Feasibility and potential effects of using the electro-dress Mollii on spasticity and functioning in chronic stroke

Effects of a Wearable-Based Intervention on the Hemiparetic Upper Limb in Persons With Stroke: A Randomized Controlled Trial

INTRODUCTION

Wearables have emerged as a transformative rehabilitation tool to provide self-directed training in the home. Objective. In this study, we examined the efficacy of a novel wearable device, "Smart Reminder" (SR), to provide home-based telerehabilitation for hemiparetic upper limb (UL) training in persons with stroke.

METHODS

Forty stroke survivors from community support groups were randomized (stratified by the period after stroke onset and impairment severity) to either the SR group or the sham device group. Participants received either 20 hours of telerehabilitation using the SR device or training with pictorial handouts and a sham device over 4 weeks. In addition, all participants wore a standard accelerometer for 3 hours each day, 5 times a week, outside the prescribed training. Participants were assessed by a masked assessor at baseline, post-intervention (week 4), and follow-up (week 8). The outcome measures included Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test, Motor Activity Log, muscle strength, active range of motion and amount of movement of the UL, and compliance rate of training.

RESULTS

The SR group improved substantially in their FMA-UE scores after treatment (mean difference = 2.05, P = .036) compared to the sham group. Also, adherence to the training using the SR device was significantly higher, 97%, than the sham group, 82.3% (P = .038).

CONCLUSION

The 4-week telerehabilitation program using a "SR" device demonstrated potential efficacy in improving FMA-UE scores of the hemiparetic upper limb. However, it did not significantly enhance the performance of the affected limb in daily activities. The trial was registered on ClinicalTrial.gov (URL: http://www.clinicaltrials.gov) with the identifier NCT05877183.

Effects of a full-body electrostimulation garment application in a cohort of subjects with cerebral palsy, multiple sclerosis, and stroke on upper motor neuron syndrome symptoms

OBJECTIVES

Dysfunction of the central nervous system may inflict spastic movement disorder (SMD). Electrical stimuli were identified as promising therapeutic option. Electrical stimulation provided by a 58-electrode full body garment was investigated based on data from regular trial fittings.

METHODS

Data from 72 testees were investigated. Age averages 36.6 (19.8) ys with 44 females. The cohort spans infantile cerebral paresis (CP) (n=29), multiple sclerosis (MS) (n=23) and stroke (n=20). Data were stratified by etiology and an entry BBS Score<45.

RESULTS

Effect sizes (Cohen`s d) related BBS, TUG, FGA, 10mWT, WMFT, EQ5D5L and Pain. Significance levels are indicated by *: p<0.05, **: p<0.01, ***: p<0.001, (t): p<0.1: CP: 1.64***, 0.29*, 1.59***, 0.76(t), 1.00***, 0.5*, 1.28***; MS: 1.83***, 0.83***, 1.28**, 1.07***, 0.93*, 1,11**, 0.78*; Stroke: 1.28**, 0.78**, 0.89, 0.92**, 0.71, 1.26*, 0.78*.

CONCLUSIONS

Multi-site transcutaneous electrical stimulation may increase ambulation related skills in subjects with SMD stemming from CP, MS and stroke. The results indicate effects on static and dynamic balance, fall risk, mobility, upper extremity improvement and an overall increase in health utility and a reduction in spasticity related pain. Effects are immediate as well as sustained. These results may inspire individual trial fittings and inform further controlled trials.

'Smart reminder': A feasibility pilot study on the effects of a wearable device treatment on the hemiplegic upper limb in persons with stroke

INTRODUCTION

Emerging literature suggests that wearable devices offer a promising option for self-directed home-based upper limb training for persons with stroke. However, little research is available to explore integrating smartphone applications with wearable devices to provide upper limb telerehabilitation to stroke survivors at home. This study examined the feasibility and potential therapeutic effects of a wearable device integrated with a smartphone-based telerehabilitation system to provide upper limb rehabilitation to stroke survivors at home.

METHODS

Twelve stroke survivors from community support groups participated in a treatment consisting of 4-week telerehabilitation using a wearable device and 4-week conventional therapy successively in a single-blind, randomised crossover study. A 3-week washout period was administered between the two 4-week treatments. The primary outcome measures were the Fugl Meyer Assessment, the Action Research Arm Test, and the active range of motion (ROM) of the upper limb. Secondary outcome measures included the Motor Activity Log and exercise adherence.

RESULTS

Results showed that the active ROM of participants' hemiplegic shoulder improved more significantly after 4 weeks of telerehabilitation with the wearable device than with conventional therapy. No significant differences were found in other outcome measures.

CONCLUSIONS

A 4-week telerehabilitation programme using a wearable device improves the hemiplegic upper limb in community-dwelling stroke survivors and may be feasible as an effective intervention for self-directed upper limb rehabilitation at home.

Seamlessly integrated textile electrodes and conductive routing in a garment for electrostimulation: design, manufacturing and evaluation

Electro-stimulation to alleviate spasticity, pain and to increase mobility has been used successfully for years. Usually, gelled electrodes are used for this. In a garment intended for repeated use such electrodes must be replaced. The Mollii-suit by the company Inerventions utilises dry conductive rubber electrodes. The electrodes work satisfactory, but the garment is cumbersome to fit on the body. In this paper we show that knitted dry electrodes can be used instead. The knitted electrodes present a lower friction against the skin and a garment is easily fitted to the body. The fabric is stretchable and provides a tight fit to the body ensuring electrical contact. We present three candidate textrodes and show how we choose the one with most favourable features for producing the garment. We validate the performance of the garment by measuring three electrical parameters: rise time (10-90%) of the applied voltage, net injected charge and the low frequency value of the skin-electrode impedance. It is concluded that the use of flat knitting intarsia technique can produce a garment with seamlessly integrated conductive leads and electrodes and that this garment delivers energy to the body as targeted and is beneficial from manufacturing and comfort perspectives.

Use and Effectiveness of Electrosuit in Neurological Disorders: A Systematic Review with Clinical Implications

Electrical stimulation through surface electrodes is a non-invasive therapeutic technique used to improve voluntary motor control and reduce pain and spasticity in patients with central nervous system injuries. The Exopulse Mollii Suit (EMS) is a non-invasive full-body suit with integrated electrodes designed for self-administered electrical stimulation to reduce spasticity and promote flexibility. The EMS has been evaluated in several clinical trials with positive findings, indicating its potential in rehabilitation. This review investigates the effectiveness of the EMS for rehabilitation and its acceptability by patients. The literature was collected through several databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Positive effects of the garment on improving motor functions and reducing spasticity have been shown to be related to the duration of the administration period and to the dosage of the treatment, which, in turn, depend on the individual's condition and the treatment goals. Moreover, patients reported wellbeing during stimulation and a muscle-relaxing effect on the affected limb. Although additional research is required to determine the efficacy of this device, the reviewed literature highlights the EMS potential to improve the motor capabilities of neurological patients in clinical practice.

Use of the EXOPULSE Mollii for severe ataxia in an adult male 4 months after cardiac arrest

The EXOPULSE Mollii is designed to reduce spasticity through low-current electrical stimulation of major muscle groups. The effect on severe cerebellar ataxia has not been investigated. This case describes the use of the EXOPULSE Mollii in an adult male with severe cerebellar ataxia 4 months after cardiac arrest and ischaemic stroke. The patient used the suit in 15 of 19 possible sessions (78.9%). He improved in the sit-to-stand test, arm function test and 10 m walking test. He described improved visual focus, ability to speak and swallow. Improvements were maintained for 1 week after the last session. The EXOPULSE Mollii is relevant to consider in the early stages of inpatient rehabilitation for patients with severe ataxia, but further research is warranted.

Acute Effects of a Session with The EXOPULSE Mollii Suit in a Fibromyalgia Patient: A Case Report

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain and associated fatigue, sleep disturbances, and other cognitive and somatic symptoms. A multidisciplinary approach including pharmacological therapies along with behavioral therapy, exercise, patient education, and pain management is a possible solution for the treatment of this disease. The EXOPULSE Mollii^® method (EXONEURAL NETWORK AB, Danderyd, Sweden) is an innovative approach for non-invasive and self-administered electrical stimulation with multiple electrodes incorporated in a full-body suit, with already proven benefits for other diseases. Therefore, the present case report study aims to evaluate the effects that a 60 min session with the EXOPULSE Mollii suit has on a female fibromyalgia patient. After the intervention, we can conclude that a 60 min session with the EXOPULSE Mollii suit has beneficial effects on pain perception, muscle oxygenation, parasympathetic modulation, and function in a female fibromyalgia patient.

Neurointerface with oscillator motifs for inhibitory effect over antagonist muscles

The effect of inhibitory management is usually underestimated in artificial control systems, using biological analogy. According to our hypothesis, the muscle hypertonus could be effectively compensated via stimulation by bio-plausible patterns. We proposed an approach for the compensatory stimulation device as implementation of previously presented architecture of the neurointerface, where (1) the neuroport is implemented as a DAC and stimulator, (2) neuroterminal is used for neurosimulation of a set of oscillator motifs on one-board computer. In the set of experiments with five volunteers, we measured the efficacy of motor neuron inhibition via the antagonist muscle or nerve stimulation registering muscle force with and without antagonist stimulation. For the agonist activation, we used both voluntary activity and electrical stimulation. In the case of stimulation of both the agonist and the antagonist muscles and nerves, we experimented with delays between muscle stimulation in the range of 0-20 ms. We registered the subjective discomfort rate. We did not identify any significant difference between the antagonist muscle and nerve stimulation in both voluntary activity and electrical stimulation of cases showing agonist activity. We determined the most effective delay between the stimulation of the agonist and the antagonist muscles and nerves as 10-20 ms.

Patients' experiences of self-administered electrotherapy for spasticity in stroke and cerebral palsy: A qualitative study

OBJECTIVE

To explore patients' experiences of a self-administered electrotherapy treatment for muscle spasticity in cerebral palsy and stroke; the Exopulse Mollii Suit®.

DESIGN

Qualitative design with an inductive approach Subjects: Fifteen patients with spasticity due to stroke or cerebral palsy, participating in a previous randomized controlled trial (RCT) evaluating the treatment concept.  Methods: Information letters were sent to all potential participants (n = 27) in the previous study. Semi-structured interviews (21-57 min) were carried out with all subjects who volunteered (n = 15), administered by an experienced interviewer who was not involved in the previous study. Transcribed interviews were subject to content analysis.  Results: The 5 categories that emerged from the content analysis were "New method gives hope", experiences related to "Using the assistive technology", "Outcome from training with the assistive technology", "The assistive technology" and "Taking part in the study". Respondents felt hopeful when included in the previous study, motivated when experiencing a treatment effect, and disappointed when not.  Conclusion: The qualitative approach used in this study elicited complementary information that was not evident from the previous RCT. This included statements regarding increased mobility, reduced spasticity, reduced use of medication, and problems related to using the treatment concept.

Effects of 60 Min Electrostimulation With the EXOPULSE Mollii Suit on Objective Signs of Spasticity

Background: The EXOPULSE Mollii method is an innovative full-body suit approach for non-invasive electrical stimulation, primarily designed to reduce disabling spasticity and improve motor function through the mechanism of reciprocal inhibition. This study aimed to evaluate the effectiveness of one session of stimulation with the EXOPULSE Mollii suit at different stimulation frequencies on objective signs of spasticity and clinical measures, and the subjective perceptions of the intervention.

Methods: Twenty patients in the chronic phase after stroke were enrolled in a cross-over, double-blind controlled study. Electrical stimulation delivered through EXOPULSE Mollii was applied for 60 min at two active frequencies (20 and 30 Hz) and in OFF-settings (placebo) in a randomized order, every second day. Spasticity was assessed with controlled-velocity passive muscle stretches using the NeuroFlexor hand and foot modules. Surface electromyography (EMG) for characterizing flexor carpi radialis, medial gastrocnemius, and soleus muscles activation, Modified Ashworth Scale and range of motion were used as complementary tests. Finally, a questionnaire was used to assess the participants' perceptions of using the EXOPULSE Mollii suit.

Results: At group level, analyses showed no significant effect of stimulation at any frequency on NeuroFlexor neural component (NC) and EMG amplitude in the upper or lower extremities (p > 0.35). Nevertheless, the effect was highly variable at the individual level, with eight patients exhibiting reduced NC (>1 N) in the upper extremity after stimulation at 30 Hz, 5 at 20 Hz and 3 in OFF settings. All these patients presented severe spasticity at baseline, i.e., NC > 8 N. Modified Ashworth ratings of spasticity and range of motion did not change significantly after stimulation at any frequency. Finally, 75% of participants reported an overall feeling of well-being during stimulation, with 25% patients describing a muscle-relaxing effect on the affected hand and/or foot at both 20 and 30 Hz.

Conclusions: The 60 min of electrical stimulation with EXOPULSE Mollii suit did not reduce spasticity consistently in the upper and lower extremities in the chronic phase after stroke. Findings suggest a need for further studies in patients with severe spasticity after stroke including repeated stimulation sessions.

Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT04076878, identifier: NCT04076878.