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Musselman KE, Mayhew M, Somal H, Benn NL, Salbach NM, Switzer-McIntyre S. Physical and occupational therapists' learning needs and preferences for education on functional electrical stimulation: A qualitative descriptive study. Artif Organs 2024. [PMID: 38622826 DOI: 10.1111/aor.14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/21/2024] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Functional electrical stimulation (FES) is an evidence-based intervention that is rarely used by Canadian physical therapists (PTs) and occupational therapists (OTs). A common barrier to FES implementation is a lack of knowledge and training. FES learning resources that meet therapists' learning needs and preferences may address this barrier. OBJECTIVE To explore OTs' and PTs' perspectives on the utility of FES e-learning resources, including whether the resources met their learning needs and preferences. METHODS Through this qualitative descriptive study, feedback on FES e-learning resources was solicited from 5 PTs and 18 OTs who work clinically, but do not use FES. Participants reviewed ≥3 prerecorded lectures on FES topics and then completed a semi-structured interview. Participants were asked about the lectures' content, delivery, ease of use and comprehensibility, and were asked to suggest modifications to facilitate self-directed learning about FES. Interviews were analyzed using conventional content analysis. RESULTS Three themes were identified. (1) Feedback on FES e-learning: the content and delivery of the prerecorded lectures facilitated participants' learning, although opportunities to improve content and delivery were identified. (2) Factors influencing FES learning needs and preferences: Participants identified internal (i.e., baseline knowledge, learning style) and external (i.e., learning with colleagues, practice setting) factors that affected learning. Themes 1 and 2 impacted (3) the effects of FES e-learning: Participants described the outcomes of their FES e-learning, including increases in FES knowledge, confidence, and use in clinical practice. CONCLUSION Therapists' perceived the FES e-learning resources to be useful and to address their learning needs and preferences.
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Affiliation(s)
- Kristin E Musselman
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Madi Mayhew
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Harneet Somal
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natasha L Benn
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Sharon Switzer-McIntyre
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Musselman KE, Provad E, Djuric A, Bercovitch D, Yuen I, Kane KJ. Exploring the Experiences and Perceptions of Pediatric Therapists who use Functional Electrical Stimulation in their Clinical Practice. Phys Occup Ther Pediatr 2023; 43:759-779. [PMID: 37125689 DOI: 10.1080/01942638.2023.2197053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 05/02/2023]
Abstract
Aim: This study aimed to 1) explore the experiences and perceptions of pediatric physical therapists (PTs) and occupational therapists (OTs) who use FES in their practice, and 2) provide recommendations for overcoming common barriers to FES implementation.Methods: Eight Canadian PTs (n = 6) and OTs (n = 2), who use FES in their pediatric practice, participated in semi-structured interviews. Open-ended questions queried the motivation, goals, perceived benefits and challenges, and facilitators and barriers of FES use. Interviews were audio recorded and transcribed verbatim. Interpretive description was used to analyze the transcripts.Results: One overarching theme emerged: FES is a useful adjunct to therapy for certain pediatric clients. Four sub-themes were identified: Participants described 1) motivation for incorporating FES into clinical practice, which led to 2) experiences with the implementation of FES in clinical practice, including strategies for overcoming implementation barriers. These experiences influenced 3) how FES is used in practice (e.g. for which populations and therapeutic goals), and informed 4) recommendations for pediatric FES practice (e.g. more educational opportunities, research, and access for families).Conclusions: Pediatric PTs and OTs who use FES in clinical practice view FES as a valuable adjunct, especially for motor training to improve functional skills.
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Affiliation(s)
- Kristin E Musselman
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elina Provad
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexander Djuric
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Dayna Bercovitch
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ingrid Yuen
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kyra J Kane
- Children's Program, Wascana Rehabilitation Centre, Regina, SK, Canada
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Lou X, Wu Y, Lu S, Shen X. Control strategy for intraspinal microstimulation based on central pattern generator. Comput Methods Biomech Biomed Engin 2023; 26:305-314. [PMID: 35400261 DOI: 10.1080/10255842.2022.2062230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Intraspinal microstimulation (ISMS) is considered as a special functional electrical stimulation (FES) method. This method can restore the movement of paralyzed limbs in patients with spinal cord injury (SCI) using electrical stimulation of spinal cord. There is a special site for central pattern generator (CPG) in the spinal cord. The ISMS acts on the CPG site, and single electrode stimulation produces alternating motion in the hindlimbs of SCI rats. Based on the long short-term memory network (LSTM), a mapping model was established between the stimulation intensity of specific CPG sites and the angle of the knee joint to reflect the motor characteristics of the rat hindlimb. We proposed an LSTM-iterative learning control (ILC) strategy to form a closed-loop control to accurately control hindlimb movement. The proposed LSTM model fits the actual joint angle curve well, and the LSTM-ILC strategy can accurately regulate the hindlimb movement, allowing rats to perform rehabilitation training based on pre-set knee trajectories.
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Affiliation(s)
- Xiongjie Lou
- School of Information Science and Technology, Nantong University, Nantong, China
| | - Yan Wu
- School of Information Science and Technology, Nantong University, Nantong, China
| | - Song Lu
- School of Information Science and Technology, Nantong University, Nantong, China
| | - Xiaoyan Shen
- School of Information Science and Technology, Nantong University, Nantong, China.,Collaborative Innovation Center for Nerve Regeneration, Nantong University, Nantong, China
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Brown L, Street T, Adonis A, Johnston TE, Ferrante S, Burridge JH, Bulley C. Implementing functional electrical stimulation clinical practice guidelines to support mobility: A stakeholder consultation. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1062356. [PMID: 36776737 PMCID: PMC9909018 DOI: 10.3389/fresc.2023.1062356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023]
Abstract
Functional Electrical Stimulation (FES) has been used to support mobility for people with upper motor neuron conditions such as stroke and multiple sclerosis for over 25 years. Recent development and publication of clinical practice guidelines (CPGs) provide evidence to guide clinical decision making for application of FES to improve mobility. Understanding key barriers to the implementation of these CPGs is a critical initial step necessary to create tailored knowledge translation strategies. A public involvement and engagement consultation was conducted with international stakeholders including researchers, clinicians and engineers working with FES to inform implementation strategies for CPG use internationally. Reflexive thematic analysis of the consultation transcripts revealed themes including inconsistent use of CPGs, barriers to implementation such as limited access to FES and low clinician confidence, and the need for a tiered education approach with ongoing support. Insights derived from this consultation will inform the development of knowledge translation strategies to support the next steps to implementing FES use for mobility.
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Affiliation(s)
- Lisa Brown
- Department of Physical Therapy, Boston University, Boston, MA, United States
| | - Tamsyn Street
- Salisbury NHS Foundation Trust, Salisbury, United Kingdom,Correspondence: Tamsyn Street
| | - Adine Adonis
- Department of Physiotherapy, Imperial College Healthcare NHS, London, United Kingdom
| | - Therese E. Johnston
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Simona Ferrante
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Abouzakhm N, Choy S, Feld R, Taylor C, Carter K, Degroot S, Musselman KE. Evaluating the validity of a functional electrical stimulation clinical decision making tool: A qualitative study. Front Neurol 2022; 13:1001123. [PMID: 36457863 PMCID: PMC9707702 DOI: 10.3389/fneur.2022.1001123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/31/2022] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Following central nervous system damage, the recovery of motor function is a priority. For some neurological populations, functional electrical stimulation (FES) is recommended in best practice guidelines for neurorehabilitation. However, limited resources exist to guide FES application, despite clinicians reporting that a lack of FES knowledge prevents use in clinical practice. The FES Clinical Decision Making Tool was developed to assist clinicians with FES application and translation into clinical practice. The purpose of this study was to evaluate the content validity of the Tool from the perspectives of Canadian physical and occupational therapists using FES in neurorehabilitation. METHODS Thirteen participants (twelve women, one man), aged 40.5 ± 10.3 years, participated in individual semi-structured interviews to explore their clinical decision making experiences when applying FES and to evaluate the content validity (i.e., appropriateness, comprehensibility, and comprehensiveness) of the Tool. Interviews were analyzed using a qualitative conventional content analysis following the DEPICT model. RESULTS Three themes were identified. 1) Clinician context influences FES usage. Participants' experiences with FES use varied and application was influenced by treatment goals. 2) Parameter selection in clinical practice. Participants identified decision-making strategies and the challenges of parameter selection. 3) With modifications, the Tool is a valid resource to inform FES applications. Participants discussed its strengths, limitations, and suggested changes. While the Tool is useful, a more extensive resource (e.g., appendix) for the Tool is warranted. DISCUSSION A revised Tool was created to improve its comprehensiveness and comprehensibility. Thus, the Tool is a valid resource for applying FES in neurorehabilitation.
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Affiliation(s)
- Nathalie Abouzakhm
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samantha Choy
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rebecca Feld
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Chris Taylor
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kathryn Carter
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Spencer Degroot
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristin E. Musselman
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Shen X, Lou X, Shao W, Li Z, Wu Y, Lu S. Gait regulation of hindlimb based on central pattern generator in rats with a spinal cord injury. Proc Inst Mech Eng H 2022; 236:979-987. [DOI: 10.1177/09544119221095341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A spinal stimulator that can regulate hindlimb movements using monopolar stimulation has not been developed yet. Nevertheless, in a previous study, we found a specific central pattern generator site on the right side of the rat spinal cord. By stimulating these sites with certain pulse signals, the alternating movement of the hindlimb can be obtained using fewer electrodes. Therefore, in this research, considering the specific central pattern generator site as the target, functional electrical stimulation was performed on rats with spinal cord injury using monopolar stimulation. Angle sensors were used to track and capture the knee joint angle data of the right hindlimb; thus, the mapping relationship between the voltage amplitude and the knee angle parameters was established. Based on this relationship, the rats’ hindlimb were controlled. Compared with the traditional spinal stimulator, the proposed approach increases the gait feedback, requires fewer electrodes, and simplifies the timing of stimulation. The rats with spinal cord injury were subjected to stimulation training for half an hour every day for 28 consecutive days. The Basso, Beattie and Bresnahan score showed that 76% of the health level could be achieved on the 28th day. Finally, somatosensory evoked potential analysis showed that the measurement results were close to the standard value on the 28th day. This study lays a foundation for future rehabilitation research on the hindlimb.
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Affiliation(s)
- Xiaoyan Shen
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
- Nantong Research Institute for Advanced Communication Technologies, Jiangsu, P.R. China
| | - Xiongjie Lou
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
| | - Wei Shao
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
| | - Zhiling Li
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
| | - Yan Wu
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
| | - Song Lu
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu, P.R. China
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