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Osman H, Siu R, Makowski NS, Knutson JS, Cunningham DA. Neurostimulation After Stroke. Phys Med Rehabil Clin N Am 2024; 35:369-382. [PMID: 38514224 DOI: 10.1016/j.pmr.2023.06.008] [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: 03/23/2024]
Abstract
Neural stimulation technology aids stroke survivors in regaining lost motor functions. This article explores its applications in upper and lower limb stroke rehabilitation. The authors review various methods to target the corticomotor system, including transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and vagus nerve stimulation. In addition, the authors review the use of peripheral neuromuscular electrical stimulation for therapeutic and assistive purposes, including transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, and functional electrical stimulation. For each, the authors examine the potential benefits, limitations, safety considerations, and FDA status.
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Affiliation(s)
- Hala Osman
- MetroHealth Center for Rehabilitation Research, 4229 Pearl Dr, Cleveland, OH 44109, USA; APT Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Ricardo Siu
- MetroHealth Center for Rehabilitation Research, 4229 Pearl Dr, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 9501 Euclid Avenue, Cleveland, OH 44106, USA
| | - Nathan S Makowski
- MetroHealth Center for Rehabilitation Research, 4229 Pearl Dr, Cleveland, OH 44109, USA; APT Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 9501 Euclid Avenue, Cleveland, OH 44106, USA
| | - Jayme S Knutson
- MetroHealth Center for Rehabilitation Research, 4229 Pearl Dr, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 9501 Euclid Avenue, Cleveland, OH 44106, USA; Cleveland FES Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - David A Cunningham
- MetroHealth Center for Rehabilitation Research, 4229 Pearl Dr, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 9501 Euclid Avenue, Cleveland, OH 44106, USA; Cleveland FES Center, 10701 East Boulevard, Cleveland, OH 44106, USA.
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2
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Allen CB, Williamson TK, Norwood SM, Gupta A. Do Electrical Stimulation Devices Reduce Pain and Improve Function?-A Comparative Review. Pain Ther 2023; 12:1339-1354. [PMID: 37751060 PMCID: PMC10616008 DOI: 10.1007/s40122-023-00554-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Multiple forms of electrical stimulation (ES) potentially offer widely varying clinical benefits. Diminished function commonly associated with acute and chronic pain lessens productivity and increases medical costs. This review aims to compare the relative effects of various forms of ES on functional and pain outcomes. METHODS A comprehensive literature search focused on studies of commonly marketed forms of ES used for treatment of pain and improvement of function. Peer-reviewed manuscripts were categorized as "Important" (systematic review or meta-analysis, randomized controlled trial, observational cohort study) and "Minor" (retrospective case series, case report, opinion review) for each identified form of ES. RESULTS AND DISCUSSION Varying forms of ES have markedly different technical parameters, applications, and indications, based on clinically meaningful impact on pain perception, function improvement, and medication reduction. Despite being around for decades, there is limited quality evidence for most forms of ES, although there are several notable exceptions for treatment of specific indications. Neuromuscular electrical stimulation (NMES) has well-demonstrated beneficial effects for rehabilitation of selective spinal cord injured (SCI), post-stroke, and debilitated inpatients. Functional electrical stimulation (FES) has similarly shown effectiveness in rehabilitation of some stroke, SCI, and foot drop outpatients. H-Wave® device stimulation (HWDS) has moderate supportive evidence for treatment of acute and refractory chronic pain, consistently demonstrating improvements in function and pain measures across diverse populations. Interestingly, transcutaneous electrical nerve stimulation (TENS), the most widely used form of ES, demonstrated insignificant or very low levels of pain and functional improvement. CONCLUSION Ten of 13 reviewed forms of ES have only limited quality evidence for clinically significant reduction of pain or improvement of function across different patient populations. NMES and FES have reasonably demonstrated effectiveness, albeit for specific clinical rehabilitation indications. HWDS was associated with the most clinically significant outcomes, in terms of functional improvement combined with reduction of pain and medication use. More rigorous long-term clinical trials are needed to further validate appropriate use and specific indications for most forms of ES. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Christian B Allen
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, 78235, USA
| | - Tyler K Williamson
- Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX, 78229, USA
| | | | - Ashim Gupta
- Future Biologics, Lawrenceville, GA, 30043, USA.
- Regenerative Orthopaedics, Noida, Uttar Pradesh, 201301, India.
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Lee Y, Kim K. The influence of Gait Training Combined with Portable Functional Electrical Stimulation on motor function, balance and gait ability in stroke patients. J Back Musculoskelet Rehabil 2022; 35:1171-1178. [PMID: 35754258 DOI: 10.3233/bmr-210154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Problems with motor functions, balance and gait ability commonly occur in stroke patients and cause asymmetric posture imbalance and gait patterns. OBJECTIVE We examined the effects of gait training (GT) combined with portable functional electrical stimulation (FES) on motor functions, balance and gait ability of stroke patients. METHODS A single blind, randomized control trial was conducted with 34 post stroke patients who were randomly allocated to two groups: 1) FES + GT group (n= 17) and the placebo FES + GT (PLBO + GT) group (n= 17). All interventions were given for 30 minutes, 5 days a week for 4 weeks. Fugl-Meyer assessment (FMA) was used to measure motor function of lower extremity. Performance oriented mobility assessment (POMA) was used to balance and gait ability. OptoGait was used to analyze gait ability. RESULTS Both groups showed significant improvements in motor function, balance and gait ability. The FES + GT group showed significantly greater improvement in motor function, balance and gait abilities after four weeks compared to the PLBO + GT group. CONCLUSION It was found that the gait training applied with FES is effective in improving the motor function, balance and gait abilities of stroke patients.
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Affiliation(s)
- Yangjin Lee
- Department of Physical Therapy, Kyungbuk College, Gyeongsangbuk-do, Korea
| | - Kyunghun Kim
- Department of Physical Therapy, Gimcheon University, Gyeongsangbuk-do, Korea
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Gil-Castillo J, Alnajjar F, Koutsou A, Torricelli D, Moreno JC. Advances in neuroprosthetic management of foot drop: a review. J Neuroeng Rehabil 2020; 17:46. [PMID: 32213196 PMCID: PMC7093967 DOI: 10.1186/s12984-020-00668-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
This paper reviews the technological advances and clinical results obtained in the neuroprosthetic management of foot drop. Functional electrical stimulation has been widely applied owing to its corrective abilities in patients suffering from a stroke, multiple sclerosis, or spinal cord injury among other pathologies. This review aims at identifying the progress made in this area over the last two decades, addressing two main questions: What is the status of neuroprosthetic technology in terms of architecture, sensorization, and control algorithms?. What is the current evidence on its functional and clinical efficacy? The results reveal the importance of systems capable of self-adjustment and the need for closed-loop control systems to adequately modulate assistance in individual conditions. Other advanced strategies, such as combining variable and constant frequency pulses, could also play an important role in reducing fatigue and obtaining better therapeutic results. The field not only would benefit from a deeper understanding of the kinematic, kinetic and neuromuscular implications and effects of more promising assistance strategies, but also there is a clear lack of long-term clinical studies addressing the therapeutic potential of these systems. This review paper provides an overview of current system design and control architectures choices with regard to their clinical effectiveness. Shortcomings and recommendations for future directions are identified.
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Affiliation(s)
- Javier Gil-Castillo
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Fady Alnajjar
- College of Information Technology (CIT), The United Arab Emirates University, P.O. Box 15551, Al Ain, UAE.
| | - Aikaterini Koutsou
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
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Bae DY, Shin JH, Kim JS. Effects of dorsiflexor functional electrical stimulation compared to an ankle/foot orthosis on stroke-related genu recurvatum gait. J Phys Ther Sci 2019; 31:865-868. [PMID: 31871367 PMCID: PMC6879415 DOI: 10.1589/jpts.31.865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/01/2019] [Indexed: 12/05/2022] Open
Abstract
[Purpose] We evaluated the effects of functional electrical stimulation (FES) and an
ankle/foot orthosis (AFO) in hemiplegic patients exhibiting excessive plantar flexion
during the stance phase, associated with genu recurvatum. [Participants and Methods] In
total, 12 stroke patients were recruited. We measured changes in knee and ankle joint
angles, gait speed, and step and stride length during the gait cycle during barefoot
walking, walking while wearing an AFO, and walking after FES application; we used a three
dimensional gait analysis system. [Results] In terms of kinematic variables, FES walking
was associated with significant increases in peak ankle dorsiflexion during swing,
dorsiflexion angle at initial contact, peak ankle dorsiflexion during stance, knee angle
at initial contact, and peak knee flexion in the loading response compared to AFO and
barefoot walking. AFO walking was associated with a significant difference in peak ankle
dorsiflexion during swing compared to barefoot walking. [Conclusion] FES afforded
kinematic advantages to the ankle and knee joints compared to AFO in hemiplegic patients
with a genu recurvatum gait.
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Affiliation(s)
- Dong-Yun Bae
- Department of Physical Therapy, Pusan National University Yangsan Hospital: 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan 50612, Republic of Korea
| | - Jong-Hwa Shin
- Department of Physical Therapy, Pusan National University Yangsan Hospital: 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan 50612, Republic of Korea
| | - Ju-Seung Kim
- Department of Physical Therapy, Pusan National University Yangsan Hospital: 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan 50612, Republic of Korea
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Moran U, Gottlieb U, Gam A, Springer S. Functional electrical stimulation following anterior cruciate ligament reconstruction: a randomized controlled pilot study. J Neuroeng Rehabil 2019; 16:89. [PMID: 31299999 PMCID: PMC6626389 DOI: 10.1186/s12984-019-0566-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/06/2019] [Indexed: 11/29/2022] Open
Abstract
Background Inadequate quadriceps strength following anterior cruciate ligament reconstruction (ACLR) often results in alterations in gait pattern that are usually reported during loading response. Neuro-muscular electrical stimulation (NMES) is frequently used to overcome this quadriceps weakness. Despite the beneficial effects of NMES, persistent deficits in strength and gait are reported. The aim of this study was to investigate the feasibility of applying quadriceps functional electrical stimulation (FES) during walking in addition to standard rehabilitation, in the initial stage of ACLR rehabilitation. Methods Subjects were randomized to quadriceps FES synchronized with walking group (n = 10) or quadriceps NMES (duty cycle of 10 s on/10 s off) group (n = 13). Both interventions were performed for 10 min three days a week, in addition to a standard rehabilitation program. Assessments were performed up to 2 weeks before the ACLR (pre-ACLR), and 4 weeks postoperatively. Outcomes measured were gait speed, single limb stance gait symmetry, quadriceps isometric peak strength ratio (peak strength at 4 weeks/peak strength pre-ACLR) and peak strength inter-limb symmetry. Gait outcomes were also assessed 1-week post-surgery. Results Subjects in both groups regained pre-ACLR gait speed and symmetry after 4 weeks of rehabilitation, with no difference between groups. However, although pre-ACLR quadriceps peak strength was similar between groups (FES - 205 Nm, NMES − 225 Nm, p = 0.605), subjects in the FES group regained 82% of their pre-quadriceps strength compared to 47% in the NMES group (p = 0.02). In addition, after 4 weeks, the FES group had significantly better inter-limb strength symmetry 0.63 ± 0.15 vs. 0.39 ± 0.18 in the NMES group (p = 0.01). Conclusions Quadriceps FES combined with traditional rehabilitation is a feasible, early intervention treatment option, post-ACLR. Furthermore, at 4 weeks post-surgery, FES was more effective in recovering quadriceps muscle strength than was NMES. While spatiotemporal gait parameters did not differ between groups, kinetic and kinematic studies may be useful to further understand the effects of quadriceps FES post-ACLR. The promising results of this preliminary investigation suggest that such studies are warranted. Trial registration ISRCTN 02817399. First posted June 29, 2016.
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Affiliation(s)
- Uria Moran
- Israel Defense Forces Medical Corps, Ariel, Israel.,Department of Physical Therapy, Faculty of Health Sciences, Ariel University, 40700, Ariel, Israel
| | - Uri Gottlieb
- Israel Defense Forces Medical Corps, Ariel, Israel.,Department of Physical Therapy, Faculty of Health Sciences, Ariel University, 40700, Ariel, Israel
| | - Arnon Gam
- Israel Defense Forces Medical Corps, Ariel, Israel
| | - Shmuel Springer
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, 40700, Ariel, Israel.
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Wilson RD, Bryden AM, Kilgore KL, Makowski N, Bourbeau D, Kowalski KE, DiMarco AF, Knutson JS. Neuromodulation for Functional Electrical Stimulation. Phys Med Rehabil Clin N Am 2019; 30:301-318. [DOI: 10.1016/j.pmr.2018.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rodgers MM, Alon G, Pai VM, Conroy RS. Wearable technologies for active living and rehabilitation: Current research challenges and future opportunities. J Rehabil Assist Technol Eng 2019; 6:2055668319839607. [PMID: 31245033 PMCID: PMC6582279 DOI: 10.1177/2055668319839607] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 02/20/2019] [Indexed: 12/28/2022] Open
Abstract
This paper presents some recent developments in the field of wearable sensors and systems that are relevant to rehabilitation and provides examples of systems with evidence supporting their effectiveness for rehabilitation. A discussion of current challenges and future developments for selected systems is followed by suggestions for future directions needed to advance towards wider deployment of wearable sensors and systems for rehabilitation.
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Affiliation(s)
- Mary M Rodgers
- Department of Physical Therapy & Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gad Alon
- Department of Physical Therapy & Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Richard S Conroy
- Office of Strategic Coordination, National Institutes of Health, Bethesda, MD, USA
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A Randomized Clinical Trial of a Functional Electrical Stimulation Mimic to Gait Promotes Motor Recovery and Brain Remodeling in Acute Stroke. Behav Neurol 2018; 2018:8923520. [PMID: 30662575 PMCID: PMC6312612 DOI: 10.1155/2018/8923520] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/22/2018] [Indexed: 11/20/2022] Open
Abstract
Functional electrical stimulation can improve motor function after stroke. The mechanism may involve activity-dependent plasticity and brain remodeling. The aim of our study was to investigate the effectiveness of a patterned electrical stimulation FES mimic to gait in motor recovery among stroke survivors and to investigate possible mechanisms through brain fMRI. Forty-eight subjects were recruited and randomly assigned to a four-channel FES group (n = 18), a placebo group (n = 15), or a dual-channel FES group (n = 15). Stimulation lasted for 30 minutes in each session for 3 weeks. All of the subjects were assessed at baseline and after weeks 1, 2, and 3. The assessments included the Fugl-Meyer Assessment, the Postural Assessment Scale for Stroke Patients, Brunel's Balance Assessment, the Berg Balance Scale, and the modified Barthel Index. Brain fMRI were acquired before and after the intervention. All of the motor assessment scores significantly increased week by week in all the three groups. The four-channel group showed significantly better improvement than the dual-channel group and placebo groups. fMRI showed that fractional anisotropy was significantly increased in both the four-channel and dual-channel groups compared with the placebo group and fiber bundles had increased significantly on the ipsilateral side, but not on the contralateral side in the group given four-channel stimulation. In conclusion, when four-channel FES induces cycling movement of the lower extremities based on a gait pattern, it may be more effective in promoting motor recovery and induce more plastic changes and brain remodeling than two-channel stimulation. This trial is registered with clinical trial registration unique identifier ChiCTR-TRC-11001615.
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10
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Chen G, Ma L, Song R, Li L, Wang X, Tong K. Speed-adaptive control of functional electrical stimulation for dropfoot correction. J Neuroeng Rehabil 2018; 15:98. [PMID: 30400918 PMCID: PMC6220509 DOI: 10.1186/s12984-018-0448-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 10/23/2018] [Indexed: 11/21/2022] Open
Abstract
Background Functional electrical stimulation is an important therapy technique for dropfoot correction. In order to achieve natural control, the parameter setting of FES should be associated with the activation of the tibialis anterior. Methods This study recruited nine healthy subjects and investigated the relations of walking speed with the onset timing and duration of tibialis anterior activation. Linear models were built for the walking speed with respect to these two parameters. Based on these models, the speed-adaptive onset timing and duration were applied in FES-assisted walking for nine healthy subjects and ten subjects with dropfoot. The kinematic performance of FES-assisted walking triggered by speed-adaptive stimulation were compared with those triggered by the heel-off event, and no-stimulation walking at different walking speeds. Results Higher ankle dorsiflexion angle was observed in heel-off stimulation and speed-adaptive stimulation conditions than that in no-stimulation walking condition at all the speeds. For subjects with stroke, the ankle plantarflexion angle in speed-adaptive stimulation condition was similar to that in no-stimulation walking condition, and it was significant larger than that in heel-off stimulation condition at all speeds. Conclusions The improvement in ankle dorsiflexion without worsening ankle plantarflexion in speed-adaptive stimulation condition could be attributed to the appropriate stimulation timing and duration. These results provide evidence that the proposed stimulation system with speed-related parameters is more physiologically appropriate in dropfoot correction, and it may have great potential value in future clinical applications. Trial registration Medical Ethics Committee of Guangdong Work Injury Rehabilitation Center, AF/SC-07/2016.22. Registered 26 May 2016.
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Affiliation(s)
- Guangtao Chen
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Engineering, Sun Yat-sen University, Guangzhou, Guang Dong, China
| | - Le Ma
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Engineering, Sun Yat-sen University, Guangzhou, Guang Dong, China
| | - Rong Song
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Engineering, Sun Yat-sen University, Guangzhou, Guang Dong, China.
| | - Le Li
- Department of Rehabilitation Medicine, Sun Yat-sen First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyun Wang
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China
| | - Kaiyu Tong
- Department of Biomedical Engineering, the Chinese University of Hong Kong, Hong Kong, China
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Foglyano KM, Schnellenberger JR, Kobetic R, Lombardo L, Pinault G, Selkirk S, Makowski NS, Triolo RJ. Accelerometer-based step initiation control for gait-assist neuroprostheses. ACTA ACUST UNITED AC 2018; 53:919-932. [PMID: 28475203 DOI: 10.1682/jrrd.2015.09.0188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 04/14/2016] [Indexed: 11/05/2022]
Abstract
Electrical activation of paralyzed musculature can generate or augment joint movements required for walking after central nervous system trauma. Proper timing of stimulation relative to residual volitional control is critical to usefully affecting ambulation. This study evaluates three-dimensional accelerometers and customized algorithms to detect the intent to step from voluntary movements to trigger stimulation during walking in individuals with significantly different etiologies, mobility limitations, manual dexterities, and walking aids. Three individuals with poststroke hemiplegia or partial spinal cord injury exhibiting varying gait deficits were implanted with multichannel pulse generators to provide joint motions at the hip, knee, and ankle. An accelerometer integrated into the external control unit was used to detect heel strike or walker movement, and wireless accelerometers were used to detect crutch strike. Algorithms were developed for each sensor location to detect intent to step to progress through individualized stimulation patterns. Testing these algorithms produced detection accuracies of at least 90% on both level ground and uneven terrain. All participants use their accelerometer-triggered implanted gait systems in the community; the validation/system testing was completed in the hospital. The results demonstrated that safe, reliable, and convenient accelerometer-based step initiation can be achieved regardless of specific gait deficits, manual dexterities, and walking aids.
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Affiliation(s)
- Kevin M Foglyano
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | | | - Rudi Kobetic
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | - Lisa Lombardo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | - Gilles Pinault
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | - Stephen Selkirk
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH.,Departments of Neurology and
| | - Nathaniel S Makowski
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | - Ronald J Triolo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH.,Biomedical Engineering and Orthopaedics, Case Western Reserve University, Cleveland, OH
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Chen G, Shen Z, Zhuang Y, Wang X, Song R. Intensity- and Duration-Adaptive Functional Electrical Stimulation Using Fuzzy Logic Control and a Linear Model for Dropfoot Correction. Front Neurol 2018; 9:165. [PMID: 29615963 PMCID: PMC5868077 DOI: 10.3389/fneur.2018.00165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/05/2018] [Indexed: 01/25/2023] Open
Abstract
Functional electrical stimulation (FES) is important in gait rehabilitation for patients with dropfoot. Since there are time-varying velocities during FES-assisted walking, it is difficult to achieve a good movement performance during walking. To account for the time-varying walking velocities, seven poststroke subjects were recruited and fuzzy logic control and a linear model were applied in FES-assisted walking to enable intensity- and duration-adaptive stimulation (IDAS) for poststroke subjects with dropfoot. In this study, the performance of IDAS was evaluated using kinematic data, and was compared with the performance under no stimulation (NS), FES-assisted walking triggered by heel-off stimulation (HOS), and speed-adaptive stimulation. A larger maximum ankle dorsiflexion angle in the IDAS condition than those in other conditions was observed. The ankle plantar flexion angle in the IDAS condition was similar to that of normal walking. Improvement in the maximum ankle dorsiflexion and plantar flexion angles in the IDAS condition could be attributed to having the appropriate stimulation intensity and duration. In summary, the intensity- and duration-adaptive controller can attain better movement performance and may have great potential in future clinical applications.
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Affiliation(s)
- Guangtao Chen
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Zhihang Shen
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Yu Zhuang
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyun Wang
- The Guangdong Work Injury Rehabilitation Center, Guangzhou, China
| | - Rong Song
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Engineering, Sun Yat-Sen University, Guangzhou, China
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13
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Knutson JS, Wilson RD, Makowski NS, Chae J. Functional Electrical Stimulation for Return of Function After Stroke. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00094-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Control of Stroke-Related Genu Recurvatum With Prolonged Timing of Dorsiflexor Functional Electrical Stimulation: A Case Study. J Neurol Phys Ther 2017; 40:209-15. [PMID: 27164309 DOI: 10.1097/npt.0000000000000137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Abnormal knee hyperextension during the stance phase (genu recurvatum) is a common gait abnormality in persons with hemiparesis due to stroke. While ankle-foot orthoses (AFOs) are often used to prevent genu recurvatum by maintaining ankle dorsiflexion during the stance phase, AFOs reduce ankle joint mobility. Functional electrical stimulation (FES) is an alternative to the use of AFO for producing appropriately timed ankle dorsiflexion and with prolonged timing may also have value for reducing genu recurvatum. CASE DESCRIPTION A 51-year-old man with chronic stroke was the subject of this case study. The patient had excessive plantarflexion during stance phase (ie, dynamic equinus foot), with associated genu recurvatum. INTERVENTION Evaluation included clinical examination, instrumented gait analysis, 10-meter walk test, and 6-minute walk test. The patient underwent a trial of botulinum toxin to the plantarflexor muscles that was not effective for controlling the genu recurvatum. A subsequent trial with surface FES to elicit dorsiflexion during gait was effective, and he subsequently received an implanted FES system. OUTCOMES Stimulation-induced contraction of the dorsiflexors during terminal swing phase resulted in improved ankle dorsiflexion at initial contact. Moreover, extension of stimulation into the loading phase ensured tibial advancement, which limited knee hyperextension. The patient was reevaluated 12 months following implantation with continued positive outcomes. DISCUSSION This case study illustrates the potential value of prolonged timing of dorsiflexor FES to manage genu recurvatum attributed to a dynamic equinus foot in a stroke survivor.
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Khamis S, Martikaro R, Wientroub S, Hemo Y, Hayek S. A functional electrical stimulation system improves knee control in crouch gait. J Child Orthop 2015; 9:137-43. [PMID: 25786388 PMCID: PMC4417739 DOI: 10.1007/s11832-015-0651-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/10/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Crouch gait is a major sagittal plane deviation in children diagnosed with cerebral palsy (CP). It is defined as a combination of excessive ankle dorsiflexion and knee and hip flexion throughout the stance phase. To the best of our knowledge, functional electrical stimulation (FES) has not been used to decrease the severity of crouch gait in CP subjects and assist in achieving lower limb extension. PURPOSE To evaluate the short- and long-term effects of FES to the quadriceps muscles in preventing crouch gait and achieving ankle plantar flexion, knee and hip extension at the stance phase. METHODS An 18-year-old boy diagnosed with CP diplegia [Gross Motor Function Classification System (GMFCS) level II] was evaluated. The NESS L300(®) Plus neuroprosthesis system provided electrical stimulation of the quadriceps muscle. A three-dimensional gait analysis was performed using an eight-camera system measuring gait kinematics and spatiotemporal parameters while the subject walked shod only, with ground reaction ankle foot orthotics (GRAFOs) and using an FES device. RESULTS Walking with the FES device showed an increase in the patient's knee extension at midstance and increased knee maximal extension at the stance phase. In addition, the patient was able to ascend and descend stairs with a "step-through" pattern immediately after adjusting the FES device. CONCLUSIONS This report suggests that FES to the quadriceps muscles may affect knee extension at stance and decrease crouch gait, depending on the adequate passive range of motion of the hip, knee extension, and plantar flexion. Further studies are needed in order to validate these results.
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Affiliation(s)
- Sam Khamis
- The Gait and Motion Analysis Laboratory, Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman St., 64239, Tel Aviv, Israel,
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Alam M, Choudhury IA, Mamat AB. Mechanism and design analysis of articulated ankle foot orthoses for drop-foot. ScientificWorldJournal 2014; 2014:867869. [PMID: 24892102 PMCID: PMC4032669 DOI: 10.1155/2014/867869] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/23/2014] [Indexed: 11/25/2022] Open
Abstract
Robotic technologies are being employed increasingly in the treatment of lower limb disabilities. Individuals suffering from stroke and other neurological disorders often experience inadequate dorsiflexion during swing phase of the gait cycle due to dorsiflexor muscle weakness. This type of pathological gait, mostly known as drop-foot gait, has two major complications, foot-slap during loading response and toe-drag during swing. Ankle foot orthotic (AFO) devices are mostly prescribed to resolve these complications. Existing AFOs are designed with or without articulated joint with various motion control elements like springs, dampers, four-bar mechanism, series elastic actuator, and so forth. This paper examines various AFO designs for drop-foot, discusses the mechanism, and identifies limitations and remaining design challenges. Along with two commercially available AFOs some designs possess promising prospective to be used as daily-wear device. However, the design and mechanism of AFO must ensure compactness, light weight, low noise, and high efficiency. These entailments present significant engineering challenges to develop a new design with wide consumer adoption.
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Affiliation(s)
- Morshed Alam
- Manufacturing System Integration, Department of Mechanical Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Imtiaz Ahmed Choudhury
- Manufacturing System Integration, Department of Mechanical Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Azuddin Bin Mamat
- Manufacturing System Integration, Department of Mechanical Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
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The influence of 'Slacklining' on quadriceps rehabilitation, activation and intensity. J Sci Med Sport 2013; 18:62-6. [PMID: 24373899 DOI: 10.1016/j.jsams.2013.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/11/2013] [Accepted: 11/15/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine and compare the level of quadriceps activation for knee injured participants during kinetic open-chain, closed-chain and composite-chain (Slackline) clinical exercises. Quadriceps activation is a critical component of lower limb movement and subsequently, rehabilitation. However, selective activation can be difficult due to pain, loss of function and impaired neuro-motor activation. DESIGN Repeated measures (within-subjects) ANOVA. METHODS Consecutive physiotherapy outpatients (n=49, 41.8±16.8 years, range 13-72 years, 57% female) with an acute (<2 weeks) knee injury were recruited. Participants were assessed for quadriceps activation using skin mounted electromyography during five separate clinical quadriceps activation exercises: two open-chain, inner range quads and straight leg raise; two closed-chain, step down and step up; and a composite-chain, slacklining step-up. Outcome measures were: median score on electromyography as measured in microvolts (μV); and perceived exertion on an 11-point numerical rating scale. RESULTS Median scores of the open- and closed-chain exercises showed no statistical difference, while composite-chain Slackline exercise showed significantly (p<0.0001) higher quadriceps activation (F(2.52, 121.00)=21.53, p<0.0001) at significantly lower exertion (F(1.62, 77.70)=26.88, p<0.0001). CONCLUSIONS The use of Slackline rehabilitation training can provide significant increases in activation and recruitment of the quadriceps for composite-chain exercises in the clinical setting. This activation occurs spontaneously at significantly lower levels of perceived exertion. This spontaneous quadriceps activation in a selective and simple manner is a valuable adjunct exercise for lower limb rehabilitation programmes. This is of particular relevance for the outpatient setting and circumstances where the quadriceps is inhibited and activation is required.
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Springer S, Laufer Y, Becher M, Vatine JJ. Dual-channel functional electrical stimulation improvements in speed-based gait classifications. Clin Interv Aging 2013; 8:271-7. [PMID: 23467567 PMCID: PMC3588608 DOI: 10.2147/cia.s41141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Functional electrical stimulation (FES) is becoming an accepted treatment method for enhancing gait performance in patients who present with gait difficulties resulting from hemiparesis. The purpose of this study was to test whether individuals with hemiparesis who have varied gait speeds, which place them in different functional categories, benefit to the same extent from the application of FES. Methods Thirty-six subjects with chronic hemiparesis demonstrating foot-drop and deficits in knee and/or hip control were fitted with a dual-channel FES system activating the dorsiflexors and hamstring muscles. Gait was assessed during a 2-minute walk test with and without stimulation. A second assessment was conducted after 6 weeks of daily use. Analysis was performed with the subjects stratified into three functional ambulation classes according to their initial gait categories. Results The dual-channel FES improved the gait velocity of all three subgroups. No minimal gait velocity was required in order to gain benefits from FES. For example, subjects with limited household ambulation capabilities improved their gait speed by 63.3% (from 0.30 ± 0.09 m/sec to 0.49 ± 0.20 m/sec; P < 0.01), while subjects with functional community ambulation capabilities improved their gait speed by 25.5% (from 0.90 ± 0.11 m/sec to 1.13 ± 0.22 m/sec; P < 0.01). Conclusion Dual-channel FES positively affects gait velocity in patients with chronic hemiparesis, regardless of their initial gait velocity. Furthermore, gait velocity gains may be large enough to change an individual’s ambulation status to a higher functional category.
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Affiliation(s)
- Shmuel Springer
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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