A pilot study of contralateral homonymous muscle activity simulated electrical stimulation in chronic hemiplegia

Contralaterally-controlled functional electrical stimulation-induced muscle contraction for severe lower extremity paralysis

[Purpose] We describe a new method of functional electrical stimulation therapy for severe hemiparesis. Conventional functional electrical stimulation of the lower legs has limited applications. It is only suitable for patients who can monitor their muscle contractions, and it has complicated equipment installation procedures. [Participant and Methods] The participant was a male in his 40s with severe motor paralysis following brain surgery. We monitored the participant's healthy side using the external assist mode of an Integrated Volitional Control Electrical Stimulation (IVES® OG Giken, Okayama, Japan) system while forcibly contracting the paralyzed side. The participant received this new functional electrical stimulation therapy five times per week. [Results] Two weeks after initiation of therapy, paralysis was noticeably improved, and motor function was maintained for approximately 1 year. [Conclusion] The outcomes of this case suggest that the addition of forced contraction therapy, mirror therapy, and repetitive exercise therapy to regular physical therapy may be beneficial. This treatment method may also be useful in postoperative patients with central motor palsy and no muscle contraction ability.

Review of devices used in neuromuscular electrical stimulation for stroke rehabilitation

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.

Pulsed assistance: a new paradigm of robot training

In this preliminary study we compare continuous with pulsed robot assistance in five chronic stroke survivors with a mild degree of spasticity, with the aim of promoting volitional effort and reducing assistance during a reaching task. The protocol consists of one familiarization session and a single training session during which a manipulandum provides subjects with pulsed or continuous assistance in random order. The basic level of assistive force is calibrated for each subject and is the same for both modalities; however, the average force during continuous assistance is about twice the average force in pulsed assistance. In spite of this, the results show that pulsed assistance allows subjects to reach similar performance levels as compared to continuous assistance after a single training session. Moreover, we introduce a novel kinematic-based measure to assess voluntary participation of subjects during the rehabilitation task, which is only applicable with pulsed assistance.

Event related desynchronization-modulated functional electrical stimulation system for stroke rehabilitation: a feasibility study

BACKGROUND

We developed an electroencephalogram-based brain computer interface system to modulate functional electrical stimulation (FES) to the affected tibialis anterior muscle in a stroke patient. The intensity of FES current increased in a stepwise manner when the event-related desynchronization (ERD) reflecting motor intent was continuously detected from the primary cortical motor area.

METHODS

We tested the feasibility of the ERD-modulated FES system in comparison with FES without ERD modulation. The stroke patient who presented with severe hemiparesis attempted to perform dorsiflexion of the paralyzed ankle during which FES was applied either with or without ERD modulation.

RESULTS

After 20 minutes of training, the range of movement at the ankle joint and the electromyography amplitude of the affected tibialis anterior muscle were significantly increased following the ERD-modulated FES compared with the FES alone.

CONCLUSIONS

The proposed rehabilitation technique using ERD-modulated FES for stroke patients was feasible. The system holds potentials to improve the limb function and to benefit stroke patients.