1
|
Tilborg NAWV, de Groot V, Meskers CGM. The effectiveness of early interventions for post-stroke spasticity: a systematic review. Disabil Rehabil 2024:1-12. [PMID: 38907596 DOI: 10.1080/09638288.2024.2363963] [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: 03/04/2024] [Accepted: 05/31/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE To synthesize evidence on the effect of early post-stroke spasticity interventions. METHODS Systematic literature search (PubMed, Embase, and Web of Science) encompassing studies on spasticity reducing interventions within 3 months post stroke on outcome defined within the International Classification of Functioning (ICF). RESULTS In total, 27 studies were identified with n = 1.658 cases. Botulinum toxin (2-12 weeks; 10 studies, n = 794) showed consistent and significant reduced spasticity by Modified Ashworth Scale (MAS) or electromyography (EMG). Electrical muscle stimulation (1-8 weeks; 6 studies, n = 335) showed lower MAS/Composite Spasticity Scale scores in 4 studies. Transcranial stimulation (3 studies; n = 131), oral spasmolytics (1 study; n = 38), shockwave (1 study; n = 40), orthotics (3 studies; n = 197 and robot-assisted therapy (3 studies; n = 123) showed inconclusive results. Effects on ICF activity domain could not be established due to limited data and large outcome measures heterogeneity. One out of two studies showed significant benefit for early compared to late BoNT intervention (< 90 vs> 90 days). CONCLUSION This study provides evidence for early applied (<3 months) BoNT to effectively reduce spasticity and probable effectiveness of electrical stimulation. Establishing effects of interventions in the acute/hospitalization phase (<7 days) needs further work, specifically on the ICF activity domain. Standardization of outcome measures is required.
Collapse
Affiliation(s)
- Nino A W van Tilborg
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, the Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, the Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Lim D, Pei W, Lee JW, Musselman KE, Masani K. Feasibility of using a depth camera or pressure mat for visual feedback balance training with functional electrical stimulation. Biomed Eng Online 2024; 23:19. [PMID: 38347584 PMCID: PMC10863251 DOI: 10.1186/s12938-023-01191-y] [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: 09/26/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024] Open
Abstract
Individuals with incomplete spinal-cord injury/disease are at an increased risk of falling due to their impaired ability to maintain balance. Our research group has developed a closed-loop visual-feedback balance training (VFBT) system coupled with functional electrical stimulation (FES) for rehabilitation of standing balance (FES + VFBT system); however, clinical usage of this system is limited by the use of force plates, which are expensive and not easily accessible. This study aimed to investigate the feasibility of a more affordable and accessible sensor such as a depth camera or pressure mat in place of the force plate. Ten able-bodied participants (7 males, 3 females) performed three sets of four different standing balance exercises using the FES + VFBT system with the force plate. A depth camera and pressure mat collected centre of mass and centre of pressure data passively, respectively. The depth camera showed higher Pearson's correlation (r > 98) and lower root mean squared error (RMSE < 10 mm) than the pressure mat (r > 0.82; RMSE < 4.5 mm) when compared with the force plate overall. Stimulation based on the depth camera showed lower RMSE than that based on the pressure mat relative to the FES + VFBT system. The depth camera shows potential as a replacement sensor to the force plate for providing feedback to the FES + VFBT system.
Collapse
Affiliation(s)
- Derrick Lim
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - William Pei
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jae W Lee
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
| |
Collapse
|
4
|
Perpetuini D, Russo EF, Cardone D, Palmieri R, De Giacomo A, Pellegrino R, Merla A, Calabrò RS, Filoni S. Use and Effectiveness of Electrosuit in Neurological Disorders: A Systematic Review with Clinical Implications. Bioengineering (Basel) 2023; 10:680. [PMID: 37370612 DOI: 10.3390/bioengineering10060680] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- David Perpetuini
- Department of Engineering and Geology, University G. D'Annunzio of Chieti-Pescara, 65127 Pescara, Italy
| | | | - Daniela Cardone
- Department of Engineering and Geology, University G. D'Annunzio of Chieti-Pescara, 65127 Pescara, Italy
| | - Roberta Palmieri
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Andrea De Giacomo
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland
| | - Arcangelo Merla
- Department of Engineering and Geology, University G. D'Annunzio of Chieti-Pescara, 65127 Pescara, Italy
| | | | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Centers, 71013 San Giovanni Rotondo, Italy
| |
Collapse
|
5
|
Cho JE, Shin JH, Kim H. Does electrical stimulation synchronized with ankle movements better improve ankle proprioception and gait kinematics in chronic stroke? A randomized controlled study. NeuroRehabilitation 2022; 51:259-269. [PMID: 35527578 PMCID: PMC9535592 DOI: 10.3233/nre-220018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND: Individuals with stroke have impaired sensorimotor function of ankle. OBJECTIVE: To investigate the effects of passive biaxial ankle movement training synchronized with electrical stimulation therapy (AMT-EST) on ankle proprioception, passive range of motion (pROM), and strength, balance, and gait of chronic stroke patients. METHODS: Thirty-five stroke patients were randomized. The experimental group received a total of 20 AMT-EST sessions. The control group received only EST. Primary outcome measures were ankle functions. Secondary outcome measures were clinical assessments of motor, balance, and gait-related functions. All assessments were compared before and after the intervention. RESULTS: The experimental group had significantly improved ankle dorsiflexor strength (p = 0.015) and ankle pROM during foot supination (p = 0.026) and pronation (p = 0.004) and clinical assessment (Fugl–Meyer Assessment of the lower extremities [FM-L], Berg Balance Scale, Timed Up and Go test, Fall Efficacy Scale, walking speed, and step length; all p < 0.05) values. The regression model predicting ankle proprioception showed significantly large effects (adjusted R2 = 0.493; p < 0.01) of the combined FM-L score and time since stroke. CONCLUSION: Biaxial AMT-EST resulted in better ankle pROM and strength than conventional EST. Ankle proprioception was not significantly improved after AMT-EST and was predicted by the FM-L score and time since stroke.
Collapse
Affiliation(s)
- Ji-Eun Cho
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Center, Seoul, South Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, South Korea
| | - Hogene Kim
- Department of Clinical Rehabilitation Research, National Rehabilitation Center, Seoul, South Korea
| |
Collapse
|
6
|
Effectiveness of Repetitive Facilitative Exercise Combined with Electrical Stimulation Therapy to Improve Very Severe Paretic Upper Limbs in with Stroke Patients: A Randomized Controlled Trial. Occup Ther Int 2022; 2022:4847363. [PMID: 35572164 PMCID: PMC9068343 DOI: 10.1155/2022/4847363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background The difference in the effects of combined therapy with repetitive facilitative exercise (RFE) and neuromuscular electrical stimulation (NMES) on stroke upper limb paralysis was only reported by a pilot study; it has not been investigated in many patients. Objective We investigated the effect of combined therapy with RFE and NMES on stroke patients with severe upper paresis. Methods This study included 99 of the very severe paresis stroke patients with scores of zero or 1a in the Finger-Function test of the Stroke Impairment Assessment Set (SIAS). We randomly divided the patients into four groups, namely, NMES, RFE, RFE under NMES, and conventional training (CT) groups. A total of 20 min of group-specific training in addition to 40 min of conventional exercise per day, seven times a week for 4 weeks after admission, was performed. The upper extremity items of the Fugl-Meyer Assessment (FMA) were evaluated before and after the training period. Results The total score gains of the FMA, FMA wrist item, and FMA finger item were significantly larger in the RFE under NMES group than those in the CT group (p < 0.05). Conclusion The combination of voluntary movement and electrical stimulation may promote the activation of paralyzed muscles and improve distal function for very severe paralyzed upper limbs.
Collapse
|
7
|
Fusion of Unobtrusive Sensing Solutions for Sprained Ankle Rehabilitation Exercises Monitoring in Home Environments. SENSORS 2021; 21:s21227560. [PMID: 34833636 PMCID: PMC8623414 DOI: 10.3390/s21227560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
The ability to monitor Sprained Ankle Rehabilitation Exercises (SPAREs) in home environments can help therapists ascertain if exercises have been performed as prescribed. Whilst wearable devices have been shown to provide advantages such as high accuracy and precision during monitoring activities, disadvantages such as limited battery life and users’ inability to remember to charge and wear the devices are often the challenges for their usage. In addition, video cameras, which are notable for high frame rates and granularity, are not privacy-friendly. Therefore, this paper proposes the use and fusion of privacy-friendly and Unobtrusive Sensing Solutions (USSs) for data collection and processing during SPAREs in home environments. The present work aims to monitor SPAREs such as dorsiflexion, plantarflexion, inversion, and eversion using radar and thermal sensors. The main contributions of this paper include (i) privacy-friendly monitoring of SPAREs in a home environment, (ii) fusion of SPAREs data from homogeneous and heterogeneous USSs, and (iii) analysis and comparison of results from single, homogeneous, and heterogeneous USSs. Experimental results indicated the advantages of using heterogeneous USSs and data fusion. Cluster-based analysis of data gleaned from the sensors indicated an average classification accuracy of 96.9% with Neural Network, AdaBoost, and Support Vector Machine, amongst others.
Collapse
|
8
|
Pennati GV, Bergling H, Carment L, Borg J, Lindberg PG, Palmcrantz S. Effects of 60 Min Electrostimulation With the EXOPULSE Mollii Suit on Objective Signs of Spasticity. Front Neurol 2021; 12:706610. [PMID: 34721255 PMCID: PMC8554021 DOI: 10.3389/fneur.2021.706610] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Gaia Valentina Pennati
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
| | - Hanna Bergling
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
| | - Loïc Carment
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université de Paris, Paris, France
| | - Jörgen Borg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
| | - Påvel G Lindberg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden.,Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université de Paris, Paris, France
| | - Susanne Palmcrantz
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
| |
Collapse
|
9
|
Busan P, Moret B, Masina F, Del Ben G, Campana G. Speech Fluency Improvement in Developmental Stuttering Using Non-invasive Brain Stimulation: Insights From Available Evidence. Front Hum Neurosci 2021; 15:662016. [PMID: 34456692 PMCID: PMC8386014 DOI: 10.3389/fnhum.2021.662016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022] Open
Abstract
Developmental stuttering (DS) is a disturbance of the normal rhythm of speech that may be interpreted as very debilitating in the most affected cases. Interventions for DS are historically based on the behavioral modifications of speech patterns (e.g., through speech therapy), which are useful to regain a better speech fluency. However, a great variability in intervention outcomes is normally observed, and no definitive evidence is currently available to resolve stuttering, especially in the case of its persistence in adulthood. In the last few decades, DS has been increasingly considered as a functional disturbance, affecting the correct programming of complex motor sequences such as speech. Compatibly, understanding of the neurophysiological bases of DS has dramatically improved, thanks to neuroimaging, and techniques able to interact with neural tissue functioning [e.g., non-invasive brain stimulation (NIBS)]. In this context, the dysfunctional activity of the cortico-basal-thalamo-cortical networks, as well as the defective patterns of connectivity, seems to play a key role, especially in sensorimotor networks. As a consequence, a direct action on the functionality of "defective" or "impaired" brain circuits may help people who stutter to manage dysfluencies in a better way. This may also "potentiate" available interventions, thus favoring more stable outcomes of speech fluency. Attempts aiming at modulating (and improving) brain functioning of people who stutter, realized by using NIBS, are quickly increasing. Here, we will review these recent advancements being applied to the treatment of DS. Insights will be useful not only to assess whether the speech fluency of people who stutter may be ameliorated by acting directly on brain functioning but also will provide further suggestions about the complex and dynamic pathophysiology of DS, where causal effects and "adaptive''/''maladaptive" compensation mechanisms may be strongly overlapped. In conclusion, this review focuses future research toward more specific, targeted, and effective interventions for DS, based on neuromodulation of brain functioning.
Collapse
Affiliation(s)
| | | | | | - Giovanni Del Ben
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Gianluca Campana
- Department of General Psychology, University of Padua, Padua, Italy
| |
Collapse
|
10
|
Bastos JAI, Martins W, Junior GC, Collins DF, Durigan JLQ. CONTRACTION FATIGUE, STRENGTH ADAPTATIONS, AND DISCOMFORT DURING CONVENTIONAL VERSUS WIDE-PULSE, HIGH-FREQUENCY, NEUROMUSCULAR ELECTRICAL STIMULATION: A SYSTEMATIC REVIEW. Appl Physiol Nutr Metab 2021; 46:1314-1321. [PMID: 34260861 DOI: 10.1139/apnm-2021-0269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neuromuscular electrical stimulation (NMES) can be delivered in a conventional form (CONVNMES) and using relatively wide-pulses and high-frequencies (WPHFNMES). WPHFNMES is proposed to reduce contraction fatigability and generate larger contractions with less discomfort than CONVNMES, however, there are no systematic reviews to guide the selection of NMES types. This systematic review compared the effects of CONVNMES versus WPHFNMES on contraction fatigability, strength adaptations, and perceived discomfort in clinical and non-clinical populations. Eight studies were included. When averaged across all non-clinical participants in individual short- and long-term studies, there was either no difference between CONVNMES and WPHFNMES for all outcomes or WPHFNMES produced more fatigability. In a subset of non-clinical participants ("responders"), however, WPHFNMES reduced contraction fatigability during a single session. Long-term studies found no differences between protocols for strength adaptations in non-clinical participants and those with multiple sclerosis. We concluded that WPHFNMES reduces contraction fatigability only in the short-term and in non-clinical responder participants and may exacerbate fatigability in non-responders. This review was registered in the prospective international registry of systematic reviews/PROSPERO (Registration Number: CRD42020153907, accessed at https://www.crd.york.ac.uk/PROSPERO/). Novelty bullets: • WPHF NMES may reduce fatigue in some participants and exacerbate fatigue in others. • There were no differences in long-term between WPHF and CONV NMES on strength adaptations. • Future high-quality research is needed to optimize outcomes of NMES-based programs.
Collapse
Affiliation(s)
| | - Wagner Martins
- Universidade de Brasilia, 28127, Faculdade de Fisioterapia, Ceilândia , Distrito Federal, Brazil;
| | | | - David F Collins
- University of Alberta, 3158, Kinesiology, Sport, and Recreation, Edmonton, Alberta, Canada, T6G 2R3;
| | - Joao Luiz Quaglioti Durigan
- UnB, Physical Therapy, D- Graduate program of Science and Technology of Health and Graduate program of Physical Education, University of Brasília, Distrito Federal, Brazil, Brasiia, Select a State / Province, Brazil, 13560210;
| |
Collapse
|
11
|
Perini G, Bertoni R, Thorsen R, Carpinella I, Lencioni T, Ferrarin M, Jonsdottir J. Sequentially applied myoelectrically controlled FES in a task-oriented approach and robotic therapy for the recovery of upper limb in post-stroke patients: A randomized controlled pilot study. Technol Health Care 2021; 29:419-429. [PMID: 33386831 DOI: 10.3233/thc-202371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Functional recovery of the plegic upper limb in post-stroke patients may be enhanced by sequentially applying a myoelectrically controlled FES (MeCFES), which allows the patient to voluntarily control the muscle contraction during a functional movement, and robotic therapy which allows many repetitions of movements. OBJECTIVE Evaluate the efficacy of MeCFES followed by robotic therapy compared to standard care arm rehabilitation for post-stroke patients. METHODS Eighteen stroke subjects (onset ⩾ 3 months, age 60.1 ± 15.5) were recruited and randomized to receive an experimental combination of MeCFES during task-oriented reaching followed by robot therapy (MRG) or same intensity conventional rehabilitation care (CG) aimed at the recovery of the upper limb (20 sessions/45 minutes). Change was evaluated through Fugl-Meyer upper extremity (FMA-UE), Reaching Performance Scale and Box and Block Test. RESULTS The experimental treatment resulted in higher improvement on the FMA-UE compared with CG (P= 0.04), with a 10-point increase following intervention. Effect sizes were moderate in favor of the MRG group on FMA-UE, FMA-UE proximal and RPS (0.37-0.56). CONCLUSIONS Preliminary findings indicate that a combination of MeCFES and robotic treatment may be more effective than standard care for recovery of the plegic arm in persons > 3 months after stroke. The mix of motor learning techniques may be important for successful rehabilitation of arm function.
Collapse
|
12
|
Franz KS, Patel K, Kilkenny DM. A biomedical Engineering Laboratory module for exploring involuntary muscle reflexes using Electromyography. J Biol Eng 2020; 14:26. [PMID: 33292462 PMCID: PMC7650172 DOI: 10.1186/s13036-020-00248-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Undergraduate biomedical engineering (BME) students interested in pursuing a career in research and development of medical or physiological monitoring devices require a strong foundation in biosignal analysis as well as physiological theory. Applied learning approaches are reported to be effective for reinforcing physiological coursework; therefore, we propose a new laboratory protocol for BME undergraduate physiology courses that integrates both neural engineering and physiological concepts to explore involuntary skeletal muscle reflexes. The protocol consists of two sections: the first focuses on recruiting soleus motor units through transcutaneous electrical nerve stimulation (TENS), while the second focuses on exploring the natural stretch reflex with and without the Jendrassik maneuver. In this case study, third-year biomedical engineering students collected electromyographic (EMG) activity of skeletal muscle contractions in response to peripheral nerve stimulation using a BioRadio Wireless Physiology Monitor system and analyzed the corresponding signal parameters (latency and amplitude) using the MATLAB platform. Results/protocol validation Electrical tibial nerve stimulation successfully recruited M-waves in all 8 student participants and F-waves in three student participants. The students used this data to learn about orthodromic and antidromic motor fiber activation as well as estimate the neural response latency and amplitude. With the stretch reflex, students were able to collect distinct signals corresponding to the tendon strike and motor response. From this, they were able to estimate the sensorimotor conduction velocity. Additionally, a significant increase in the stretch reflex EMG amplitude response was observed when using the Jendrassik maneuver during the knee-jerk response. A student exit survey on the laboratory experience reported that the class found the module engaging and helpful for reinforcing physiological course concepts. Conclusion This newly developed protocol not only allows BME students to explore physiological responses using natural and electrically-induced involuntary reflexes, but demonstrates that budget-friendly commercially available devices are capable of eliciting and measuring involuntary reflexes in an engaging manner. Despite some limitations caused by the equipment and students’ lack of signal processing experience, this new laboratory protocol provides a robust framework for integrating engineering and physiology in an applied approach for BME students to learn about involuntary reflexes, neurophysiology, and neural engineering. Supplementary Information The online version contains supplementary material available at 10.1186/s13036-020-00248-z.
Collapse
Affiliation(s)
- Karly S Franz
- Institute of Biomedical Engineering, University of Toronto, 164 College St Room 407, Toronto, ON, M5S 3G9, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation, 150 Kilgour Rd, East York, ON, M4G 1R8, Canada
| | - Kramay Patel
- Institute of Biomedical Engineering, University of Toronto, 164 College St Room 407, Toronto, ON, M5S 3G9, Canada.,Krembil Research Institute, 60 Leonard Avenue, Toronto, ON, M5T 0S8, Canada.,Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Dawn M Kilkenny
- Institute of Biomedical Engineering, University of Toronto, 164 College St Room 407, Toronto, ON, M5S 3G9, Canada. .,Institute for Studies in Transdisciplinary Engineering Education & Practice, University of Toronto, 35 St. George Street, Toronto, ON, M5S 1A4, Canada.
| |
Collapse
|
13
|
Hedin H, Wong C, Sjödén A. The effects of using an electrodress (Mollii®) to reduce spasticity and enhance functioning in children with cerebral palsy: a pilot study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1807602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Christian Wong
- Orthopaedic Department, Hvidovre Hospital, Hvidovre, Denmark
| | - Ann Sjödén
- Orthopaedics and Spasticity Treatment at the Neuropediatric Clinic, Falun Hospital, Sweden
| |
Collapse
|
14
|
Merlo S. Surface Electrical Stimulation for Persistent Stuttering and Concomitant Orofacial Disorders: A Multiple Case Study. Percept Mot Skills 2020; 127:698-721. [PMID: 32233734 DOI: 10.1177/0031512520915027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This multiple case study analysis describes the immediate effects on speech fluency of transcutaneous electrical nerve stimulation (TENS) applied to participants with persistent stuttering and concomitant orofacial disorders. Study participants were 14 adolescents and adults who stuttered and had jaw clenching bruxism or mouth breathing. Participants experienced low-frequency TENS applied at mild motor level for 20 minutes with electrodes placed at the lower third of the face (Area A), submandibular region (Area B), posterior neck (Area C), or shoulder girdle (Area D), with speech fluency assessed immediately before and after each stimulation.For participants with stuttering and bruxism, AB stimulation reduced the median frequency of syllables stuttered by 27% and reduced the median duration of the three highest stuttering moments by 29%. In addition, for participants with stuttering and mouth breathing, CD stimulation reduced the median duration of the three highest stuttering moments by 28% and increased their median speech rate by 113%. As a single session of TENS may help participants with stuttering and concomitant orofacial disorders better use fluency shaping techniques, the therapeutic potential of TENS for treating stuttering should be further investigated.
Collapse
|
15
|
Jia M, Rolandi M. Soft and Ion-Conducting Materials in Bioelectronics: From Conducting Polymers to Hydrogels. Adv Healthc Mater 2020; 9:e1901372. [PMID: 31976634 DOI: 10.1002/adhm.201901372] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/17/2019] [Indexed: 12/11/2022]
Abstract
Bioelectronics devices that directly interface with cells and tissue have applications in neural and cardiac stimulation and recording, electroceuticals, and brain machine interfaces for prostheses. The interface between bioelectronic devices and biological tissue is inherently challenging due to the mismatch in both mechanical properties (hard vs soft) and charge carriers (electrons vs ions). In addition to conventional metals and silicon, new materials have bridged this interface, including conducting polymers, carbon-based nanomaterials, as well as ion-conducting polymers and hydrogels. This review provides an update on advances in soft bioelectronic materials for current and future therapeutic applications. Specifically, this review focuses on soft materials that can conduct both electrons and ions, and also deliver drugs and small molecules. The future opportunities and emerging challenges in the field are also highlighted.
Collapse
Affiliation(s)
- Manping Jia
- Department of Electrical and Computer Engineering University of California Santa Cruz CA 94064 USA
| | - Marco Rolandi
- Department of Electrical and Computer Engineering University of California Santa Cruz CA 94064 USA
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Aksöz EA, Laubacher M, Riener R, Hunt KJ. Design of an isokinetic knee dynamometer for evaluation of functional electrical stimulation strategies. Med Eng Phys 2019; 73:100-106. [PMID: 31421979 DOI: 10.1016/j.medengphy.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The limitations of functional electrical stimulation (FES) cycling directly affect the health benefits acquired from this technology and prevents its' full potential to be realised. Experiments should be done on a test bed which can isolate and focus only on one muscle group, namely the quadriceps. The aim of this work was to design and develop an isokinetic robotic leg extension/flexion dynamometer which can mimic knee joint motion during actual cycling to be used for evaluation of novel functional electrical stimulation strategies. Although the main motivation for development of the dynamometer was for application in FES studies, it has the potential to be used for various different muscle physiology studies. METHODS A feedback control system with integrated electrical stimulation for isokinetic knee joint torque measurement has been developed and tested for safety and functionality. The leg extension/flexion device was modified and equipped with a DC motor drive system to imitate isokinetic knee joint motion during cycling when the hip joint remains fixed. Real-time bi-directional effective torque on the lever arm was measured by a magnetostrictive torque sensor and a load cell. Closed-loop motor control system was also designed to mimic the cyclical motion at desired angular velocity. RESULTS A functional model of the robotic dynamometer was developed and evaluated. The dynamometer is capable of simulating the knee angle during cycling at a cadence of up to 70 rpm with range of motion of 72∘. The magnetostrictive torque sensor can measure torque values up to 75 Nm. The lever arm can be adjusted and the target knee angle was controlled with RMSE tracking error of less than 2.1∘ in tests with and without a test person, and with and without muscle stimulation. CONCLUSIONS The isokinetic knee joint torque measurement system was designed and validated in this work, and subsequently used to develop and evaluate novel muscle activation strategies. This is important for fundamental research on effective stimulation patterns and novel activation strategies. This will, in turn, enhance the efficiency of FES cycling exercise and has the potential to improve the health-beneficial effects.
Collapse
Affiliation(s)
- Efe Anil Aksöz
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, BurgdorfCH-3400, Switzerland; Sensory Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zürich, CH-8000 Zürich, Switzerland
| | - Marco Laubacher
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, BurgdorfCH-3400, Switzerland; Sensory Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zürich, CH-8000 Zürich, Switzerland
| | - Robert Riener
- Sensory Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zürich, CH-8000 Zürich, Switzerland
| | - Kenneth J Hunt
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, BurgdorfCH-3400, Switzerland.
| |
Collapse
|
18
|
Repetitive Transcranial Magnetic Stimulation on Motor Recovery for Patients With Stroke. Am J Phys Med Rehabil 2019; 99:99-108. [DOI: 10.1097/phm.0000000000001277] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Wainwright TW, Burgess LC, Middleton RG. Does Neuromuscular Electrical Stimulation Improve Recovery Following Acute Ankle Sprain? A Pilot Randomised Controlled Trial. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2019; 12:1179544119849024. [PMID: 31205428 PMCID: PMC6535900 DOI: 10.1177/1179544119849024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/13/2019] [Indexed: 12/26/2022]
Abstract
Aim: Following soft tissue ankle injury, patients are often referred for out-patient physiotherapy and present symptoms including pain, reduced range of movement and function, and oedema. In this study, we assess the use of a neuromuscular electrical stimulation (NMES) device as an adjunctive therapy to reduce oedema in patients recovering from grade I and II ankle sprains. Methods: This was a single-centre, pilot randomised controlled study, recruiting patients referred to physiotherapy following an ankle sprain. Participants presenting with oedema were randomised to one of two treatment groups: (1) the current standard of care and (2) the current standard of care plus NMES use. Participants were identified in an emergency department and referred to a physiotherapy department for treatment 1 to 5 days following the injury and returned to clinic 7 days later. Results: Twenty-two participants completed the study and had full data sets for analysis (11 in each group). Mean volumetric displacement was reduced in the intervention group in comparison to the standard care group (P = .011); however, there were no between-group differences in figure of eight measurements, function or pain scores. The device was well tolerated, with no device-related adverse events recorded. Conclusions: In this pilot, randomised controlled trial, NMES was well tolerated by patients following ankle sprain and demonstrated statistically significant improvements in oedema reduction as measured by fluid displacement. No other changes were observed. Further work will need to confirm the clinical significance and effect on longer term recovery post-ankle sprain.
Collapse
Affiliation(s)
- Thomas W Wainwright
- Orthopaedic Research Institute, Executive Business Centre, Bournemouth University, Bournemouth, UK.,Orthopaedic Department, Royal Bournemouth Hospital, Bournemouth, UK
| | - Louise C Burgess
- Orthopaedic Research Institute, Executive Business Centre, Bournemouth University, Bournemouth, UK
| | - Robert G Middleton
- Orthopaedic Research Institute, Executive Business Centre, Bournemouth University, Bournemouth, UK.,Orthopaedic Department, Royal Bournemouth Hospital, Bournemouth, UK
| |
Collapse
|
20
|
Elnaggar RK, Elbanna MF. Evaluation of independent versus integrated effects of reciprocal electrical stimulation and botulinum toxin-A on dynamic limits of postural stability and ankle kinematics in spastic diplegia: a single-blinded randomized trial. Eur J Phys Rehabil Med 2019; 55:241-249. [DOI: 10.23736/s1973-9087.18.05196-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
21
|
Yen HC, Chen WS, Jeng JS, Luh JJ, Lee YY, Pan GS. Standard early rehabilitation and lower limb transcutaneous nerve or neuromuscular electrical stimulation in acute stroke patients: a randomized controlled pilot study. Clin Rehabil 2019; 33:1344-1354. [PMID: 30977392 DOI: 10.1177/0269215519841420] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We investigated adding lower limb transcutaneous nerve stimulation or neuromuscular electrical stimulation to standard early rehabilitation in acute stroke patients. DESIGN An assessor-blinded, randomized controlled pilot study. SETTING A medical stroke center. SUBJECTS First-stroke patients aged 20-80 years admitted to the stroke center within 24 hours post stroke. INTERVENTIONS A total of 42 participants were randomly assigned to groups: transcutaneous nerve stimulation + standard early rehabilitation, neuromuscular electrical stimulation + standard early rehabilitation, or standard early rehabilitation-only. Transcutaneous nerve or neuromuscular electrical stimulation was delivered to the affected tibialis anterior and quadriceps muscles for 30 minutes a day, five days per week for two weeks. MAIN MEASURES The Postural Assessment Scale for Stroke Patients, the Functional Independence Measure, and three mobility milestones, namely, sitting for >five minutes, standing for >one minute, and walking ⩾50 m, were evaluated, respectively, at baseline, at the two-week post-intervention, and at two-week follow-up. RESULTS Significant differences existed in the Postural Assessment Scale for Stroke Patients scores between the transcutaneous nerve stimulation and standard early rehabilitation-only groups measured at two-weeks post-intervention (mean (SD) = 31.38 (5.39) and 18.00 (8.65), respectively) and at the two-week follow-up (34.08 (2.69) and 26.14 (7.77), respectively). A higher proportion of participants could walk ⩾50 m independently in the transcutaneous nerve stimulation group than in the standard early rehabilitation-only group at the two-week post-intervention (P = 0.013) and two-week follow-up (P = 0.01) marks. CONCLUSION Two weeks of transcutaneous nerve stimulation added to standard early rehabilitation improved postural stability and walking in acute stroke patients.
Collapse
Affiliation(s)
- Hsiao-Ching Yen
- 1 Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei
| | - Wen-Shiang Chen
- 2 Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei
| | - Jiann-Shing Jeng
- 3 Stroke Center & Department of Neurology, National Taiwan University Hospital, Taipei
| | - Jer-Junn Luh
- 4 School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei
| | - Ya-Yun Lee
- 4 School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei
| | - Guan-Shuo Pan
- 1 Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei
| |
Collapse
|
22
|
Alhusaini AA, Fallatah S, Melam GR, Buragadda S. Efficacy of transcutaneous electrical nerve stimulation combined with therapeutic exercise on hand function in children with hemiplegic cerebral palsy. Somatosens Mot Res 2019; 36:49-55. [PMID: 30913943 DOI: 10.1080/08990220.2019.1584555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological method used to reduce spasticity. It was also assumed that TENS reduces pain and therefore improves limb function. Most of the previous studies about the effect of TENS were done in the lower limb and in stroke patients. There is a lack of enough literature about the direct and indirect effects of TENS in the upper limb. Hence, our study aimed to determine whether TENS combined with therapeutic exercises helps to improves hand function by reducing spasticity in children with hemiplegic cerebral palsy (CP). MATERIALS AND METHODS Twenty-nine children with hemiplegic CP were randomly assigned to the TENS group (n = 15) or the control group (n = 14). The TENS group received traditional physical therapy with the adjunct application of conventional TENS for 30 minutes (pulse duration, 250 µs; pulse rate, 100 Hz) on the wrist extensors, once daily, 3 days a week, for 8 weeks, while the control group received traditional physical therapy. RESULTS The results showed a significant intergroup difference in handgrip strength over the 8-week period. The time to accomplish the Jebsen Taylor Hand Function Test (JTHFT) task decreased by 48% and the ABILHAND-Kids questionnaire scores improved by 23% in the TENS group. CONCLUSIONS The use of TENS in combination with therapeutic exercise may improve strength and hand function.
Collapse
Affiliation(s)
- Adel A Alhusaini
- a The Rehabilitation Health Sciences Department, College of Applied Medical Sciences , King Saud University , Riyadh , Saudi Arabia
| | - Saber Fallatah
- b Rehabilitation Department , Medical Rehabilitation Hospital , Riyadh , Saudi Arabia
| | - Ganeswara Rao Melam
- c Rehabilitation Health Sciences Department, College of Applied Medical Sciences , King Saud University , Riyadh , Saudi Arabia
| | - Syamala Buragadda
- c Rehabilitation Health Sciences Department, College of Applied Medical Sciences , King Saud University , Riyadh , Saudi Arabia
| |
Collapse
|
23
|
Sardaru DP, Matei D, Zaharia-Kezdi D, Pendefunda L. Effects of biofeedback versus switch-triggered functional electrical stimulation on sciatica-related foot drop. J Back Musculoskelet Rehabil 2018; 31:239-245. [PMID: 28946515 DOI: 10.3233/bmr-169578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sciatica-related Foot Drop is a peripheral nervous condition that produces a loss of power in the ankle dorsiflexion muscles. Functional electrical stimulation is a modality of electrical stimulation that produces muscle contraction in a functional movement of the limb. This technique was utilized with positive effects in central nervous afflictions but it is not known whether or not it has any influence in motor recovery following peripheral nervous system problems. This study aims to clarify the effects of functional electrical stimulation on foot drop caused by peripheral nerve compression resulting from lumbar disc herniation. METHODS Fifty patients were enrolled in our study; of whom 25 were treated with EMG triggered electrical stimulation (EMG-FES) and 25 with heel-floor sensor triggered electrical stimulation (SWITCH-FES) during normal gait cycle. Patients received functional electrical stimulation (with a pulse of 60 Hz and phase duration of 200 ms) once a day, for 30 minutes during 5 consecutive days, over a period of 4 weeks. Electrical diagnostic tests (nerve conduction velocity/NCV and the amplitude of compound muscle action potential/CMAP), dynamometry and Osvestry Disability Index scores were measured at baseline and after treatment. RESULTS We found that axonal loss was lower in the EMG-FES group than in the SWITCH-FES group (p< 0.004). The motor functional recovery was higher in terms of muscle force and overall functional status for the EMG-FES group compared to the SWITCH-FES group. This was underlined by Dynamometry test with a p value of < 0.0001 and ODI score with a statistical significant p value of < 0.0001. CONCLUSIONS The overall results showed that there was a significant increase in all the parameters studied for both types of FES applications. However we found that the EMG triggered electrical stimulation technique had a higher influence on the quality of the muscle action control. For patients who cannot yet produce minimal muscle active contraction we recommend switch triggered stimulation first and then, immediately after the recovery of the motor control, to change to EMG triggered functional electrical stimulation.
Collapse
Affiliation(s)
- Dragos Petrica Sardaru
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Daniela Matei
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Dan Zaharia-Kezdi
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Liviu Pendefunda
- Department of Neurology, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| |
Collapse
|
24
|
Kelly G, Shanley J. Functional electrical stimulation to improve upper limb function in a child with an acquired brain injury. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.8.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gemma Kelly
- Research physiotherapist, The Children's Trust, Surrey, UK
| | - Jackie Shanley
- Course Director, School of Health Faculty of Health and Life Sciences, Coventry University
| |
Collapse
|
25
|
Ku J, Lim T, Han Y, Kang YJ. Mobile Game Induces Active Engagement on Neuromuscular Electrical Stimulation Training in Patients with Stroke. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018; 21:504-510. [PMID: 30052055 DOI: 10.1089/cyber.2018.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This study aimed to investigate the effectiveness of the mobile game-based neuromuscular electrical stimulation (MG-NMES) with assessing usability issues, such as attention and curiosity, and intrinsically interesting issues, which is necessary for successful poststroke rehabilitation. With the conventional NMES (C-NMES) system, the subjects underwent active repetitive cyclic NMES training. For assessment of usability issues, 20 hemiplegic stroke subjects were randomly divided into two groups. The subjects in the MG-NMES group (n = 9) and C-NMES group (n = 11) underwent 20 minutes of training each day for 5 days. We assessed the subjects' attention, curiosity, and intrinsically interesting issues; and using questionnaires they answered questions regarding their expectations of the training outcome after each training session. We found that the subjects in the MG-NMES group maintained their attention and interest for the 5 days, and their curiosity and expectation of a positive training outcome gradually increased as the training proceeded. In contrast, the C-NMES group reported no change in their attention or curiosity, but it was lower than the subjects in the MG-NMES group. In addition, their interest gradually decreased, which may have reduced their expectations of a positive outcome as the sessions progressed. There were no side effects during the training sessions in either group. The MG-NMES training paradigm developed is a new, readily available, and highly motivating MG-NMES training system. Based on the usability test, the reported advantages of the system were improved attention and flow experience during NMES training.
Collapse
Affiliation(s)
- Jeonghun Ku
- 1 Department of Biomedical Engineering, College of Medicine, Keimyung University , Daegu, Korea
| | - Teo Lim
- 2 Department of Physical Therapy, Eulji Hospital , Seoul, Korea
| | - Yong Han
- 3 Department of Rehabilitation Medicine, Eulji Hospital , Seoul, Korea
| | - Youn Joo Kang
- 4 Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine , Seoul, Korea
| |
Collapse
|
26
|
Multifractality, Interactivity, and the Adaptive Capacity of the Human Movement System: A Perspective for Advancing the Conceptual Basis of Neurologic Physical Therapy. J Neurol Phys Ther 2018; 41:245-251. [PMID: 28834791 DOI: 10.1097/npt.0000000000000199] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Physical therapists seek to optimize movement as a means of reducing disability and improving health. The short-term effects of interventions designed to optimize movement ultimately are intended to be adapted for use across various future patterns of behavior, in potentially unpredictable ways, with varying frequency, and in the context of multiple tasks and environmental conditions. In this perspective article, we review and discuss the implications of recent evidence that optimal movement variability, which previously had been associated with adaptable motor behavior, contains a specific complex nonlinear feature known as "multifractality." SUMMARY OF KEY POINTS Multifractal movement fluctuation patterns reflect robust physiologic interactivity occurring within the movement system across multiple time scales. Such patterns provide conceptual support for the idea that patterns of motor behavior occurring in the moment are inextricably linked in complex, physiologic ways to patterns of motor behavior occurring over much longer periods. The human movement system appears to be particularly tuned to multifractal fluctuation patterns and exhibits the ability to reorganize its output in response to external stimulation embedded with multifractal features. RECOMMENDATIONS FOR CLINICAL PRACTICE As a fundamental feature of human movement, multifractality opens new avenues for conceptualizing the link between physiologic interactivity and adaptive capacity. Preliminary evidence supporting the positive influence of multifractal rhythmic auditory stimulation on the gait patterns of individuals with Parkinson disease is used to illustrate how physical therapy interventions might be devised to specifically target the adaptive capacity of the human movement system.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A183).
Collapse
|
27
|
Abstract
Neuromodulation, or the utilization of advanced technology for targeted electrical or chemical neuronal stimulation or inhibition, has been expanding in several neurological subspecialties. In the past decades, immune-modulating therapy has been the main focus of multiple sclerosis (MS) research with little attention to neuromodulation. However, with the recent advances in disease-modifying therapies, it is time to shift the focus of MS research to neuromodulation and restoration of function as with other neurological subspecialties. Preliminary research supports the value of intrathecal baclofen pump and functional electrical stimulation in improving spasticity and motor function in MS patients. Deep brain stimulation can improve MS-related tremor and trigeminal neuralgia. Spinal cord stimulation has been shown to be effective against MS-related pain and bladder dysfunction. Bladder overactivity also responds to sacral neuromodulation and posterior tibial nerve stimulation. Despite limited data in MS, transcranial magnetic stimulation and brain-computer interface are promising neuromodulatory techniques for symptom mitigation and neurorehabilitation of MS patients. In this review, we provide an overview of the available neuromodulatory techniques and the evidence for their use in MS.
Collapse
Affiliation(s)
- Hesham Abboud
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, OH, USA/School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Neurology Department, Alexandria University, Alexandria, Egypt
| | - Eddie Hill
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Junaid Siddiqui
- Movement Disorders, University of Missouri- School of Medicine, Columbia, MO, USA
| | - Alessandro Serra
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, OH, USA/School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Multiple Sclerosis Center of Excellence, Cleveland VA Medical Center Hub Site, East Cleveland, OH, USA
| | - Benjamin Walter
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Parkinson's and Movement Disorders Center, University Hospitals of Cleveland, Cleveland, OH, USA
| |
Collapse
|
28
|
Virtual Reality Rehabilitation With Functional Electrical Stimulation Improves Upper Extremity Function in Patients With Chronic Stroke: A Pilot Randomized Controlled Study. Arch Phys Med Rehabil 2018; 99:1447-1453.e1. [PMID: 29505744 DOI: 10.1016/j.apmr.2018.01.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/21/2018] [Accepted: 01/22/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke. DESIGN A pilot, randomized, single-blind, controlled trial. SETTING Stroke rehabilitation inpatient unit. PARTICIPANTS Participants (N=48) with hemiplegia secondary to a unilateral stroke for >3 months and with a hemiplegic wrist extensor Medical Research Council scale score ranging from 1 to 3. INTERVENTIONS FES was applied to the wrist extensors and finger extensors. A VR-based wearable rehabilitation device was used combined with FES and virtual activity-based training for the intervention group. The control group received cyclic FES only. Both groups completed 20 sessions over a 4-week period. MAIN OUTCOME MEASURES Primary outcome measures were changes in Fugl-Meyer Assessment-Upper Extremity and Wolf Motor Function Test scores. Secondary outcome measures were changes in Box and Block Test, Jebsen-Taylor Hand Function Test, and Stroke Impact Scale scores. Assessments were performed at baseline (t0) and at 2 weeks (t1), 4 weeks (t4), and 8 weeks (t8). Between-group comparisons were evaluated using a repeated-measures analysis of variance. RESULTS Forty-one participants were included in the analysis. Compared with FES alone, VR-FES produced a substantial increase in Fugl-Meyer Assessment-distal score (P=.011) and marginal improvement in Jebsen-Taylor Hand Function Test-gross score (P=.057). VR-FES produced greater, although nonsignificant, improvements in all other outcome measures, except in the Stroke Impact Scale-activities of daily living/instrumental activities of daily living score. CONCLUSIONS FES with VR-based rehabilitation may be more effective than cyclic FES in improving distal upper extremity gross motor performance poststroke.
Collapse
|
29
|
Baek J, Park N, Lee B, Jee S, Yang S, Kang S. Effects of Repetitive Peripheral Magnetic Stimulation Over Vastus Lateralis in Patients After Hip Replacement Surgery. Ann Rehabil Med 2018; 42:67-75. [PMID: 29560326 PMCID: PMC5852231 DOI: 10.5535/arm.2018.42.1.67] [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: 05/19/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the effects of repetitive peripheral magnetic stimulation (rPMS) on the vastus lateralis (VL) in the early stage after hip replacement surgery. Methods Twenty-two patients who underwent hip replacement after proximal femur fracture were included in this study. After hip surgery, the experimental group was applied with 15 sessions of 10 Hz rPMS over the VL 5 times per week for 3 weeks, while the control group took sham stimulation. All patients were also given conventional physical therapy. The VL strength was measured with the root mean square (RMS) value of the VL with surface electromyography technique. The ratio of RMS values between fractured and unfractured legs and tandem stand test were used to assess standing balance. Usual gait speed was measured to evaluate gait function. Pain in two groups was assessed with visual analog scale (VAS). Results Both RMS value of the VL and the ratio of RMS values after rPMS were significantly improved (p<0.05). Also, tandem standing time and usual gait speed in rPMS group were dramatically increased (p<0.05). However, no significant difference in VAS was found between the two groups after 3 weeks. Conclusion rPMS on the VL improved muscle strength, standing balance and gait function in the early stage after hip surgery. Therefore, rPMS could be applied to patients who cannot take electrical stimulation due to pain and an unhealed wound.
Collapse
Affiliation(s)
- Junghyun Baek
- Department of Physical Medicine and Rehabilitation, Sun General Hospital, Daejeon, Korea
| | - Nohkyoung Park
- Department of Physical Medicine and Rehabilitation, Sun General Hospital, Daejeon, Korea
| | - Bongju Lee
- Department of Orthopedic Surgery, Sun General Hospital, Daejeon, Korea
| | - Sungju Jee
- Department of Physical Medicine and Rehabilitation, Chungnam National University Hospital, Daejeon, Korea
| | - Shinseung Yang
- Department of Physical Medicine and Rehabilitation, Chungnam National University Hospital, Daejeon, Korea
| | - Sangkuk Kang
- Department of Physical Medicine and Rehabilitation, Sun General Hospital, Daejeon, Korea
| |
Collapse
|
30
|
Bolognini N, Russo C, Edwards DJ. The sensory side of post-stroke motor rehabilitation. Restor Neurol Neurosci 2018; 34:571-86. [PMID: 27080070 DOI: 10.3233/rnn-150606] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Contemporary strategies to promote motor recovery following stroke focus on repetitive voluntary movements. Although successful movement relies on efficient sensorimotor integration, functional outcomes often bias motor therapy toward motor-related impairments such as weakness, spasticity and synergies; sensory therapy and reintegration is implied, but seldom targeted. However, the planning and execution of voluntary movement requires that the brain extracts sensory information regarding body position and predicts future positions, by integrating a variety of sensory inputs with ongoing and planned motor activity. Neurological patients who have lost one or more of their senses may show profoundly affected motor functions, even if muscle strength remains unaffected. Following stroke, motor recovery can be dictated by the degree of sensory disruption. Consequently, a thorough account of sensory function might be both prognostic and prescriptive in neurorehabilitation. This review outlines the key sensory components of human voluntary movement, describes how sensory disruption can influence prognosis and expected outcomes in stroke patients, reports on current sensory-based approaches in post-stroke motor rehabilitation, and makes recommendations for optimizing rehabilitation programs based on sensory stimulation.
Collapse
Affiliation(s)
- Nadia Bolognini
- Department of Psychology and Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico, Milano, Italy
| | - Cristina Russo
- Department of Psychology and Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy
| | - Dylan J Edwards
- Burke-Cornell Medical Research Institute, White Plains, New York, NY, USA
| |
Collapse
|
31
|
A wearable multi-pad electrode prototype for selective functional electrical stimulation of upper extremities. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:714-717. [PMID: 29059972 DOI: 10.1109/embc.2017.8036924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this paper, a surface multi-pad stimulation electrode with selective characteristics was designed, it was safe to use and easy to mount. Then a wearable and distributed multi-pad functional electrical stimulation (FES) prototype combined with sensing, communication and smart technology was designed, which can achieve a fast, intelligent optimization to determine stimulation electrode sites and comfortable stimulation. In addition, in order to improve the application and convenience of FES in the rehabilitation at clinical and home-setting, an Android application (APP) based on smart phone was designed for running an algorithm of searching optimal stimulation site. The prototype has been validated by performing selective stimulation on one healthy subject, and showed that the FES system can automatically determine the stimulation site.
Collapse
|
32
|
Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8905637. [PMID: 29057269 PMCID: PMC5615953 DOI: 10.1155/2017/8905637] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 07/12/2017] [Accepted: 08/10/2017] [Indexed: 01/19/2023]
Abstract
A better understanding of the neural substrates that underlie motor recovery after stroke has led to the development of innovative rehabilitation strategies and tools that incorporate key elements of motor skill relearning, that is, intensive motor training involving goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing motor impairments, but less so for the improvement of upper limb function. Other studies have begun to investigate the benefits of combined approaches that target muscle function (functional electrical stimulation and botulinum toxin injections), modulate neural activity (noninvasive brain stimulation), and enhance motivation (virtual reality) in an attempt to potentialize the benefits of robot-mediated training. The aim of this paper is to overview the current status of such combined treatments and to analyze the rationale behind them.
Collapse
|
33
|
Takeda K, Tanino G, Miyasaka H. Review of devices used in neuromuscular electrical stimulation for stroke rehabilitation. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:207-213. [PMID: 28883745 PMCID: PMC5576704 DOI: 10.2147/mder.s123464] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neuromuscular electrical stimulation (NMES), specifically functional electrical stimulation (FES) that compensates for voluntary motion, and therapeutic electrical stimulation (TES) aimed at muscle strengthening and recovery from paralysis are widely used in stroke rehabilitation. The electrical stimulation of muscle contraction should be synchronized with intended motion to restore paralysis. Therefore, NMES devices, which monitor electromyogram (EMG) or electroencephalogram (EEG) changes with motor intention and use them as a trigger, have been developed. Devices that modify the current intensity of NMES, based on EMG or EEG, have also been proposed. Given the diversity in devices and stimulation methods of NMES, the aim of the current review was to introduce some commercial FES and TES devices and application methods, which depend on the condition of the patient with stroke, including the degree of paralysis.
Collapse
Affiliation(s)
- Kotaro Takeda
- Faculty of Rehabilitation, School of Health Sciences
| | - Genichi Tanino
- Joint Research Support Promotion Facility, Center for Research Promotion and Support, Fujita Health University, Toyoake, Aichi
| | - Hiroyuki Miyasaka
- Faculty of Rehabilitation, School of Health Sciences.,Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, Tsu, Mie, Japan
| |
Collapse
|
34
|
Simonsen D, Spaich EG, Hansen J, Andersen OK. Design and Test of a Closed-Loop FES System for Supporting Function of the Hemiparetic Hand Based on Automatic Detection Using the Microsoft Kinect Sensor. IEEE Trans Neural Syst Rehabil Eng 2017; 25:1249-1256. [DOI: 10.1109/tnsre.2016.2622160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
35
|
Gandolfi M, Geroin C, Antonini A, Smania N, Tinazzi M. Understanding and Treating Pain Syndromes in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:827-858. [PMID: 28805585 DOI: 10.1016/bs.irn.2017.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pain affects many people with Parkinson's disease (PD) and diminishes their quality of life. Different types of pain have been described, but their related pathophysiological mechanisms remain unclear. The aim of this chapter is to provide movement disorders specialists an update about the pathophysiology of pain and a practical guide for the management of pain syndromes in clinical practice. This chapter reviews current knowledge on the pathophysiological mechanisms of sensory changes and pain in PD, as well as assessment and treatment procedures to manage these symptoms. In summary, changes in peripheral and central pain processing have been demonstrated in PD patients. A decrease in pain threshold and tolerance to several stimuli, a reduced nociceptive withdrawal reflex, a reduced pain threshold, and abnormal pain-induced activation in cortical pain-related areas have been reported. There is no direct association between improvement of motor symptoms and sensory/pain changes, suggesting that motor and nonmotor symptoms do not inevitably share the same mechanisms. Special care in pain assessment in PD is warranted by the specific pathophysiological aspects and the complexity of motor and nonmotor symptoms associated with pain symptoms. Rehabilitation may represent a valid option to manage pain syndromes in PD. However, further research in this field is needed. An integrated approach to pain involving a multidisciplinary team of medical specialists and rehabilitation experts should allow a comprehensive approach to pain in PD.
Collapse
Affiliation(s)
- Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy; Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Christian Geroin
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy
| | - Angelo Antonini
- University of Padua and Hospital San Camillo IRCCS, Venice, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy; Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, University of Verona, Verona, Italy.
| |
Collapse
|
36
|
Strengthening of Quadriceps by Neuromuscular Magnetic Stimulation in Healthy Subjects. PM R 2017; 9:767-773. [DOI: 10.1016/j.pmrj.2016.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 12/13/2016] [Accepted: 12/23/2016] [Indexed: 11/16/2022]
|
37
|
Transient Sensory Recovery in Stroke Patients After Pulsed Radiofrequency Electrical Stimulation on Dorsal Root Ganglia. Neurologist 2017; 22:18-20. [DOI: 10.1097/nrl.0000000000000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Lozano R, Gilmore KJ, Thompson BC, Stewart EM, Waters AM, Romero-Ortega M, Wallace GG. Electrical stimulation enhances the acetylcholine receptors available for neuromuscular junction formation. Acta Biomater 2016; 45:328-339. [PMID: 27554016 DOI: 10.1016/j.actbio.2016.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/18/2016] [Accepted: 08/05/2016] [Indexed: 01/17/2023]
Abstract
Neuromuscular junctions (NMJ) are specialized synapses that link motor neurons with muscle fibers. These sites are fundamental to human muscle activity, controlling swallowing and breathing amongst many other vital functions. Study of this synapse formation is an essential area in neuroscience; the understanding of how neurons interact and control their targets during development and regeneration are fundamental questions. Existing data reveals that during initial stages of development neurons target and form synapses driven by biophysical and biochemical cues, and during later stages they require electrical activity to develop their functional interactions. The aim of this study was to investigate the effect of exogenous electrical stimulation (ES) electrodes directly in contact with cells, on the number and size of acetylcholine receptor (AChR) clusters available for NMJ formation. We used a novel in vitro model that utilizes a flexible electrical stimulation system and allows the systematic testing of several stimulation parameters simultaneously as well as the use of alternative electrode materials such as conductive polymers to deliver the stimulation. Functionality of NMJs under our co-culture conditions was demonstrated by monitoring changes in the responses of primary myoblasts to chemical stimulants that specifically target neuronal signaling. Our results suggest that biphasic electrical stimulation at 250Hz, 100μs pulse width and current density of 1mA/cm2 for 8h, applied via either gold-coated mylar or the conductive polymer PPy, significantly increased the number and size of AChRs clusters available for NMJ formation. This study supports the beneficial use of direct electrical stimulation as a strategic therapy for neuromuscular disorders. STATEMENT OF SIGNIFICANCE The beneficial effects of electrical stimulation (ES) on human cells in vitro and in vivo have long been known. Although the effects of stimulation are clear and the therapeutic benefits are known, no uniform parameters exist with regard to the duration, frequency and amplitude of the ES. To this end, we are answering several important questions on the parameters for ES of nerve and muscle monocultures and co-cultures by probing the effects on the enhancement of acetylcholine receptors (AChR) clustering available for neuromuscular junction formation using a conductive platform. This work opens the possibility to combine electrical stimulus delivered via conductive polymer substrates, from which biomolecules could also be delivered, providing opportunities to further enhance the therapeutic effect.
Collapse
Affiliation(s)
- Rodrigo Lozano
- Intelligent Polymer Research Institute, ARC Centre of Excellence for Electromaterials Science, AIIM Facility, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Kerry J Gilmore
- Intelligent Polymer Research Institute, ARC Centre of Excellence for Electromaterials Science, AIIM Facility, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Brianna C Thompson
- Intelligent Polymer Research Institute, ARC Centre of Excellence for Electromaterials Science, AIIM Facility, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Elise M Stewart
- Intelligent Polymer Research Institute, ARC Centre of Excellence for Electromaterials Science, AIIM Facility, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Aaron M Waters
- Intelligent Polymer Research Institute, ARC Centre of Excellence for Electromaterials Science, AIIM Facility, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Mario Romero-Ortega
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Gordon G Wallace
- Intelligent Polymer Research Institute, ARC Centre of Excellence for Electromaterials Science, AIIM Facility, University of Wollongong, Wollongong, NSW 2522, Australia.
| |
Collapse
|
39
|
Hatem SM, Saussez G, Della Faille M, Prist V, Zhang X, Dispa D, Bleyenheuft Y. Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery. Front Hum Neurosci 2016; 10:442. [PMID: 27679565 PMCID: PMC5020059 DOI: 10.3389/fnhum.2016.00442] [Citation(s) in RCA: 402] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/18/2016] [Indexed: 12/27/2022] Open
Abstract
Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients' mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.
Collapse
Affiliation(s)
- Samar M Hatem
- Physical and Rehabilitation Medicine, Brugmann University HospitalBrussels, Belgium; Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de LouvainBrussels, Belgium; Faculty of Medicine and Pharmacy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit BrusselBrussels, Belgium
| | - Geoffroy Saussez
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
| | - Margaux Della Faille
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
| | - Vincent Prist
- Physical and Rehabilitation Medicine, Centre Hospitalier de l'Ardenne Libramont, Belgium
| | - Xue Zhang
- Movement Control and Neuroplasticity Research Group, Motor Control Laboratory, Department of Kinesiology, Katholieke Universiteit Leuven Leuven, Belgium
| | - Delphine Dispa
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de LouvainBrussels, Belgium; Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Université Catholique de LouvainBrussels, Belgium
| | - Yannick Bleyenheuft
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
| |
Collapse
|
40
|
Zhou YX, Wang HP, Bao XL, Lü XY, Wang ZG. A frequency and pulse-width co-modulation strategy for transcutaneous neuromuscular electrical stimulation based on sEMG time-domain features. J Neural Eng 2015; 13:016004. [DOI: 10.1088/1741-2560/13/1/016004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
41
|
Etoh S, Noma T, Takiyoshi Y, Arima M, Ohama R, Yokoyama K, Hokazono A, Amano Y, Shimodozono M, Kawahira K. Effects of repetitive facilitative exercise with neuromuscular electrical stimulation, vibratory stimulation and repetitive transcranial magnetic stimulation of the hemiplegic hand in chronic stroke patients. Int J Neurosci 2015; 126:1007-12. [PMID: 26473535 DOI: 10.3109/00207454.2015.1094473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM Repetitive facilitative exercise (RFE) is a developed approach to the rehabilitation of hemiplegia. RFE can be integrated with neuromuscular electrical stimulation (NMES), direct application of vibratory stimulation (DAVS) and repetitive transcranial magnetic stimulation (rTMS). The aims of the present study were to retrospectively compare the effects of RFE and NMES, DAVS with those of RFE and rTMS, and to determine the maximal effect of the combination of RFE with NMES, DAVS, rTMS and pharmacological treatments in stroke patients. SUBJECTS AND METHODS Thirty-three stroke patients were enrolled and divided into three groups: 15 who received RFE with rTMS (4 min) (TMS4 alone), 9 who received RFE with NMES, DAVS (NMES, DAVS alone) and 9 who received RFE with NMES, DAVS and rTMS (10 min) (rTMS10 + NMES, DAVS). The subjects performed the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) before and after the 2-week session. The 18 patients in the NMES, DAVS alone and rTMS10 + NMES, DAVS group underwent the intervention for 4 weeks. RESULT There were no significant differences in the increases in the FMA, ARAT scores in the three groups. The FMA or ARAT scores in the NMES, DAVS alone and the rTMS10 + NMES, DAVS group were increased significantly. The FMA and ARAT scores were significantly improved after 4 weeks in the NMES, DAVS alone group. DISCUSSION RFE with NMES, DAVS may be more effective than RFE with rTMS for the recovery of upper-limb function. Patients who received RFE with NMES, DAVS and pharmacological treatments showed significant functional recovery.
Collapse
Affiliation(s)
- Seiji Etoh
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Tomokazu Noma
- b 2 Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital , Kagoshima , Japan
| | | | - Michiko Arima
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Rintaro Ohama
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Katsuya Yokoyama
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Akihiko Hokazono
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Yumeko Amano
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Megumi Shimodozono
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Kazumi Kawahira
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| |
Collapse
|
42
|
Tang Q, Li G, Liu T, Wang A, Feng S, Liao X, Jin Y, Guo Z, He B, McClure MA, Xing G, Mu Q. Modulation of interhemispheric activation balance in motor-related areas of stroke patients with motor recovery: Systematic review and meta-analysis of fMRI studies. Neurosci Biobehav Rev 2015; 57:392-400. [DOI: 10.1016/j.neubiorev.2015.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 08/27/2015] [Accepted: 09/02/2015] [Indexed: 02/07/2023]
|
43
|
Repetitive peripheral magnetic stimulation to reduce pain or improve sensorimotor impairments: A literature review on parameters of application and afferents recruitment. Neurophysiol Clin 2015; 45:223-37. [DOI: 10.1016/j.neucli.2015.08.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 08/06/2015] [Accepted: 08/06/2015] [Indexed: 11/22/2022] Open
|
44
|
Wang YH, Meng F, Zhang Y, Xu MY, Yue SW. Full-movement neuromuscular electrical stimulation improves plantar flexor spasticity and ankle active dorsiflexion in stroke patients: a randomized controlled study. Clin Rehabil 2015; 30:577-86. [PMID: 26292692 DOI: 10.1177/0269215515597048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 06/06/2015] [Indexed: 11/16/2022]
Abstract
Objective: To investigate whether full-movement neuromuscular electrical stimulation, which can generate full range of movement, reduces spasticity and/or improves motor function more effectively than control, sensory threshold—neuromuscular electrical stimulation, and motor threshold—neuromuscular electrical stimulation in sub-acute stroke patients. Design: A randomized, single-blind, controlled study. Setting: Physical therapy room and functional assessment room. Participants: A total of 72 adult patients with sub-acute post-stroke hemiplegia and plantar flexor spasticity. Method: Patients received 30-minute sessions of neuromuscular electrical stimulation on the motor points of the extensor hallucis and digitorum longus twice a day, five days per week for four weeks. Measures: Composite Spasticity Scale, Ankle Active Dorsiflexion Score, and walking time in the Timed Up and Go Test were assessed at pretreatment, posttreatment, and at two-week follow-up. Results: After four weeks of treatment, when comparing interclass pretreatment and posttreatment, only the full-movement neuromuscular electrical stimulation group had a significant reduction in the Composite Spasticity Scale (mean % reduction = 19.91(4.96)%, F = 3.878, p < 0.05) and improvement in the Ankle Active Dorsiflexion Score (mean scores = 3.29(0.91), F = 3.140, p < 0.05). Furthermore, these improvements were maintained two weeks after the treatment ended. However, there were no significant differences in the walking time after four weeks of treatment among the four groups (F = 1.861, p > 0.05). Conclusions: Full-movement neuromuscular electrical stimulation with a stimulus intensity capable of generating full movement can significantly reduce plantar flexor spasticity and improve ankle active dorsiflexion, but cannot decrease walking time in the Timed Up and Go Test in sub-acute stroke patients.
Collapse
Affiliation(s)
- Yong-hui Wang
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
| | - Fei Meng
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
| | - Yang Zhang
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
| | - Mao-yu Xu
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
| | - Shou-wei Yue
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
| |
Collapse
|
45
|
Cui BJ, Wang DQ, Qiu JQ, Huang LG, Zeng FS, Zhang Q, Sun M, Liu BL, Sun QS. Effects of a 12-hour neuromuscular electrical stimulation treatment program on the recovery of upper extremity function in sub-acute stroke patients: a randomized controlled pilot trial. J Phys Ther Sci 2015; 27:2327-31. [PMID: 26311975 PMCID: PMC4540873 DOI: 10.1589/jpts.27.2327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/16/2015] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This study investigated the effects of a 12-hour neuromuscular electrical
stimulation program in the evening hours on upper extremity function in sub-acute stroke
patients. [Subjects and Methods] Forty-five subjects were randomized to one of three
groups: 12-hour neuromuscular electrical stimulation group (n=15), which received 12 hours
of neuromuscular electrical stimulation and conventional rehabilitation for the affected
upper extremity; neuromuscular electrical stimulation group (n=15), which received 30 min
of neuromuscular electrical stimulation and conventional rehabilitation; and control group
(n=15), which received conventional rehabilitation only. The Fugl-Meyer assessment, Action
Research Arm Test, and modified Ashworth scale were used to evaluate the effects before
and after intervention, and 4 weeks later. [Results] The improvement in the distal
(wrist-hand) components of the Fugl-Meyer assessment and Action Research Arm Test in the
12-hour neuromuscular electrical stimulation group was more significant than that in the
neuromuscular electrical stimulation group. No significant difference was found between
the two groups in the proximal component (shoulder-elbow) of the Fugl-Meyer assessment.
[Conclusion] The 12-hour neuromuscular electrical stimulation group achieved better
improvement in upper extremity motor function, especially in the wrist-hand function. This
alternative therapeutic approach is easily applicable and can be used in stroke patients
during rest or sleep.
Collapse
Affiliation(s)
- Bao-Juan Cui
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Dao-Qing Wang
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Jian-Qing Qiu
- Department of Obstetrics and Gynecology, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Lai-Gang Huang
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Fan-Shuo Zeng
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Qi Zhang
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Min Sun
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Ben-Ling Liu
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Qiang-San Sun
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| |
Collapse
|
46
|
Beaulieu LD, Massé-Alarie H, Brouwer B, Schneider C. Noninvasive neurostimulation in chronic stroke: a double-blind randomized sham-controlled testing of clinical and corticomotor effects. Top Stroke Rehabil 2015; 22:8-17. [PMID: 25776116 DOI: 10.1179/1074935714z.0000000032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Repetitive peripheral magnetic stimulation (RPMS) is a painless and noninvasive method to produce afferents via the depolarization of the peripheral nervous system. A few studies tested RPMS after-effects on cerebral plasticity and motor recovery in stroke individuals, but evidences remain limited. OBJECTIVES This study aimed to explore whether RPMS could mediate improvements in corticomotor and clinical outcomes associated with ankle impairments in chronic stroke. METHODS Eighteen subjects with chronic stroke were randomly allocated to RPMS or sham group and compared to 14 healthy subjects. Stimulation was applied over the paretic tibialis anterior (TA). Ankle impairments on the paretic side and ipsilesional TA cortical motor representation were tested clinically and by transcranial magnetic stimulation (TMS), respectively. RESULTS In the RPMS group, ankle dorsiflexion mobility and maximal isometric strength increased and resistance to plantar flexor stretch decreased. The magnitude of change seemed to be related to cortical and corticospinal integrity. Sham stimulation yielded no effect. Changes in TMS outcome and their relationships with clinical improvements were limited. CONCLUSIONS RPMS improved ankle impairments in chronic stroke likely by a dynamic influence of sensory inputs on synaptic plasticity. The neurophysiological mechanisms potentially underlying the clinical effects are unclear. More studies are warranted to test the spinal and hemispheric changes responsible for the clinical improvements with emphasis on circuits spared by the lesion.
Collapse
|
47
|
Kafri M, Laufer Y. Therapeutic effects of functional electrical stimulation on gait in individuals post-stroke. Ann Biomed Eng 2014; 43:451-66. [PMID: 25316590 DOI: 10.1007/s10439-014-1148-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
Functional electrical stimulation (FES) to lower extremity (LE) muscles is used by individuals post-stroke as an alternative to mechanical orthotic devices during gait or as a training modality during rehabilitation. Technological developments which improve the feasibility, accessibility and effectiveness of FES systems as orthotic and training devices, highlight the potential of FES for rehabilitating LE function in individuals post-stroke. This study presents a systematic review of the carryover effects of LE FES to motor performance when stimulation is not applied (therapeutic effects) in subjects post-stroke. A description of advances in FES technologies, with an emphasis on systems designed to promote LE function is included, and mechanisms that may be associated with the observed therapeutic effects are discussed. Eligible studies were reviewed for methodological quality, population, intervention and outcome characteristics. Therapeutic effects of FES were consistently demonstrated at the body function and activity levels when it was used as a training modality. Compared to matched treatments that did not incorporate FES, no definite conclusions can be drawn regarding the superiority of FES. When FES was used as an alternative to an orthotic device, it had no superior therapeutic effects at the activity level, yet patients still seemed to prefer it.
Collapse
Affiliation(s)
- Michal Kafri
- Department of Physical Therapy Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa, 3498838, Israel,
| | | |
Collapse
|
48
|
Liu J, Li S, Li X, Klein C, Rymer WZ, Zhou P. Suppression of stimulus artifact contaminating electrically evoked electromyography. NeuroRehabilitation 2014; 34:381-9. [PMID: 24419021 DOI: 10.3233/nre-131045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Electrical stimulation of muscle or nerve is a very useful technique for understanding of muscle activity and its pathological changes for both diagnostic and therapeutic purposes. During electrical stimulation of a muscle, the recorded M wave is often contaminated by a stimulus artifact. The stimulus artifact must be removed for appropriate analysis and interpretation of M waves. OBJECTIVES The objective of this study was to develop a novel software based method to remove stimulus artifacts contaminating or superimposing with electrically evoked surface electromyography (EMG) or M wave signals. METHODS The multiple stage method uses a series of signal processing techniques, including highlighting and detection of stimulus artifacts using Savitzky-Golay filtering, estimation of the artifact contaminated region with Otsu thresholding, and reconstruction of such region using signal interpolation and smoothing. The developed method was tested using M wave signals recorded from biceps brachii muscles by a linear surface electrode array. To evaluate the performance, a series of semi-synthetic signals were constructed from clean M wave and stimulus artifact recordings with different degrees of overlap between them. RESULTS The effectiveness of the developed method was quantified by a significant increase in correlation coefficient and a significant decrease in root mean square error between the clean M wave and the reconstructed M wave, compared with those between the clean M wave and the originally contaminated signal. The validity of the developed method was also demonstrated when tested on each channel's M wave recording using a linear electrode array. CONCLUSIONS The developed method can suppress stimulus artifacts contaminating M wave recordings.
Collapse
Affiliation(s)
- Jie Liu
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, USA The Neurorehabilitation Research Laboratory, The Institute of Rehabilitation and Research (TIRR)-Memorial Hermann Hospital, Houston, TX, USA
| | - Xiaoyan Li
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Cliff Klein
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - William Z Rymer
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ping Zhou
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA Institute of Biomedical Engineering, University of Science and Technology of China, Hefei, China
| |
Collapse
|
49
|
Laffont I, Bakhti K, Coroian F, van Dokkum L, Mottet D, Schweighofer N, Froger J. Innovative technologies applied to sensorimotor rehabilitation after stroke. Ann Phys Rehabil Med 2014; 57:543-551. [PMID: 25261273 DOI: 10.1016/j.rehab.2014.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
Abstract
Innovative technologies for sensorimotor rehabilitation after stroke have dramatically increased these past 20 years. Based on a review of the literature on "Medline" and "Web of Science" between 1990 and 2013, we offer an overview of available tools and their current level of validation. Neuromuscular electric stimulation and/or functional electric stimulation are widely used and highly suspected of being effective in upper or lower limb stroke rehabilitation. Robotic rehabilitation has yielded various results in the literature. It seems to have some effect on functional capacities when used for the upper limb. Its effectiveness in gait training is more controversial. Virtual reality is widely used in the rehabilitation of cognitive and motor impairments, as well as posture, with admitted benefits. Non-invasive brain stimulation (rTMS and TDCS) are promising in this indication but clinical evidence of their effectiveness is still lacking. In the same manner, these past five years, neurofeedback techniques based on brain signal recordings have emerged with a special focus on their therapeutic relevance in rehabilitation. Technological devices applied to rehabilitation are revolutionizing our clinical practices. Most of them are based on advances in neurosciences allowing us to better understand the phenomenon of brain plasticity, which underlies the effectiveness of rehabilitation. The acceptation and "real use" of those devices is still an issue since most of them are not easily available in current practice.
Collapse
Affiliation(s)
- I Laffont
- Département de médecine physique et de réadaptation, hôpital Lapeyronie, CHU de Montpellier, 191, boulevard du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France.
| | - K Bakhti
- Département de médecine physique et de réadaptation, hôpital Lapeyronie, CHU de Montpellier, 191, boulevard du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France
| | - F Coroian
- Département de médecine physique et de réadaptation, hôpital Lapeyronie, CHU de Montpellier, 191, boulevard du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France
| | - L van Dokkum
- Département de médecine physique et de réadaptation, hôpital Lapeyronie, CHU de Montpellier, 191, boulevard du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France
| | - D Mottet
- Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France
| | - N Schweighofer
- Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France; Computational Neuro-Rehabilitation Laboratory, University of Southern California, 1540 Alcazar Street, CHP 155, Los Angeles, CA 90089-9006, USA
| | - J Froger
- Movement to Health, Euromov, université Montpellier 1, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France; Département de médecine physique et de réadaptation, hôpital universitaire de rééducation et de réadaptation, CHU de Nîmes, Le Boucanet, 30240 Le-Grau-du-Roi, France
| |
Collapse
|
50
|
Flamand VH, Schneider C. Noninvasive and painless magnetic stimulation of nerves improved brain motor function and mobility in a cerebral palsy case. Arch Phys Med Rehabil 2014; 95:1984-90. [PMID: 24907638 DOI: 10.1016/j.apmr.2014.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/06/2014] [Accepted: 05/17/2014] [Indexed: 10/25/2022]
Abstract
Motor deficits in cerebral palsy disturb functional independence. This study tested whether noninvasive and painless repetitive peripheral magnetic stimulation could improve motor function in a 7-year-old boy with spastic hemiparetic cerebral palsy. Stimulation was applied over different nerves of the lower limbs for 5 sessions. We measured the concurrent aftereffects of this intervention on ankle motor control, gait (walking velocity, stride length, cadence, cycle duration), and function of brain motor pathways. We observed a decrease of ankle plantar flexors resistance to stretch, an increase of active dorsiflexion range of movement, and improvements of corticospinal control of ankle dorsiflexors. Joint mobility changes were still present 15 days after the end of stimulation, when all gait parameters were also improved. Resistance to stretch was still lower than prestimulation values 45 days after the end of stimulation. This case illustrates the sustained effects of repetitive peripheral magnetic stimulation on brain plasticity, motor function, and gait. It suggests a potential impact for physical rehabilitation in cerebral palsy.
Collapse
Affiliation(s)
- Véronique H Flamand
- Neuroscience Division, CHU de Québec Research Center, Québec, QC, Canada; Faculty of Medicine, Université Laval, Québec, QC, Canada.
| | - Cyril Schneider
- Neuroscience Division, CHU de Québec Research Center, Québec, QC, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
| |
Collapse
|