Archive for category Functional Electrical Stimulation (FES)

[VIDEO] 5 Easy Foot Drop Exercises for Beginners

Check out these 5 easy foot drop exercises for beginners. If you suffer from drop foot, these exercises are a great tool for getting back on your feet. Presented by Dr. Scott Thompson OTD.


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[VIDEO] Foot Drop and Functional Electrical Stimulation (FES)

PhysioFunction are recognised as international experts in the use of Functional Electrical Stimulation (FES). We ensure our clients receive the most clinically correct rehabilitation technology suited to their needs. Jon Graham, Clinical Director at PhysioFunction talks about Foot Drop and Functional Electrical Stimulation.


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[Abstract + References] EEG-controlled functional electrical stimulation rehabilitation for chronic stroke: system design and clinical application


Stroke is one of the most serious diseases that threaten human life and health. It is a major cause of death and disability in the clinic. New strategies for motor rehabilitation after stroke are undergoing exploration. We aimed to develop a novel artificial neural rehabilitation system, which integrates brain-computer interface (BCI) and functional electrical stimulation (FES) technologies, for limb motor function recovery after stroke. We conducted clinical trials (including controlled trials) in 32 patients with chronic stroke. Patients were randomly divided into the BCI-FES group and the neuromuscular electrical stimulation (NMES) group. The changes in outcome measures during intervention were compared between groups, and the trends of ERD values based on EEG were analyzed for BCI-FES group. Results showed that the increase in Fugl Meyer Assessment of the Upper Extremity (FMA-UE) and Kendall Manual Muscle Testing (Kendall MMT) scores of the BCI-FES group was significantly higher than that in the sham group, which indicated the practicality and superiority of the BCI-FES system in clinical practice. The change in the laterality coefficient (LC) values based on μ-ERD (ΔLCm-ERD) had high significant positive correlation with the change in FMA-UE(r = 0.6093, P = 0.012), which provides theoretical basis for exploring novel objective evaluation methods.


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[GUIDELINE] A Clinical Practice Guideline for the Use of Ankle-Foot Orthoses and Functional Electrical Stimulation Post-Stroke



Level of ambulation following stroke is a long-term predictor of participation and disability. Decreased lower extremity motor control can impact ambulation and overall mobility. The purpose of this clinical practice guideline (CPG) is to provide evidence to guide clinical decision-making for the use of either ankle-foot orthosis (AFO) or functional electrical stimulation (FES) as an intervention to improve body function and structure, activity, and participation as defined by the International Classification of Functioning, Disability and Health (ICF) for individuals with poststroke hemiplegia with decreased lower extremity motor control.


A review of literature published through November 2019 was performed across 7 databases for all studies involving stroke and AFO or FES. Data extracted included time post-stroke, participant characteristics, device types, outcomes assessed, and intervention parameters. Outcomes were examined upon initial application and after training. Recommendations were determined on the basis of the strength of the evidence and the potential benefits, harm, risks, or costs of providing AFO or FES.


One-hundred twenty-two meta-analyses, systematic reviews, randomized controlled trials, and cohort studies were included. Strong evidence exists that AFO and FES can each increase gait speed, mobility, and dynamic balance. Moderate evidence exists that AFO and FES increase quality of life, walking endurance, and muscle activation, and weak evidence exists for improving gait kinematics. AFO or FES should not be used to decrease plantarflexor spasticity. Studies that directly compare AFO and FES do not indicate overall superiority of one over the other. But evidence suggests that AFO may lead to more compensatory effects while FES may lead to more therapeutic effects. Due to the potential for gains at any phase post-stroke, the most appropriate device for an individual may change, and reassessments should be completed to ensure the device is meeting the individual’s needs.


This CPG cannot address the effects of one type of AFO over another for the majority of outcomes, as studies used a variety of AFO types and rarely differentiated effects. The recommendations also do not address the severity of hemiparesis, and most studies included participants with varied baseline ambulation ability.


This CPG suggests that AFO and FES both lead to improvements post-stroke. Future studies should examine timing of provision, device types, intervention duration and delivery, longer term follow-up, responders versus nonresponders, and individuals with greater impairments.


These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for people with poststroke hemiplegia who have decreased lower extremity motor control that impacts ambulation and overall mobility.

A Video Abstract is available as supplemental digital content from the authors (available at:



Levels of Evidence and Grades of Recommendations … 117

Summary of Action Statements … 118

Introduction … 119

Methods … 121

Action Statements and Research Recommendations … 128

Action Statement 1: Quality of Life … 128

Action Statement 2: Gait Speed … 129

Action Statement 3: Other Mobility … 135

Action Statement 4: Dynamic Balance … 139

Action Statement 5: Walking Endurance … 143

Action Statement 6: Plantarflexor Spasticity … 147

Action Statement 7: Muscle Activation … 149

Action Statement 8: Gait Kinematics … 152

Overall CPG Clinical Recommendations … 156

Summary of Research Recommendations … 157

Limitations … 158

Guideline Implementation Recommendations … 159


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[Abstract] A Robotic System with EMG-Triggered Functional Eletrical Stimulation for Restoring Arm Functions in Stroke Survivors



Robotic systems combined with Functional Electrical Stimulation (FES) showed promising results on upper-limb motor recovery after stroke, but adequately-sized randomized controlled trials (RCTs) are still missing.


To evaluate whether arm training supported by RETRAINER, a passive exoskeleton integrated with electromyograph-triggered functional electrical stimulation, is superior to advanced conventional therapy (ACT) of equal intensity in the recovery of arm functions, dexterity, strength, activities of daily living, and quality of life after stroke.


A single-blind RCT recruiting 72 patients was conducted. Patients, randomly allocated to 2 groups, were trained for 9 weeks, 3 times per week: the experimental group performed task-oriented exercises assisted by RETRAINER for 30 minutes plus ACT (60 minutes), whereas the control group performed only ACT (90 minutes). Patients were assessed before, soon after, and 1 month after the end of the intervention. Outcome measures were as follows: Action Research Arm Test (ARAT), Motricity Index, Motor Activity Log, Box and Blocks Test (BBT), Stroke Specific Quality of Life Scale (SSQoL), and Muscle Research Council.


All outcomes but SSQoL significantly improved over time in both groups (P < .001); a significant interaction effect in favor of the experimental group was found for ARAT and BBT. ARAT showed a between-group change of 11.5 points (P = .010) at the end of the intervention, which increased to 13.6 points 1 month after. Patients considered RETRAINER moderately usable (System Usability Score of 61.5 ± 22.8).


Hybrid robotic systems, allowing to perform personalized, intensive, and task-oriented training, with an enriched sensory feedback, was superior to ACT in improving arm functions and dexterity after stroke.


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[VIDEO] Electrical Stimulation in Biomedical Engineering Part 1 – YouTube


In this video we show how to model Electrical Stimulation (ES) for biomedical engineering applications using Electric Currents Interface. The Electrical Stimulation simply means: applying electrical pulses through human skin to the nerves inside muscles to activate the muscles. Electrical Stimulation is commonly used for the therapy and recovery from impairment due to a trauma or disease. The electrodes attached to skin are the interface where the electric pulses are applied to human body. First, we explain the concepts of Electrical Stimulation, the modeling assumptions, and expected outputs. Then, we perform a stationary study to analyze the steady-state condition in which we use a fixed current as the stimulation pulse. We consider both bipolar and monopolar configurations for the electrodes as well as anisotropic properties of muscle tissues. We investigate the effectiveness of the stimulation through a parameter known as Activating Function. We also compare our results with the results of a research article to verify our model and simulation. This video is very useful to understand the concepts of Electrical Stimulation which can further be used for the development of functional electrical stimulation systems and neural engineering studies

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[VIDEO] Electrical Stimulation Therapies and Technology • Lucinda Baker, PhD – YouTube

The Brain Recovery Project

Lucinda Baker, PhD, PT, is a retired associate professor of biokinesiology and physical therapy at the University of Southern California.Her research has focused on electrical stimulation for wound healing for patients with spinal cord injury and diabetes, as well as rehabilitation of sensory and motor deficits for patients with stroke and traumatic brain injury.

Her talk summarizes efficacy neuromuscular electric simulation, the convenience of wearable technology, and the effectiveness of NMES for spasticity and strength.

Dr. Baker is the author of many scientific papers and co-author of the leading book on the subject NeuroMuscular Electrical Stimulation – A Practical Guide.

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[Abstract + References] Iterative Adjustment of Stimulation Timing and Intensity During FES-Assisted Treadmill Walking for Patients After Stroke


Functional electric stimulation (FES) is a common intervention to correct foot drop for patients after stroke. Due to the disturbances from internal time-varying muscle characteristics under electrical stimulation and external environmental uncertainties, most of the existing FES system used pre-set stimulation parameters and cannot achieve good gait performances during FES-assisted walking. Therefore, an adaptive FES control system, which used the iterative learning control to adjust the stimulation intensity based on kinematic data and a linear model to modulate the stimulation timing based on walking speed during FES-assisted treadmill walking, was designed and tested on ten patients with foot drop after stroke. In order to examine its orthotic effects, the kinematic data of the patients using the proposed control strategy were collected and compared with the data of the same patients walking using other three FES control strategies, including (1) constant pre-set stimulation intensity and timing, (2) constant pre-set stimulation intensity with speed-adaptive stimulation timing and (3) walking without FES intervention. The error between the maximum ankle dorsiflexion angle during swing phase and the target angle using the proposed control strategy was the smallest among the four conditions. Moreover, there was no significant difference in the ankle plantar flexion angle at the toe-off event and the maximum knee flexion angle during swing phase between the proposed control strategy and walking without FES. In summary, the proposed control strategy can improve FES-assisted walking performances through adaptive modulation of stimulation timing and intensity when coping with variation, and may have good potential in clinic.



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[EU Project] Neuroprosthesis user interface based on residual motor skills and muscle activity in persons with upper limb disabilities

Project description

A novel neuroprosthesis control system

Neuroprosthetic devices employ electrodes to interface with the nervous system and attempt to restore loss of function or movement. Scientists of the EU-funded Neuroprosthesis-UI project propose to develop a user interface that will allow people with upper limb disabilities to control the neuroprosthesis using residual motor skills. This interface will comprise different sensors to capture muscle contraction, and with the help of machine learning, it will decode user input into movement intention. This hybrid system will assist patients with upper limb disabilities such as spinal cord injury, stroke and multiple sclerosis in performing activities of daily life independently.Hide the project objective


In this project, I will develop a user interface that will allow persons with upper limb disabilities to control neuroprosthesis using their residual motor skills. This interface will consist of inertial sensors (IMU) and electromyography (EMG) that are capable of capturing movements and muscle contraction that even persons with high tetraplegia still can control. The interface will also be able to learn different inputs, customizing the system for each user. This requires techniques of machine learning, making it flexible and indicated for users with different upper limb disabilities, such as spinal cord injury, stroke and multiple sclerosis. The machine learning techniques will classify the user inputs into desired commands, working as an intention decoder. The interface will be used to control a hybrid upper limb neuroprosthesis based on surface functional electrical stimulation (FES) and a semi passive mechanical orthosis. The system will allow users to perform activities of daily life independently. To my knowledge, such a hybrid system with FES, and controlled by an interface based on IMUs, EMG and machine learning techniques is novel. I will be working with Christine Coste, an expert in neuroprosthesis for disabled persons, and her interdisciplinary team, which consist of engineers and health professionals with vast experience in neurorehabilitation. This fellowship will enable the transfer of knowledge between her team and me through experiments with real patients and mutual training. I can contribute to the team with my expertise in machine learning and control, whereas they have vast access to patients, medical doctors, mechanical designers, electrical stimulators and sensors. This project is going to be an important step in my career as expand my network in Europe, develop my skills as a biomedical engineer and improve my research experience towards becoming a world-leading expert in neurorehabilitation engineering.

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[VIDEO] Hand-wrist orthosis + Functional Electrical Stimulation – YouTube

Hand-wrist orthosis and functional electrical stimulation can be used in association, so that the wrist and the palm of the hand are fixed in an optimal position, while the electrodes stimulate the extrinsic muscles to flex and extend the fingers.

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