Effectiveness of a Novel Contralaterally Controlled Neuromuscular Electrical Stimulation for Restoring Lower Limb Motor Performance and Activities of Daily Living in Stroke Survivors: A Randomized Controlled Trial

Background

Contralaterally controlled neuromuscular electrical stimulation (CCNMES) is a novel electrical stimulation treatment for stroke; however, reports on the efficacy of CCNMES on lower extremity function after stroke are scarce.

Objective

To compare the effects of CCNMES versus NMES on lower extremity function and activities of daily living (ADL) in subacute stroke patients.

Methods

Forty-four patients with a history of subacute stroke were randomly assigned to a CCNMES group and a NMES group (n = 22 per group). Twenty-one patients in each group completed the study per protocol, with one subject lost in follow-up in each group. The CCNMES group received CCNMES to the tibialis anterior (TA) and the peroneus longus and brevis muscles to induce ankle dorsiflexion motion, whereas the NMES group received NMES. The stimulus current was a biphasic waveform with a pulse duration of 200 μs and a frequency of 60 Hz. Patients in both groups underwent five 15 min sessions of electrical stimulation per week for three weeks. Indicators of motor function and ADL were measured pre- and posttreatment, including the Fugl–Meyer assessment of the lower extremity (FMA-LE) and modified Barthel index (MBI). Surface electromyography (sEMG) assessments included average electromyography (aEMG), integrated electromyography (iEMG), and root mean square (RMS) of the paretic TA muscle.

Results

Values for the FMA-LE, MBI, aEMG, iEMG, and RMS of the affected TA muscle were significantly increased in both groups after treatment (p < 0.01). Patients in the CCNMES group showed significant improvements in all the measurements compared with the NMES group after treatment. Within-group differences in all post- and pretreatment indicators were significantly greater in the CCNMES group than in the NMES group (p < 0.05).

Conclusion

CCNMES improved motor function and ADL ability to a greater extent than the conventional NMES in subacute stroke patients.

Effects of Neuromuscular Electrical Stimulation Combined with Repetitive Transcranial Magnetic Stimulation on Upper Limb Motor Function Rehabilitation in Stroke Patients with Hemiplegia

OBJECTIVE

To investigate the effect of neuromuscular electrical stimulation (NMES) combined with repetitive transcranial magnetic stimulation (rTMS) on upper limb motor dysfunction in stroke patients with hemiplegia.

METHODS

A total of 240 stroke patients with hemiplegia who met the inclusion criteria were selected and randomly divided into 4 groups (60 cases in each group): control group, NMES group, rTMS group, and NMES + rTMS group. Before treatment and 4 weeks after treatment, we evaluated and compared the results including Fugl-Meyer assessment of upper extremity (FMA-UE) motor function, modified Barthel index (MBI), modified Ashworth scale (MAS), and motor nerve electrophysiological results among the 4 groups.

RESULTS

Before treatment, there was no significant difference in the scores of FMA-UE, MBI, MAS, and motor nerve electrophysiological indexes among the four groups, with comparability. Compared with those before treatment, the scores of the four groups were significantly increased and improved after treatment. And the score of the NMES + rTMS group was notably higher than those in the other three groups.

CONCLUSION

NMES combined with rTMS can conspicuously improve the upper extremity motor function and activities of daily life of stroke patients with hemiplegia, which is worthy of clinical application and promotion.

EFFECT OF MOTOR IMAGERY TRAINING IN COMBINATION WITH ELECTROMYOGRAPHY-TRIGGERED ELECTRICAL STIMULATION IN STROKE WITH HEMIPLEGIA PATIENTS: A RANDOMIZED CONTROLLED STUDY

Recently, motor imagery training combined with electromyography-triggered electrical stimulation (MIT EMG-ES) has been reported as a remedial treatment for stroke patients. However, the clinical evidence of the effect is still lacking. To investigate the effect of MIT EMG-ES on lower extremities and activities of daily of living (ADL) in patients with stroke, the participants were randomly assigned to an experimental group ([Formula: see text]) or control group ([Formula: see text]). The experimental group underwent MIT EMG-ES, whereas the control group performed underwent motor imagery training. In addition, both groups received the same conventional rehabilitation therapy. All participants underwent treatment for 30[Formula: see text]min a day, 5 sessions per week, for 4 weeks. Lower extremities function was measured by the Fugl–Meyer Assessment Lower Extremity (FMA-LE), Timed Up-and-Go (TUG) test and 10 m Walk (10[Formula: see text]MW) test. ADL were measured by the Korea version of the Modified Barthel Index (K-MBI). The experimental group except for the FMA-LE group showed more improvement in TUG and 10[Formula: see text]MW test scores than the control group ([Formula: see text]). The effect size showed FMA-LE, TUG, and 10[Formula: see text]MW test (0.7, 1.0, 0.7, respectively). However, there was no statistically significant difference between the two groups in K-MBI ([Formula: see text]). Our findings suggest that MIT EMG-ES may be a novel treatment for lower extremities function in patients with stroke better than MIT alone.

Effects of neuromuscular electrical stimulation on gait performance in chronic stroke with inadequate ankle control - A randomized controlled trial

Neuromuscular electrical stimulation (NMES) has been used to improve muscle strength and decrease spasticity of the ankle joint in stroke patients. However, it is unclear how NMES could influence dynamic spasticity of ankle plantarflexors and gait asymmetry during walking. The study aimed to evaluate the effects of applying NMES over ankle dorsiflexors or plantarflexors on ankle control during walking and gait performance in chronic stroke patients. Twenty-five stroke participants with inadequate ankle control were recruited and randomly assigned to an experimental or a control group. The experimental group received 20 minutes of NMES on either the tibialis anterior muscle (NMES-TA) or the medial gastrocnemius muscle (NMES-MG). The control group received 20 minutes of range of motion and stretching exercises. After the 20 minutes of NMES or exercises, all participants received ambulation training for 15 minutes. Training sessions occurred 3 times per week for 7 weeks. The pre- and post-training assessments included spatio-temporal parameters, ankle range of motion, and dynamic spasticity of ankle plantarflexors during walking. Muscle strength of ankle dorsiflexors and plantarflexors as well as static spasticity of ankle plantarflexors were also examined. The results showed that the static and dynamic spasticity of ankle plantarflexors of the NMES-TA group were significantly decreased after training. Reduction in dynamic spasticity of ankle plantarflexors of the NMES-TA group was significantly greater than that of the NMES-MG group. When compared to the control group, the NMES-TA group had greater improvements in spatial asymmetry, ankle plantarflexion during push off, and muscle strength of ankle dorsiflexors, and the NMES-MG group showed a significant decrease in temporal asymmetry. In summary, NMES on ankle dorsiflexors could be an effective management to enhance gait performance and ankle control during walking in chronic stroke patients. NMES on ankle plantarflexors may improve gait symmetry.

Effect of EMG-triggered neuromuscular electrical stimulation with bilateral arm training on hemiplegic shoulder pain and arm function after stroke: a randomized controlled trial

BACKGROUND

Hemiplegic shoulder pain is a frequent complication after stroke, leading to limited use of the affected arm. Neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation (TENS) are two widely used interventions to reduce pain, but the comparative efficacy of these two modalities remains uncertain. The purpose of this research was to compare the immediate and retained effects of EMG-triggered NMES and TENS, both in combination with bilateral arm training, on hemiplegic shoulder pain and arm function of stroke patients.

METHODS

A single-blind, randomized controlled trial was conducted at two medical centers. Thirty-eight patients (25 males and 13 females, 60.75 ± 10.84 years old, post stroke duration 32.68 ± 53.07 months) who had experienced a stroke more than 3 months ago at the time of recruitment and hemiplegic shoulder pain were randomized to EMG-triggered NMES or TENS. Both groups received electrical stimulation followed by bilateral arm training 3 times a week for 4 weeks. The primary outcome measures included a vertical Numerical Rating Scale supplemented with a Faces Rating Scale, and the short form of the Brief Pain Inventory. The secondary outcome measures were the upper-limb subscale of the Fugl-Meyer Assessment, and pain-free passive shoulder range of motion. All outcomes were measured pretreatment, post-treatment, and at 1-month after post-treatment. Two-way mixed repeated measures ANOVAs were used to examine treatment effects.

RESULTS

Compared to TENS with bilateral arm training, the EMG-triggered NMES with bilateral arm training was associated with lower pain intensity during active and passive shoulder movement (P =0.007, P =0.008), lower worst pain intensity (P = 0.003), and greater pain-free passive shoulder abduction (P =0.001) and internal rotation (P =0.004) at follow-up. Both groups improved in pain at rest (P =0.02), pain interference with daily activities, the Fugl-Meyer Assessment, and pain-free passive shoulder flexion and external rotation post-treatment (P < 0.001) and maintained the improvement at follow-up (P < 0.001), except for resting pain (P =0.08).

CONCLUSIONS

EMG-triggered NMES with bilateral arm training exhibited greater immediate and retained effects than TENS with bilateral arm training with respect to pain and shoulder impairment for chronic and subacute stroke patients with hemiplegic shoulder pain.

TRIAL REGISTRATION

NCT01913509 .

A feasibility study of the effect of multichannel electrical stimulation and gravity compensation on hand function in stroke patients: a pilot study

Many stroke patients have to cope with impaired arm and hand function. As a feasibility study, gravity compensation (GC) and multichannel electrical stimulation (ES) were applied to the forearm of eight stroke patients to study potential effects on dexterity. ES was triggered by positional data of the subject's hand relative to the objects that had to be grasped. Dexterity was evaluated by means of the Box and Blocks Test (BBT). The BBT was performed with four combinations of support; with and without GC and with and without ES. In all patients, it was possible to induce sufficient hand opening for grasping a block of the BBT by means of ES. There was no significant increase in dexterity as measured with the BBT. GC and/or ES did not improve instantaneous dexterity in a small sample of stroke patients although sufficient hand opening was reached in all patients. More research in a larger sample of stroke patients with more specific and more sophisticated control algorithms is needed to explore beneficial effects of GC and ES on hand function in post stroke rehabilitation.

Near-normal gait pattern with peroneal electrical stimulation as a neuroprosthesis in the chronic phase of stroke: a case report

In recent years, the use of functional electrical stimulation (FES) of the peroneal nerve has increased as an alternative for an ankle-foot orthosis (AFO) to treat stroke-related drop foot. We present a chronic stroke patient demonstrating an almost normal gait pattern with peroneal FES as a neuroprosthesis. A 60-year-old survivor of a right hemisphere infarction 21 months ago, who regularly used a polypropylene AFO, was provided with a surface-based peroneal FES device for severe drop foot. In a second instance, he received an implanted FES system because of skin problems with the surface stimulator. With both FES devices, the patient achieved an adequate foot elevation. Moreover, his hip and knee flexion angles during walking increased to normal values and his ankle push-off power increased. His gait pattern became almost symmetrical and less variable than with the AFO. Furthermore, his ability to avoid a sudden obstacle improved to normal values with FES. Our patient showed benefits from peroneal FES beyond what can be attributed to improved foot lift alone. With regard to the potential working mechanisms underlying this response to FES, biomechanical benefits related to improved ankle push-off are suggested as the main mechanism.