electrical stimulation on gait performance in stroke patients: A systematic review with meta-analysis. NeuroRehabilitation 2024; 54:185-197. [PMID: 38306066 DOI: 10.3233/nre-230360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Electrical stimulation techniques are widely utilized for rehabilitation management in individuals with stroke patients. OBJECTIVES This review aims to summarize the rehabilitative effects of electrical stimulation therapy on gait performance in stroke patients. METHODS This review included randomized controlled trials (RCT) investigating the therapeutic effects of electrical stimulation in stroke patients throughout five databases. This review qualitatively synthesized 20 studies and quantitatively analyzed 11 RCTs. RESULTS Functional electrical stimulation (FES) was the most commonly used electrical stimulation type to improve postural stability and gait performance in stroke patients. The clinical measurement tools commonly used in the three studies to assess the therapeutic effects of FES were Berg balance scale (BBS), 10-meter walk test (10MWT), 6-minute walk test (6mWT), and gait velocity. The BBS score and gait velocity had positive effects in the FES group compared with the control group, but the 10MWT and 6mWT showed the same effects between the two groups. The heterogeneity of BBS scores was also high. CONCLUSION The results of this review suggest that electrical stimulation shows little evidence of postural stability and gait performance in stroke patients, although some electrical stimulations showed positive effects on postural stability and gait performance.
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Affiliation(s)
- Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, South Korea
- Graduate School of Health and Welfare, Baekseok University, Seoul, South Korea
| | - Chiang-Soon Song
- Department of Occupational Therapy, College of Natural Science and Public Health and Safety, Chosun University, Gwangju, South Korea
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Barclay A, Gray SR, Paul L, Rooney S. The effects of cycling using lower limb active passive trainers in people with neurological conditions: a systematic review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2020.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Active passive trainers are frequently used as a safe, feasible way for people with neurological disabilities to exercise. However, evidence regarding their efficacy is limited. The aim of this study was to review the literature investigating the effects of lower limb active passive trainer cycling, with or without functional electrical stimulation, on spasticity, cardiovascular fitness, function and quality of life in people with neurological conditions Methods Five electronic databases were searched from inception to June 2021. Studies included: randomised controlled trials using lower limb active passive trainers as a cycling intervention; participants with neurological conditions, such as multiple sclerosis, spinal cord injury, stroke and Parkinson's disease; and at least one outcome related to spasticity, cardiovascular fitness, physical function or quality of life. Results A total of 12 articles were included (n=423 participants, 52% male). Of these, six used functional electrical stimulation-assisted active passive trainer interventions, and the remaining six used active passive trainer interventions alone. A meta-analysis demonstrated statistically significant improvement in walking endurance; however, this only included stroke studies (6-Minute Walk Test performance, P<0.00001). No statistically significant improvement in walking speed was found (P=0.31). A significant improvement in spasticity was reported by three studies (two using the active passive trainer intervention alone, one using the active passive trainer with functional electrical stimulation). One study reported improvement in quality of life. Few studies considered cardiovascular fitness. Conclusions The included studies featured heterogeneous designs, outcome measures, exercise prescriptions and participant disability levels, which made comparison difficult. Active passive trainer interventions appear to improve walking endurance in people with stroke; however, the effect on other outcomes and in other conditions remains unclear. It also remains uncertain as to whether functional electrical stimulation-assisted cycling is more beneficial than active passive trainer cycling alone.
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Affiliation(s)
- Alison Barclay
- Neurorehabilitation Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - Scott Rooney
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
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Shin HE, Kim M, Lee D, Jang JY, Soh Y, Yun DH, Kim S, Yang J, Kim MK, Lee H, Won CW. Therapeutic effects of functional electrical stimulation on physical performance and muscle strength in post-stroke older adults: a review. Ann Geriatr Med Res 2022; 26:16-24. [PMID: 35313099 PMCID: PMC8984173 DOI: 10.4235/agmr.22.0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/15/2022] [Indexed: 11/09/2022] Open
Abstract
Stroke-related disabilities cause poor physical performance, especially among older adults, and can lead to sarcopenia. Functional electrical stimulation (FES) has been used to improve physical performance in individuals with neurological disorders and increase muscle mass and strength to counteract muscle atrophy. This review covers the principles, underlying mechanisms, and therapeutic effects of FES on physical performance and skeletal muscle function in post-stroke older adults. We found that FES restored weakened dorsiflexor and hip abductor strength during the swing and stance phases of gait, respectively, to help support weight-bearing and upright posture and facilitate static and dynamic balance in this population. FES may also be effective in improving muscle mass and strength to prevent muscle atrophy. However, previous studies on this topic in post-stroke older adults are scarce, and further studies are needed to confirm this supposition.
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Affiliation(s)
- Hyung Eun Shin
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, East-West Medical Research Institute, Kyung Hee University College of Medicine, Seoul, Korea
| | - Daehyun Lee
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jae Young Jang
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea
| | - Yunsoo Soh
- Department of Physical Medicine & Rehabilitation Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dong Hwan Yun
- Department of Physical Medicine & Rehabilitation Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jisoo Yang
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Maeng Kyu Kim
- Sports Medicine Lab., Department of Physical Education, Kyungpook National University, Daegu, Korea
| | | | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, Kyung Hee University College of Medicine, Seoul, Korea
- Corresponding Authors: Chang Won Won, MD, PhD Department of Family Medicine, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea E-mail:
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10
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Shariat A, Nakhostin Ansari N, Honarpishe R, Moradi V, Hakakzadeh A, Cleland JA, Kordi R. Effect of cycling and functional electrical stimulation with linear and interval patterns of timing on gait parameters in patients after stroke: a randomized clinical trial. Disabil Rehabil 2021; 43:1890-1896. [PMID: 31707865 DOI: 10.1080/09638288.2019.1685600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Patients in the chronic phase after a stroke are an underrepresented group in the literature. Therefore, the aim of this study was to compare the effects of cycling and functional electrical stimulation with linear versus interval patterns of timing on gait parameters in patients after stroke. DESIGN A double blinded, parallel, randomized clinical trial. SETTING Neuroscience Institute. PARTICIPANTS Patients with lower limb disability due to stroke (N = 30) with a stroke onset >6 months and <18 months. INTERVENTIONS Twenty-eight minutes of leg cycling with functional electrical stimulation with linear or interval patterns of timing applied to the peroneal and biceps femoris muscles, 3 times/week for 4 weeks. MAIN MEASURES Timed 10-Meter Walk Test and Functional Ambulation Classification were the primary outcome measures. The Modified Modified Ashworth scale, active range of motion, Timed Up and Go Test, and Single Leg Stance Test were the secondary outcome measures. Evaluation was performed at baseline, after 4, and after 8 weeks. RESULTS Thirty participants completed the 4-week intervention (interval group, n = 16; linear group, n = 14). The Functional Ambulation Classification, Timed 10-Meter Walk Test, and the Timed Up and Go Test improved significantly in both groups. The Modified Modified Ashworth scale scores for quadriceps and plantar flexion statistically decreased after 4-weeks in the interval group. Significant group-by-time interaction was shown for Timed Up and Go Test (p = 0.003, np2=0.228), knee flexion active range of motion (p < 0.001, np2=0.256) and dorsiflexion active range of motion (p < 0.001, np2=0.359). Modified Modified Ashworth scale and active range of motion in both the ankle and knee improved significantly in the interval group. CONCLUSIONS The functional electrical stimulation with cycling protocols improved the Functional Ambulation Classification, Timed 10-Meter Walk Test, active range of motion, Timed Up and Go Test, and Modified Modified Ashworth scale. An interval protocol of timing was more effective than the linear protocol in terms of spasticity and active range of motion.Implications for rehabilitationCycling + functional electrical stimulation training with an interval pattern of timing seems superior to cycling + functional electrical stimulation training with a linear pattern.Interval protocol has positive effects on spasticity and range of motion after 12 sessions in patients post stroke.Cycling + functional electrical stimulation improves functional mobility and speed in stroke survivors and the effects of this intervention lasted in follow-up assessment after one month.
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Affiliation(s)
- Ardalan Shariat
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Honarpishe
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahideh Moradi
- Department of Orthotics and Prosthetics, Faculty of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Hakakzadeh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ramin Kordi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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11
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Xing W, Cai M, Li C, Nie Z, Tang W. Computed Tomography Image Analysis of Neuromuscular Electrical Stimulation in the Treatment of Knee Osteoarthritis with Different Radiologic Characteristics Based on Iterative Reconstruction Algorithm. World Neurosurg 2020; 149:372-379. [PMID: 33059084 DOI: 10.1016/j.wneu.2020.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To use computed tomography image analysis of iterative reconstruction algorithm to understand effect of neuromuscular electrical stimulation of quadriceps on motor function rehabilitation after total knee arthroplasty. METHODS After total knee arthroplasty, 104 patients were randomly divided into 2 groups. The treatment group comprised 52 patients. The quadriceps femoris was stimulated by neuromuscular electrical stimulation, and patients were required to actively extend the knee along with the current stimulation. In the second group, which received cutaneous nerve electrical stimulation, 2 sets of electrodes were placed on knee pain points. All patients participated in conventional rehabilitation and were discharged from the hospital a mean 14.89 ± 3.65 days after treatment. Visual analog scale, range of motion of knee joint, and Knee Injury and Osteoarthritis Score were evaluated before discharge. The mean interval between follow-up evaluations after discharge was 9.5 months. Knee Society Score and Knee Injury and Osteoarthritis Score were assessed during follow-up. RESULTS Visual analog scale scores of treatment and control groups at discharge were 18.11 ± 9.66 and 16.13 ± 4.25, and active range of motion of the knee joint was 103.21° ± 15.44° and (99.21° ± 15.19°, respectively. Limitation of active knee extension in the treatment group was 1.93° ± 3.47°, which was significantly smaller than in the control group (6.26° ± 4.28°). CONCLUSIONS Neuromuscular electrical stimulation of the quadriceps muscle early after total knee arthroplasty helps to improve the function of the knee extension device and accelerate functional rehabilitation. Computed tomography has found that changes in tibial subchondral bone plate and subchondral cancellous bone in patients with knee osteoarthritis are mainly due to destruction of ultrastructural homeostasis. This change may be the cause of knee osteoarthritis.
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Affiliation(s)
- Weijin Xing
- Department of Radiology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Mubin Cai
- Department of Radiology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Chuanzi Li
- Department of Radiology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Zhongshi Nie
- Department of Radiology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Wencai Tang
- Department of Radiology, Second Affiliated Hospital of Hainan Medical University, Haikou, China.
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12
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Kapadia N, Moineau B, Popovic MR. Functional Electrical Stimulation Therapy for Retraining Reaching and Grasping After Spinal Cord Injury and Stroke. Front Neurosci 2020; 14:718. [PMID: 32742254 PMCID: PMC7364342 DOI: 10.3389/fnins.2020.00718] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 12/31/2022] Open
Abstract
Neurological conditions like hemiplegia following stroke or tetraplegia following spinal cord injury, result in a massive compromise in motor function. Each of the two conditions can leave individuals dependent on caregivers for the rest of their lives. Once medically stable, rehabilitation is the main stay of treatment. This article will address rehabilitation of upper extremity function. It is long known that moving the affected limb is crucial to recovery following any kind of injury. Overtime, it has also been established that just moving the affected extremities does not suffice, and that the movements have to involve patient’s participation, be as close to physiologic movements as possible, and should ideally stimulate the entire neuromuscular circuitry involved in producing the desired movement. For over four decades now, functional electrical stimulation (FES) is being used to either replace or retrain function. The FES therapy discussed in this article has been used to retrain upper extremity function for over 15 years. Published data of pilot studies and randomized control trials show that FES therapy produces significant changes in arm and hand function. There are specific principles of the FES therapy as applied in our studies: (i) stimulation is applied using surface stimulation electrodes, (ii) there is minimum to virtually no pain during application, (iii) each session lasts no more than 45–60 min, (iv) the technology is quite robust and can make up for specificity to a certain extent, and (v) fine motor function like two finger precision grip can be trained (i.e., thumb and index finger tip to tip pinch). The FES therapy protocols can be successfully applied to individuals with paralysis resulting from stroke or spinal cord injury.
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Affiliation(s)
- Naaz Kapadia
- Rehabilitation Engineering Laboratory, The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Bastien Moineau
- Rehabilitation Engineering Laboratory, The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Myant Inc., Toronto, ON, Canada
| | - Milos R Popovic
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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13
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Ambrosini E, Parati M, Ferriero G, Pedrocchi A, Ferrante S. Does cycling induced by functional electrical stimulation enhance motor recovery in the subacute phase after stroke? A systematic review and meta-analysis. Clin Rehabil 2020; 34:1341-1354. [PMID: 32613859 DOI: 10.1177/0269215520938423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the effects of cycling with functional electrical stimulation on walking, muscle power and tone, balance and activities of daily living in subacute stroke survivors. DATA SOURCES Ten electronic databases were searched from inception to February 2020. REVIEW METHODS Inclusion criteria were: subacute stroke survivors (<6 months since stroke), an experimental group performing any type of cycling training with electrical stimulation, alone or in addition to usual care, and a control group performing usual care alone. Two reviewers assessed eligibility, extracted data and analyzed the risks of bias. Standardized Mean Difference (SMD) or Mean Difference (MD) with 95% Confidence Intervals (CI) were estimated using fixed- or random-effects models to evaluate the training effect. RESULTS Seven randomized controlled trials recruiting a total of 273 stroke survivors were included in the meta-analyses. There was a statistically significant, but not clinically relevant, effect of cycling with electrical stimulation compared to usual care on walking (six studies, SMD [95% CI] = 0.40 [0.13, 0.67]; P = 0.004), capability to maintain a sitting position (three studies, MD [95% CI] = 7.92 [1.01, 14.82]; P = 0.02) and work produced by the paretic leg during pedaling (2 studies, MD [95% CI] = 8.13 [1.03, 15.25]; P = 0.02). No significant between-group differences were found for muscular power, tone, standing balance, and activities of daily living. CONCLUSIONS Cycling training with functional electrical stimulation cannot be recommended in terms of being better than usual care in subacute stroke survivors. Further investigations are required to confirm these results, to determine the optimal training parameters and to evaluate long-term effects.
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Affiliation(s)
- Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, MI, Italy
| | - Monica Parati
- Bioengineering Laboratory, Scientific Institute of Milan, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Giorgio Ferriero
- Physical and Rehabilitation Medicine Unit, Scientific Institute of Tradate, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, MI, Italy
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, MI, Italy
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14
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Veldema J, Jansen P. Ergometer Training in Stroke Rehabilitation: Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 101:674-689. [DOI: 10.1016/j.apmr.2019.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/27/2019] [Indexed: 12/22/2022]
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15
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Duenas VH, Cousin CA, Rouse C, Fox EJ, Dixon WE. Distributed Repetitive Learning Control for Cooperative Cadence Tracking in Functional Electrical Stimulation Cycling. IEEE TRANSACTIONS ON CYBERNETICS 2020; 50:1084-1095. [PMID: 30530349 DOI: 10.1109/tcyb.2018.2882755] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Closed-loop control of functional electrical stimulation coupled with motorized assistance to induce cycling is a rehabilitative strategy that can improve the mobility of people with neurological conditions (NCs). However, robust control methods, which are currently pervasive in the cycling literature, have limited effectiveness due to the use of high stimulation intensity leading to accelerated fatigue during cycling protocols. This paper examines the design of a distributed repetitive learning controller (RLC) that commands an independent learning feedforward term to each of the six stimulated lower-limb muscle groups and an electric motor during the tracking of a periodic cadence trajectory. The switched controller activates lower limb muscles during kinematic efficient regions of the crank cycle and provides motorized assistance only when most needed (i.e., during the portions of the crank cycle where muscles evoke a low torque output). The controller exploits the periodicity of the desired cadence trajectory to learn from previous control inputs for each muscle group and electric motor. A Lyapunov-based stability analysis guarantees asymptotic tracking via an invariance-like corollary for nonsmooth systems. The switched distributed RLC was evaluated in experiments with seven able-bodied individuals and five participants with NCs. A mean root-mean-squared cadence error of 3.58 ± 0.43 revolutions per minute (RPM) (0.07 ± 7.35% average error) and 4.26 ± 0.84 RPM (0.1 ± 8.99% average error) was obtained for the healthy and neurologically impaired populations, respectively.
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16
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Enoka RM, Amiridis IG, Duchateau J. Electrical Stimulation of Muscle: Electrophysiology and Rehabilitation. Physiology (Bethesda) 2020; 35:40-56. [DOI: 10.1152/physiol.00015.2019] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The generation of action potentials in intramuscular motor and sensory axons in response to an imposed external current source can evoke muscle contractions and elicit widespread responses throughout the nervous system that impact sensorimotor function. The benefits experienced by individuals exposed to several weeks of treatment with electrical stimulation of muscle suggest that the underlying adaptations involve several physiological systems, but little is known about the specific changes elicited by such interventions.
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Affiliation(s)
- Roger M. Enoka
- Department of Integrative Physiology, University of Colorado Boulder, Colorado
| | - Ioannis G. Amiridis
- Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jacques Duchateau
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
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Busk H, Stausholm MB, Lykke L, Wienecke T. Electrical Stimulation in Lower Limb During Exercise to Improve Gait Speed and Functional Motor Ability 6 Months Poststroke. A Review with Meta-Analysis. J Stroke Cerebrovasc Dis 2019; 29:104565. [PMID: 31879135 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 11/13/2019] [Accepted: 11/21/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Stroke is the third most common cause of disability in adults over 65 years of age and there are 30.7 million survivors after stroke worldwide. Stroke survivors have the highest odds of reporting severe disability and the greatest variety of individual domains of disability compared to a range of other conditions. Electrical stimulation of peripheral sensory-motor systems increases voluntary movement and muscle strength and thereby raises the activities of daily living (ADL). Little is known about electrical stimulation during physical activity in rehabilitation; the objective of this review is therefore to investigate whether external electrical stimulation combined with activity improves functional motor ability and gait speed in patients who have experienced a stroke within the last 6 months. METHODS A review and random effects meta-analysis of randomized controlled clinical trials on gait speed and functional motor ability measured with Barthel Index (BI) and Bergs Balance Scale (BBS). RESULTS Eight trials were included (n = 191). Explorative meta-analysis was performed on gait speed (5 trials, n = 120), BI (3 trials, n = 74), and BBS (3 trial n = 79). A small, significant difference on gait speed 0.15 (95% confidence interval [CI]: 0.08-0.21) m/s, but no difference in BI 2.88 (95 % CI: -3.3 to 9.07) and BBS 1.73 (95% CI: -2.8 to 6.27). CONCLUSIONS Sparse, low-quality evidence indicates that electrical stimulation combined with activity is a relevant intervention to improve ADL within 6 months poststroke.
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Affiliation(s)
- Henriette Busk
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark; Department of Physiotherapy and Occupathinal Therapy, Naestved, Slagelse and Ringsted Hospitals, Slagelse, Denmark; Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.
| | - Martin Bjørn Stausholm
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Physical and Occupational Therapy Research Unit, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Louise Lykke
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Troels Wienecke
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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18
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Ambrosini E, Peri E, Nava C, Longoni L, Monticone M, Pedrocchi A, Ferriero G, Ferrante S. A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial. Eur J Phys Rehabil Med 2019; 56:24-33. [PMID: 31556542 DOI: 10.23736/s1973-9087.19.05847-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Early interventions maximizing patient's involvement are essential to promote gait restoration and motor recovery after stroke. AIM The aim of this study is to evaluate the effects of a multimodal biofeedback training involving cycling augmented by functional electrical stimulation (FES) and balance exercises on walking ability and motor recovery. DESIGN Randomized controlled trial (NCT02439515). SETTING Inpatient rehabilitation facility. POPULATION Subacute stroke survivors (less than 6 months from the first event) aged up to 90 years old. METHODS Sixty-eight participants were randomly allocated to an experimental group, performing 15 sessions of biofeedback FES-cycling training followed by 15 sessions of biofeedback balance training (20 minutes each) in addition to usual care (70 minutes), and a control group performing 30 sessions (90 minutes) of usual care. Participants were evaluated before training, after 15 sessions, after 30 sessions, and at 6-month follow-up through: gait speed (primary outcome), spatiotemporal gait parameters, Six-Minute Walking Test, Functional Independence Measure, Motricity Index, Trunk Control Test, Berg Balance Scale, and Fall Efficacy Scale. RESULTS Both groups significantly improved over time, but no group and interaction effects were found for any outcomes. The 73% of the experimental group achieved a clinically meaningful change in gait speed compared to the 38% of the control group (P=0.048). These percentages were even more unbalanced for patients with a moderate to severe gait impairment at baseline (91% versus 36%; P=0.008). CONCLUSIONS The multimodal biofeedback training was not statistically superior to usual care, showing only a positive trend in favor of the experimental group on locomotion recovery. Patients initially not able to walk might be the best candidates for such a training. CLINICAL REHABILITATION IMPACT The multimodal biofeedback training is a task-specific, repetitive and intensive training requiring a minimal supervision, which might result in a lower staff to patient ratio if organized in group sessions. Therefore, it can represent a good alternative for early stroke rehabilitation.
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Affiliation(s)
- Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information Technology, and Bioengineering, Politecnico di Milano, Milan, Italy -
| | - Elisabetta Peri
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Claudia Nava
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Luca Longoni
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Marco Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information Technology, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giorgio Ferriero
- Rehabilitation Unit of Lissone Institute, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Monza e Brianza, Italy
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information Technology, and Bioengineering, Politecnico di Milano, Milan, Italy
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Tatemoto T, Tanaka S, Maeda K, Tanabe S, Kondo K, Yamaguchi T. Skillful Cycling Training Induces Cortical Plasticity in the Lower Extremity Motor Cortex Area in Healthy Persons. Front Neurosci 2019; 13:927. [PMID: 31551689 PMCID: PMC6733988 DOI: 10.3389/fnins.2019.00927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022] Open
Abstract
Cycling exercise is commonly used in rehabilitation to improve lower extremity (LE) motor function and gait performance after stroke. Motor learning is important for regaining motor skills, suggesting that training of motor skills influences cortical plasticity. However, the effects of motor skill learning in dynamic alternating movements of both legs on cortical plasticity remain unclear. Here, we examined the effects of skillful cycling training on cortical plasticity of the LE motor area in healthy adults. Eleven healthy volunteers participated in the following three sessions on different days: skillful cycling training, constant-speed cycling training, and rest condition. Skillful cycling training required the navigation of a marker up and down curves by controlling the rotation speed of the pedals. Participants were instructed to fit the marker to the target curves as accurately as possible. Amplitudes of motor evoked potentials (MEPs) and short-interval intracortical inhibition (SICI) evoked using transcranial magnetic stimulation (TMS) were assessed at baseline, after every 10 min of the task (a total of 30 min), and 30 min after the third and final trial. A decrease in tracking errors was representative of the formation of motor learning following skillful cycling training. Compared to baseline, SICI was significantly decreased after skillful cycling training in the tibialis anterior (TA) muscle. The task-induced alterations of SICI were more prominent and lasted longer with skillful cycling training than with the other conditions. The changes in SICI were negatively correlated with a change in tracking error ratio at 20 min the task. MEP amplitudes were not significantly altered with any condition. In conclusion, skillful cycling training induced long-lasting plastic changes of intracortical inhibition, which corresponded to the learning process in the LE motor cortex. These findings suggest that skillful cycling training would be an effective LE rehabilitation method after stroke.
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Affiliation(s)
- Tsuyoshi Tatemoto
- Graduate School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Satoshi Tanaka
- Laboratory of Psychology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Kazuhei Maeda
- Department of Clinical Technology, Hokkaido Institutional Society Otaru Hospital, Hokkaido, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | | | - Tomofumi Yamaguchi
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
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20
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The effect of cycling using active-passive trainers on spasticity, cardiovascular fitness, function and quality of life in people with moderate to severe Multiple Sclerosis (MS); a feasibility study. Mult Scler Relat Disord 2019; 34:128-134. [DOI: 10.1016/j.msard.2019.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/19/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022]
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21
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Karaahmet OZ, Gurcay E, Unal ZK, Cankurtaran D, Cakci A. Effects of functional electrical stimulation-cycling on shoulder pain and subluxation in patients with acute–subacute stroke: a pilot study. Int J Rehabil Res 2019; 42:36-40. [DOI: 10.1097/mrr.0000000000000319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Shariat A, Najafabadi MG, Ansari NN, Cleland JA, Singh MAF, Memari AH, Honarpishe R, Hakakzadeh A, Ghaffari MS, Naghdi S. The effects of cycling with and without functional electrical stimulation on lower limb dysfunction in patients post-stroke: A systematic review with meta-analysis. NeuroRehabilitation 2019; 44:389-412. [PMID: 31227660 DOI: 10.3233/nre-182671] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND One of the leading causes of disability in the world with enormous economic burden is stroke. OBJECTIVE To quantify the effectiveness of different protocols of cycling with/without functional electrical stimulation on functional mobility after stroke. METHODS Multiple databases were searched till 2018. Data extraction was performed using a pre-determined data collection form. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS A total of 14 trials satisfied eligibility criteria and were included. Cycling had a positive effect on the 6-meter walking test performance (SMD, 0.41; 95% CI, 0.11 -0.71; I2 = 0% ) compared with no or placebo intervention (control). Compared with control, cycling had a positive effect on 10-meter walking speed (SMD, 0.30; 95% CI, 0.05 -0.55; I2 = 0% ), and on balance based on the Berg score (SMD, 0.32; 95% CI, 0.06 -0.57; I2 = 49% ). Cycling with functional electrical stimulation had a positive effect on balance (SMD, 1.48; 95% CI, 0.99 -1.97; I2 = 91% ) compared with cycling alone. CONCLUSIONS It appears that cycling has a positive effect on walking speed, walking ability and balance. Functional electrical stimulation combined with cycling has positive effects on balance beyond cycling alone.
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Affiliation(s)
- Ardalan Shariat
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Ghayour Najafabadi
- Department of Motor Behavior, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maria A Fiatarone Singh
- University of Sydney, Faculty of Health Sciences, Sydney, Australia
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and Hebrew SeniorLife, Boston, MA, USA
| | - Amir-Hossein Memari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Honarpishe
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Hakakzadeh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Selk Ghaffari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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23
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Aaron SE, Vanderwerker CJ, Embry AE, Newton JH, Lee SCK, Gregory CM. FES-assisted Cycling Improves Aerobic Capacity and Locomotor Function Postcerebrovascular Accident. Med Sci Sports Exerc 2018; 50:400-406. [PMID: 29461462 DOI: 10.1249/mss.0000000000001457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE After a cerebrovascular accident (CVA) aerobic deconditioning contributes to diminished physical function. Functional electrical stimulation (FES)-assisted cycling is a promising exercise paradigm designed to target both aerobic capacity and locomotor function. This pilot study aimed to evaluate the effects of an FES-assisted cycling intervention on aerobic capacity and locomotor function in individuals post-CVA. METHODS Eleven individuals with chronic (>6 months) post-CVA hemiparesis completed an 8-wk (three times per week; 24 sessions) progressive FES-assisted cycling intervention. V˙O2peak, self-selected, and fastest comfortable walking speeds, gait, and pedaling symmetry, 6-min walk test (6MWT), balance, dynamic gait movements, and health status were measured at baseline and posttraining. RESULTS Functional electrical stimulation-assisted cycling significantly improved V˙O2peak (12%, P = 0.006), self-selected walking speed (SSWS, 0.05 ± 0.1 m·s, P = 0.04), Activities-specific Balance Confidence scale score (12.75 ± 17.4, P = 0.04), Berg Balance Scale score (3.91 ± 4.2, P = 0.016), Dynamic Gait Index score (1.64 ± 1.4, P = 0.016), and Stroke Impact Scale participation/role domain score (12.74 ± 16.7, P = 0.027). Additionally, pedal symmetry, represented by the paretic limb contribution to pedaling (paretic pedaling ratio [PPR]) significantly improved (10.09% ± 9.0%, P = 0.016). Although step length symmetry (paretic step ratio [PSR]) did improve, these changes were not statistically significant (-0.05% ± 0.1%, P = 0.09). Exploratory correlations showed moderate association between change in SSWS and 6-min walk test (r = 0.74), and moderate/strong negative association between change in PPR and PSR. CONCLUSIONS These results support FES-assisted cycling as a means to improve both aerobic capacity and locomotor function. Improvements in SSWS, balance, dynamic walking movements, and participation in familial and societal roles are important targets for rehabilitation of individuals after CVA. Interestingly, the correlation between PSR and PPR suggests that improvements in pedaling symmetry may translate to a more symmetric gait pattern.
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Affiliation(s)
- Stacey E Aaron
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Catherine J Vanderwerker
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Aaron E Embry
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Jennifer H Newton
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Samuel C K Lee
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Chris M Gregory
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
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24
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Hosseini L, Shariat A, Ghaffari MS, Honarpishe R, Cleland JA. The effect of exercise therapy, dry needling, and nonfunctional electrical stimulation on radicular pain: a case report. J Exerc Rehabil 2018; 14:864-869. [PMID: 30443534 PMCID: PMC6222167 DOI: 10.12965/jer.1836356.178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/27/2018] [Indexed: 11/22/2022] Open
Abstract
A 43-year-old male, office worker with history of chronic radicular low back pain radiating into the left leg was admitted to a sports medicine research center, neuroscience institute. During the past year, he visited a physiotherapist and orthopedic experts. Magnetic resonance imaging revealed a protruded disc at L4–5 level. Additionally, electromyography indicated that there was bilateral moderate irritation at the L5–S1 root. We designed a management package including exercise therapy, dry needling, and nonfunctional electrical stimulation for four sessions. Outcomes included pain intensity, pain with lumbar flexion, with the numerical rating scale (NRS), visual analogue scale (VAS), and function measured with the Oswestry Disability Index before and after the intervention. After 4 treatment sessions, the patient reported a reduction in pain intensity from a 9 to 2 on the NRS and from 90 to 30 on the VAS. In addition, the patient was able to perform lumbar flexion fully without pain.
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Affiliation(s)
- Lida Hosseini
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardalan Shariat
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Selk Ghaffari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Honarpishe
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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25
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Lin IH, Tsai HT, Wang CY, Hsu CY, Liou TH, Lin YN. Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review. Arch Phys Med Rehabil 2018; 100:366-378. [PMID: 30686327 DOI: 10.1016/j.apmr.2018.09.123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/19/2018] [Accepted: 09/21/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP). DATA SOURCE A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017. STUDY SELECTION Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays. DATA EXTRACTION Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale. DATA SYNTHESIS Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority. CONCLUSIONS Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.
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Affiliation(s)
- I-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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26
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Shariat A, Ansari NN, Shaw BS, Kordi R, Kargarfard M, Shaw I. CYCLING TRAINING AND FUNCTIONAL ELECTRICAL STIMULATION FOR POST-STROKE PATIENTS. REV BRAS MED ESPORTE 2018. [DOI: 10.1590/1517-869220182404187549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
ABSTRACT Introducion: Stroke is one of the leading causes of morbidity and mortality in adults worldwide. The prevalence of stroke in developing countries such as South Africa and Iran is growing, especially in an increasingly younger population. In Iran, the annual stroke incidence ranges from 23 to 103 per 100,000 inhabitants, with the rate being higher in those aged 15-45 years. Problematically, almost 50% of stroke patients face difficulties in performing activities of daily living, hence the importance of functional rehabilitation. These factors necessitate cost-effective solutions in developing countries, where there is insufficient research focused on practical solutions for treatment/rehabilitation. Objective: We hypothesize that while progressive cycling training would activate cortical regions and that cycling speed feedback could lead to additional cortical activations and resultant improvements in cycling performance, combined cycling training and functional electrical stimulation would result in superior improvements in cycling performance, aerobic capacity, and functional performance in post-stroke patients. Conclusions: Ultimately, we expect this hypothesis to provide a useful framework for facilitating combined cycling and functional electrical stimulation rehabilitation research in post-stroke patient populations. Level of Evidence V; Expert opinion.
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Affiliation(s)
| | | | | | | | | | - Ina Shaw
- University of Zululand, Republic of South Africa
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27
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Rabelo M, de Moura Jucá RVB, Lima LAO, Resende-Martins H, Bó APL, Fattal C, Azevedo-Coste C, Fachin-Martins E. Overview of FES-Assisted Cycling Approaches and Their Benefits on Functional Rehabilitation and Muscle Atrophy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:561-583. [DOI: 10.1007/978-981-13-1435-3_26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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28
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McNair K, Lutjen M, Langhamer K, Nieves J, Hreha K. Comprehensive, technology-based, team approach for a patient with locked-in syndrome: A case report of improved function & quality of life. Assist Technol 2017; 31:53-58. [PMID: 28750192 DOI: 10.1080/10400435.2017.1352052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
One of the most severe types of stroke is locked-in syndrome (LIS) due to the loss of almost all voluntary motor functions and a high mortality rate. The majority of the literature regarding LIS is based on case reports that utilized multidisciplinary interventions focused on improving functional communication and respiratory care with minimal focus on motor retraining. These reports were neither dynamic nor multi-sensory, and the only technology utilized was in the form of augmentative communication. There are additional types of technology frequently used in the general stroke population that can address similar motor deficits that occur in the LIS population. This case report explains an interdisciplinary approach using motor and communication interventions that are multisensory, progressive, multi-modal, and technology- based. The length of stay was 153 days in acute rehabilitation, after which the patient returned home making significant gains in overall function. In this patient, the FIM changes in motor (+42), cognitive (+29) and total change score of (+71) surpassed what was determined to be a minimal clinically important difference. These results suggest that this treatment program and approach may be a key reason why this patient was able to achieve significant functional gains and report improved quality of life.
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Affiliation(s)
- Keara McNair
- a Kessler Institute for Rehabilitation , West Orange , New Jersey , USA
| | - Madeline Lutjen
- a Kessler Institute for Rehabilitation , West Orange , New Jersey , USA
| | - Kara Langhamer
- a Kessler Institute for Rehabilitation , West Orange , New Jersey , USA
| | - Jeremiah Nieves
- a Kessler Institute for Rehabilitation , West Orange , New Jersey , USA.,b Rutgers Medical School , Newark , New Jersey , USA
| | - Kimberly Hreha
- a Kessler Institute for Rehabilitation , West Orange , New Jersey , USA.,c Kessler Foundation , West Orange , New Jersey , USA
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29
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Salhab G, Sarraj AR, Saleh S. Mirror therapy combined with functional electrical stimulation for rehabilitation of stroke survivors' ankle dorsiflexion. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4699-4702. [PMID: 28325013 DOI: 10.1109/embc.2016.7591776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study investigates the effect of combining both mirror therapy with Electrical Stimulation (ES) on improvement of the function of lower extremity compared to conventional therapy. 18 stroke survivors (sub acute stage) were recruited, 9 of them were randomly assigned to receive conventional treatment and another 9 started the mirror therapy combined with ES treatment. Duration of each session in both interventions was 50 minutes, done 4 times per week over two weeks. After 2 weeks, subjects took one week rest before switching they type of treatment; those started with conventional therapy continued with mirror therapy combined with ES, and vice versa. The duration of this phase was 2 weeks with same schedule as the 1st one. Ankle dorsi-flexion range of motion, lower extremity sensory-motor function, and walking duration were measured at baseline, after 1st 2 weeks, and immediately after the last two weeks, and 4 weeks after end of training (retention test). Repeated Measures ANCOVA was done to compare outcome measures scores in both groups and between all testing days, and paired T-test was used measure the difference between groups. Significant increase in all outcome measures was found after the (MT+ES) training, which is higher than conventional therapy training (p<;0.0001). In conclusion, the results suggest that combination of mirror therapy and ES is more effective than conventional therapy in improving lower limb motor function after stroke.
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30
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Lendraitienė E, Tamošauskaitė A, Petruševičienė D, Savickas R. Balance evaluation techniques and physical therapy in post-stroke patients: A literature review. Neurol Neurochir Pol 2016; 51:92-100. [PMID: 27884459 DOI: 10.1016/j.pjnns.2016.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/04/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
Abstract
A stroke (cerebrovascular accident - CVA) is a significant social-economic issue. Approximately 15-30% of all patients develop life-long disability, 20% require over 3 months of specialized care in healthcare institutions, and the majority of the patients never recover the ability to maintain a proper vertical position. Such CVA sequelae as balance disturbances not only negatively affect patients' daily physical activity, but also result in social isolation. A number of standardized clinical scales, tests, and instrumental examination techniques have been proposed for evaluating not only post-CVA balance function, but also any changes in this function following various interventions. Even though scientific literature lists numerous methods and instruments for the improvement of balance after a CVA, not all of them are equally effective, and there have been rather controversial evaluations of some techniques. Nevertheless, the application of the majority of the techniques as complementary or alternative measures to traditional physical therapy (PT) frequently yields better results.
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Affiliation(s)
- Eglė Lendraitienė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Agnė Tamošauskaitė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Daiva Petruševičienė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Raimondas Savickas
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania.
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31
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Powell L, Parker J, Martyn St-James M, Mawson S. The Effectiveness of Lower-Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: A Systematic Review. J Med Internet Res 2016; 18:e259. [PMID: 27717920 PMCID: PMC5075044 DOI: 10.2196/jmir.5891] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/02/2016] [Accepted: 08/21/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Regaining ambulation is a top priority for an increasing number of stroke survivors. However, despite an increase in research exploring these devices for lower limb rehabilitation, little is known of the effectiveness. OBJECTIVE This review aims to assess the effectiveness of lower limb wearable technology for improving activity and participation in adult stroke survivors. METHODS Randomized controlled trials (RCTs) of lower limb wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs. RESULTS In the review, we included 11 RCTs with collectively 550 participants at baseline and 474 participants at final follow-up including control groups and participants post stroke. Participants' stroke type and severity varied. Only one study found significant between-group differences for systems functioning and activity. Across the included RCTs, the lowest number of participants was 12 and the highest was 151 with a mean of 49 participants. The lowest number of participants to drop out of an RCT was zero in two of the studies and 19 in one study. Significant between-group differences were found across three of the 11 included trials. Out of the activity and participation measures alone, P values ranged from P=.87 to P ≤.001. CONCLUSIONS This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes, appropriateness of the RCT methodology for complex interventions, a lack of appropriate analysis of outcome data, and participant stroke severity.
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Affiliation(s)
- Lauren Powell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
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32
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de Sousa DG, Harvey LA, Dorsch S, Leung J, Harris W. Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear: a randomised trial. J Physiother 2016; 62:203-8. [PMID: 27637770 DOI: 10.1016/j.jphys.2016.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/26/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022] Open
Abstract
QUESTION Does 4 weeks of active functional electrical stimulation (FES) cycling in addition to usual care improve mobility and strength more than usual care alone in people with a sub-acute acquired brain injury caused by stroke or trauma? DESIGN Multi centre, randomised, controlled trial. PARTICIPANTS Forty patients from three Sydney hospitals with recently acquired brain injury and a mean composite strength score in the affected lower limb of 7 (SD 5) out of 20 points. INTERVENTION Participants in the experimental group received an incremental, progressive, FES cycling program five times a week over a 4-week period. All participants received usual care. OUTCOME MEASURES Outcome measures were taken at baseline and at 4 weeks. Primary outcomes were mobility and strength of the knee extensors of the affected lower limb. Mobility was measured with three mobility items of the Functional Independence Measure and strength was measured with a hand-held dynamometer. Secondary outcomes were strength of the knee extensors of the unaffected lower limb, strength of key muscles of the affected lower limb and spasticity of the affected plantar flexors. RESULTS All but one participant completed the study. The mean between-group differences for mobility and strength of the knee extensors of the affected lower limb were -0.3/21 points (95% CI -3.2 to 2.7) and 7.5 Nm (95% CI -5.1 to 20.2), where positive values favoured the experimental group. The only secondary outcome that suggested a possible treatment effect was strength of key muscles of the affected lower limb with a mean between-group difference of 3.0/20 points (95% CI 1.3 to 4.8). CONCLUSION Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear. TRIAL REGISTRATION ACTRN12612001163897. [de Sousa DG, Harvey LA, Dorsch S, Leung J, Harris W (2016) Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear: a randomised controlled trial.Journal of Physiotherapy62: 203-208].
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Affiliation(s)
- Davide G de Sousa
- Graythwaite Rehabilitation Centre, Ryde Hospital; John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney
| | - Simone Dorsch
- School of Physiotherapy, Australian Catholic University
| | | | - Whitney Harris
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia
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33
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Ambrosini E, De Marchis C, Pedrocchi A, Ferrigno G, Monticone M, Schmid M, D'Alessio T, Conforto S, Ferrante S. Neuro-Mechanics of Recumbent Leg Cycling in Post-Acute Stroke Patients. Ann Biomed Eng 2016; 44:3238-3251. [PMID: 27251336 PMCID: PMC5093201 DOI: 10.1007/s10439-016-1660-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/20/2016] [Indexed: 11/26/2022]
Abstract
Cycling training is strongly applied in post-stroke rehabilitation, but how its modular control is altered soon after stroke has been not analyzed yet. EMG signals from 9 leg muscles and pedal forces were measured bilaterally during recumbent pedaling in 16 post-acute stroke patients and 12 age-matched healthy controls. Patients were asked to walk over a GaitRite mat and standard gait parameters were computed. Four muscle synergies were extracted through nonnegative matrix factorization in healthy subjects and patients unaffected legs. Two to four synergies were identified in the affected sides and the number of synergies significantly correlated with the Motricity Index (Spearman’s coefficient = 0.521). The reduced coordination complexity resulted in a reduced biomechanical performance, with the two-module sub-group showing the lowest work production and mechanical effectiveness in the affected side. These patients also exhibited locomotor impairments (reduced gait speed, asymmetrical stance time, prolonged double support time). Significant correlations were found between cycling-based metrics and gait parameters, suggesting that neuro-mechanical quantities of pedaling can inform on walking dysfunctions. Our findings support the use of pedaling as a rehabilitation method and an assessment tool after stroke, mainly in the early phase, when patients can be unable to perform a safe and active gait training.
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Affiliation(s)
- Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation, Institute of Care and Research (IRCCS), Lissone, Italy
| | | | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Giancarlo Ferrigno
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Marco Monticone
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation, Institute of Care and Research (IRCCS), Lissone, Italy
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Maurizio Schmid
- BioLab3, Department of Engineering, University Roma TRE, Rome, Italy
| | - Tommaso D'Alessio
- BioLab3, Department of Engineering, University Roma TRE, Rome, Italy
| | - Silvia Conforto
- BioLab3, Department of Engineering, University Roma TRE, Rome, Italy
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation, Institute of Care and Research (IRCCS), Lissone, Italy.
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Stein C, Fritsch CG, Robinson C, Sbruzzi G, Plentz RDM. Effects of Electrical Stimulation in Spastic Muscles After Stroke. Stroke 2015; 46:2197-205. [DOI: 10.1161/strokeaha.115.009633] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/15/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Neuromuscular electric stimulation (NMES) has been used to reduce spasticity and improve range of motion in patients with stroke. However, contradictory results have been reported by clinical trials. A systematic review of randomized clinical trials was conducted to assess the effect of treatment with NMES with or without association to another therapy on spastic muscles after stroke compared with placebo or another intervention.
Methods—
We searched the following electronic databases (from inception to February 2015): Medline (PubMed), EMBASE, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro). Two independent reviewers assessed the eligibility of studies based on predefined inclusion criteria (application of electric stimulation on the lower or upper extremities, regardless of NMES dosage, and comparison with a control group which was not exposed to electric stimulation), excluding studies with <3 days of intervention. The primary outcome extracted was spasticity, assessed by the Modified Ashworth Scale, and the secondary outcome extracted was range of motion, assessed by Goniometer.
Results—
Of the total of 5066 titles, 29 randomized clinical trials were included with 940 subjects. NMES provided reductions in spasticity (−0.30 [95% confidence interval, −0.58 to −0.03], n=14 randomized clinical trials) and increase in range of motion when compared with control group (2.87 [95% confidence interval, 1.18–4.56], n=13 randomized clinical trials) after stroke.
Conclusions—
NMES combined with other intervention modalities can be considered as a treatment option that provides improvements in spasticity and range of motion in patients after stroke.
Clinical Trial Registration Information—
URL:
http://www.crd.york.ac.uk/PROSPERO
. Unique identifier: CRD42014008946.
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Affiliation(s)
- Cinara Stein
- From the Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil (C.S., C.G.F., C.R., R.D.M.P.); Laboratory of Clinical Investigation, Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC), Porto Alegre, RS, Brazil (C.S.); and Physical Therapy Undergraduation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil (G.S.)
| | - Carolina Gassen Fritsch
- From the Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil (C.S., C.G.F., C.R., R.D.M.P.); Laboratory of Clinical Investigation, Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC), Porto Alegre, RS, Brazil (C.S.); and Physical Therapy Undergraduation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil (G.S.)
| | - Caroline Robinson
- From the Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil (C.S., C.G.F., C.R., R.D.M.P.); Laboratory of Clinical Investigation, Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC), Porto Alegre, RS, Brazil (C.S.); and Physical Therapy Undergraduation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil (G.S.)
| | - Graciele Sbruzzi
- From the Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil (C.S., C.G.F., C.R., R.D.M.P.); Laboratory of Clinical Investigation, Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC), Porto Alegre, RS, Brazil (C.S.); and Physical Therapy Undergraduation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil (G.S.)
| | - Rodrigo Della Méa Plentz
- From the Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil (C.S., C.G.F., C.R., R.D.M.P.); Laboratory of Clinical Investigation, Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC), Porto Alegre, RS, Brazil (C.S.); and Physical Therapy Undergraduation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil (G.S.)
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