Archive for category Functional Electrical Stimulation (FES)

[Project] Functional Electrical Stimulation for at Home Rehabilitation | WalkHome Project | H2020 | CORDIS | European Commission

Objective

The Context
Stroke has huge human and economic cost. 1 million people suffer strokes in Europe every year, with an average life expectancy after stroke of 8 years. Roughly 20% of stroke survivors suffer from drop foot, with 45 billion euros spent on rehabilitating stroke patients in Europe every year.
The opportunity:
FES offers the tantalising prospect of retraining voluntary motor functions such as walking. However:
– FES rehabilitation must be carried out in a hospital with the support of trained healthcare professionals;
– Transporting patients and supervising treatment is expensive;
– Patient’s treatment plan is sub-optimal;
– Per patient rehabilitation costs reach 32,000 euros
Our solution:
Fesia WalkHome is a FES rehabilitation device for drop foot patients which can be administered by the patient in their own home. This not only reduces costs by 43% but also means patients can have an optimal treatment plan, improving their speed of recovery.
The use of Fesia Walk at home will give autonomy, independence and improve the quality of life for chronic patients. It will also mean a substantial reduction of waiting lists, health costs, number of physician office visits, and carer support.
The Project:
WalkHome represents a disruptive change of paradigm for the FES rehabilitation standard of care. The aim of the phase 1 project is to improve our understanding of the EU market for FES rehabilitation, identifying regional market variations in terms of key decision makers, appropriate business models, pricing structure and identifying which are the most attractive markets for us to use as a beachhead. We will also analyse what key improvements need to be made to the existing technology to create the new FES home care rehabilitation market.
The Market:
Currently, there is no FES rehabilitation technology that is offered outside of a clinical setting. We estimate that this new home FES rehabilitation market could be worth up to 40 billion euros in Europe alone.

via Functional Electrical Stimulation for at Home Rehabilitation | WalkHome Project | H2020 | CORDIS | European Commission

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[Abstract] The effects of a robot-assisted arm training plus hand functional electrical stimulation on recovery after stroke: a randomized clinical trial

Abstract

Objective

To compare the effects of unilateral, proximal arm robot-assisted therapy combined with hand functional electrical stimulation to intensive conventional therapy for restoring arm function in subacute stroke survivors.

Design

This was a single blinded, randomized controlled trial.

Setting

Inpatient Rehabilitation University Hospital.

Participants

Forty patients diagnosed with ischemic stroke (time since stroke <8 weeks) and upper limb impairment were enrolled.

Interventions

Participants randomized to the experimental group received 30 sessions (5 sessions/week) of robot-assisted arm therapy and hand functional electrical stimulation (RAT + FES). Participants randomized to the control group received a time-matched intensive conventional therapy (ICT).

Main outcome measures

The primary outcome was arm motor recovery measured with the Fugl-Meyer Motor Assessment. Secondary outcomes included motor function, arm spasticity and activities of daily living. Measurements were performed at baseline, after 3 weeks, at the end of treatment and at 6-month follow-up. Presence of motor evoked potentials (MEPs) was also measured at baseline.

Results

Both groups significantly improved all outcome measures except for spasticity without differences between groups. Patients with moderate impairment and presence of MEPs who underwent early rehabilitation (<30 days post stroke) demonstrated the greatest clinical improvements.

Conclusions

A robot-assisted arm training plus hand functional electrical stimulation was no more effective than intensive conventional arm training. However, at the same level of arm impairment and corticospinal tract integrity, it induced a higher level of arm recovery.

 

via The effects of a robot-assisted arm training plus hand functional electrical stimulation on recovery after stroke: a randomized clinical trial – ScienceDirect

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[Abstract] Effect of functional electrical stimulation plus body weight-supported treadmill training for gait rehabilitation in patients with poststroke – a retrospective case-matched study.

Abstract

BACKGROUND:

Functional electrical stimulation (FES) plus body weight-supported treadmill training (BWSTT) provide effective gait training for poststroke patients with abnormal gait. These features promote a successful active motor relearning of ambulation in stroke survivors.

AIM:

This is a retrospective study to assess the effect of FES plus BWSTT for gait rehabilitation in patients poststroke.

DESIGN:

A retrospective case-matched study.

SETTING:

Participants were recruited from a rehabilitation department in an acute university-affiliated hospital.

POPULATION:

Ninety patients poststroke from Yue Bei People’s Hospital underwent BWSTT (A: control group) were compared to an equal number of cross-matched patients who received FES plus BWSTT (B: FES plus BWSTT group).

METHODS:

While B group received FES for 45 minutes plus BSWTT for 30 minutes in the program, group A received time-matched BWSTT alone. The walking speed, step length, step cadence, Fugl-Meyer lower-limb scale (LL-FMA), composite spasticity scale (CSS), 10-Meter Walk Test (10MWT), Tinetti Balance Test (TBT) and nerve physiology testing were collected before and after intervention.

RESULTS:

One hundred and eighty patients with poststroke abnormal gait were chosen. There were significant differences in walking speed, step length, step cadence, LL-FMA, CSS, TBT, and 10MWT between baseline and post-intervention (P<0.05). There were significant differences in walking speed, step length, step cadence, LL-FMA, CSS, TBT, and 10MWT between two groups at the end of the eighth week (P<0.05), but not at baseline (P>0.05). In comparison with group A, the peak of somatosensory evoked potential (SEP) and motor evoked potential (MEP) amplitude increased, the latency was shortened, and the conduction velocity of sensory nerve (SCV) and motor nerve (MCV) was significantly increased in the group B (P < 0.05). No adverse events occurred during the study.

CONCLUSIONS:

This study suggests that FES plus BWSTT could be more effective than BWSTT alone in the improvement of gait, balance, spasticity, and function of the lower limb in patients poststroke.

CLINICAL REHABILITATION IMPACT:

Introduce effective rehabilitation strategies for poststroke patients with abnormal gait.

 

via Effect of functional electrical stimulation plus body weight-supported treadmill training for gait rehabilitation in patients with poststroke-a ret… – PubMed – NCBI

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[Abstract + References] A Wireless BCI-FES Based on Motor Intent for Lower Limb Rehabilitation

Abstract

Recent investigations have proposed brain computer interfaces combined with functional electrical stimulation as a novel approach for upper limb motor recovery. These systems could detect motor intention movement as a power decrease of the sensorimotor rhythms in the electroencephalography signal, even in people with damaged brain cortex. However, these systems use a large number of electrodes and wired communication to be employed for gait rehabilitation. In this paper, the design and development of a wireless brain computer interface combined with functional electrical stimulation aimed at lower limb motor recovery is presented. The design requirements also account the dynamic of a rehabilitation therapy by allowing the therapist to adapt the system during the session. A preliminary evaluation of the system in a subject with right lower limb motor impairment due to multiple sclerosis was conducted and as a performance metric, the true positive rate was computed. The developed system evidenced a robust wireless communication and was able to detect lower limb motor intention. The mean of the performance metric was 75%. The results encouraged the possibility of testing the developed system in a gait rehabilitation clinical study.

References

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    Pfurtscheller, G., Mcfarland, D.: BCIs that use sensorimotor rhythms. In: Wolpaw, J.R., Wolpaw, E. (eds.) Brain-Computer Interfaces: Principles and Practice, pp. 227–240. Oxford University Press (2012)Google Scholar
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    Carrere, L.C., Tabernig, C.B.: Detection of foot motor imagery using the coefficient of determination for neurorehabilitation based on BCI technology. IFMBE Proc. 49, 944–947 (2015).  https://doi.org/10.1007/978-3-319-13117-7_239CrossRefGoogle Scholar
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    Sannelli, C., Vidaurre, C., Müller, K.R., Blankertz, B.: A large scale screening study with a SMR-based BCI: categorization of BCI users and differences in their SMR activity (2019)Google Scholar
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    Do, A.H., Wang, P.T., King, C.E., Schombs, A., Cramer, S.C., Nenadic, Z.: Brain-computer interface controlled functional electrical stimulation device for foot drop due to stroke, pp. 6414–6417 (2012)Google Scholar
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    Ramos-Murguialday, A., Broetz, D., Rea, M., Yilmaz, Ö., Brasil, F.L., Liberati, G., Marco, R., Garcia-cossio, E., Vyziotis, A., Cho, W., Cohen, L.G., Birbaumer, N.: Brain-Machine-interface in chronic stroke rehabilitation: a controlled study. Ann. Neurol. 74, 100–108 (2014).  https://doi.org/10.1002/ana.23879.Brain-Machine-InterfaceCrossRefGoogle Scholar
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    Biasiucci, A., Leeb, R., Iturrate, I., Perdikis, S., Al-Khodairy, A., Corbet, T., Schnider, A., Schmidlin, T., Zhang, H., Bassolino, M., Viceic, D., Vuadens, P., Guggisberg, A.G., Millán, J.D.R.: Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke. Nat. Commun. 9, 1–13 (2018).  https://doi.org/10.1038/s41467-018-04673-zCrossRefGoogle Scholar
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    Tabernig, C.B., Lopez, C.A., Carrere, L.C., Spaich, E.G., Ballario, C.H.: Neurorehabilitation therapy of patients with severe stroke based on functional electrical stimulation commanded by a brain computer interface. J. Rehabil. Assist. Technol. Eng. 5, 205566831878928 (2018).  https://doi.org/10.1177/2055668318789280CrossRefGoogle Scholar
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    McCrimmon, C.M., King, C.E., Wang, P.T., Cramer, S.C., Nenadic, Z., Do, A.H.: Brain-controlled functional electrical stimulation therapy for gait rehabilitation after stroke: a safety study. J. Neuroeng. Rehabil. 12 (2015).  https://doi.org/10.1186/s12984-015-0050-4
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    g.Nautilus wireless biosignal acquisition Homepage. http://www.gtec.at/Products/Hardware-and-Accessories/g.Nautilus-Specs-Features
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    Emotiv EpocFlex flexible wireless EEG system Homepage. https://www.emotiv.com/epoc-flex/
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    Vuckovic, A., Wallace, L., Allan, D.: Hybrid brain-computer interface and functional electrical stimulation for sensorimotor training in participants with tetraplegia: a proof-of-concept study. J. Neurol. Phys. Ther. 39, 3–14 (2015)CrossRefGoogle Scholar
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    Schalk, G., McFarland, D.J., Hinterberger, T., Birbaumer, N., Wolpaw, J.R.: BCI2000: a general-purpose brain-computer interface (BCI) system. IEEE Trans. Biomed. Eng. 51, 1034–1043 (2004).  https://doi.org/10.1109/TBME.2004.827072CrossRefGoogle Scholar
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    McCrimmon, C.M., Fu, J.L., Wang, M., Lopes, L.S., Wang, P.T., Karimi-Bidhendi, A., Liu, C.Y., Heydari, P., Nenadic, Z., Do, A.H.: Performance assessment of a custom, portable, and low-cost brain-computer interface platform. IEEE Trans. Biomed. Eng. 64, 2313–2320 (2017).  https://doi.org/10.1109/TBME.2017.2667579CrossRefGoogle Scholar

via A Wireless BCI-FES Based on Motor Intent for Lower Limb Rehabilitation | SpringerLink

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[Abstract + References] Functional Electrical Stimulation for Gait Rehabilitation – Conference paper

Abstract

Conditions that can lead to a full or partial motor function loss, such as stroke or multiple sclerosis, leave people with disabilities that may interfere severely with lower body movements, such as gait. Drop Foot (DF) is a gait disorder that results in a reduced ability or total inability to contract the Tibialis Anterior (TA) muscle, causing an inability to raise the foot during gait. One of the most effective methods to correct DF is Functional Electrical Stimulation (FES). FES is a technique used to reproduce the activation patterns of functional muscles, in order to create muscular contractions through electrical stimulation of the muscle’s nervous tissue.

FES has first been introduced in 1961. However, the available commercial FES systems still do not take into account the fact that the gait differs from subject to subject, depending on their physical conditionmuscular fatigue and rehabilitation stage. Therefore, they are unable to provide a personalized assistance to the user, delivering constant stimulation pulses that are only based on gait events. Consequently, they promote the early onset of fatigue and generate coarse movements. This dissertation aims to tackle the aforementioned issues by developing a FES system for personalized DF correction, tailored to each individual user’s needs through the use of a Neural Network (NN).

A Non-Linear Autoregressive Neural Network with Exogenous inputs (NARX Neural Network) was used to model the dynamics of the electrically stimulated TA muscle, in a novel approach that uses both the foot angle and the foot velocity. The model was combined with a Proportional Derivative controller to help compensate for any external disturbances. In order to create more natural movements, reference trajectories were obtained by recording the foot angle and velocity of healthy subjects walking at different speeds.

The system has been validated with a healthy subject walking at 3 different speeds on a treadmill: 1 km/h, 1.5 km/h and 2 km/h. It was able to track the desired trajectory for every speed, thus creating a more natural movement and effectively correcting DF gait.

References

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    Melo, P.L., Silva, M.T., Martins, J.M., Newman, D.J.: Technical developments of functional electrical stimulation to correct drop foot: sensing, actuation and control strategies. Clin. Biomech. 30(2), 101–113 (2015)CrossRefGoogle Scholar
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    Kesar, T., Chou, L.W., Binder-Macleod, S.A.: Effects of stimulation frequency versus pulse duration modulation on muscle fatigue. J. Electromyogr. Kinesiol. 18(4), 662–671 (2008)CrossRefGoogle Scholar
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    Hunt, K.J., Munih, M., Donaldson, N.D.N., Barr, F.M.D.: Investigation of the hammerstein hypothesis in the modeling of electrically stimulated muscle. IEEE Trans. Biomed. Eng. 45(8), 998–1009 (1998)CrossRefGoogle Scholar
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    Johnson, C.A., Burridge, J.H., Strike, P.W., Wood, D.E., Swain, I.D.: The effect of combined use of botulinum toxin type A and functional electric stimulation in the treatment of spastic drop foot after stroke: a preliminary investigation. Arch. Phys. Med. Rehabil. 85(June), 902–909 (2004)CrossRefGoogle Scholar
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    Brend, O., Freeman, C., French, M.: Multiple-model adaptive control of functional electrical stimulation. IEEE Trans. Control Syst. Technol. 23(5), 1901–1913 (2015)CrossRefGoogle Scholar
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    Luzio de Melo, P.: A novel functional electrical stimulation system and strategies for motor rehabilitation. Ph.D thesis, Universidade de Lisboa – Instituto Superior Técnico (2014)Google Scholar
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    Luzio de Melo, P., da Silva, M.T., Martins, J., Newman, D.: A microcontroller platform for the rapid prototyping of functional electrical stimulation-based gait neuroprostheses. Artif. Organs 39(5), E56–E66 (2015)CrossRefGoogle Scholar
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    Science, I., Hospital, M.N.: Learning control of hand posture with neural network in FES for hemiplegics, vol. 20, no. 5, pp. 2588–2589 (1998)Google Scholar
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    Imatz-ojanguren, E., Irigoyen, E., Valencia-blanco, D., Keller, T.: Electrical Stimulation in Able-bodied and Hemiplegic Subjects, vol. 0, pp. 1–9 (2016)Google Scholar
  10. 10.
    Popov, N.S., Dozić, D.J., Stanković, M., Krajoski, G.M., Stanišić, D.: Development of a Closed Loop FES System Based on NARX Radial Based Network, pp. 70–74 (2015)CrossRefGoogle Scholar
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    Previdi, F.: Identification of black-box nonlinear models for lower limb movement control using functional electrical stimulation. Control Eng. Pract. 10(1), 91–99 (2002)CrossRefGoogle Scholar
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    Chang, G.C., Luh, J.J., Liao, G.D., Lai, J.S., Cheng, C.K., Kuo, B.L., Kuo, T.S.: A neuro-control system for the knee joint position control with quadriceps stimulation. IEEE Trans. Rehabil. Eng. 5(1), 2–11 (1997)CrossRefGoogle Scholar
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    Chen, Y.L., Chen, S.C., Chen, W.L., Hsiao, C.C., Kuo, T.S., Lai, J.S.: Neural network and fuzzy control in FES-assisted locomotion for the hemiplegic. J. Med. Eng. Technol. 28(1), 32–38 (2004)CrossRefGoogle Scholar
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    Azura, N., Bin, S., Kamaruddin, A., Mohamed, N., Mohamed, N.B.: The Quadriceps Muscle of Knee Joint Modelling Using Neural Network Approach: Part 1, pp. 52–57 (2016)Google Scholar
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    Yassin, I.M., Jailani, R., Syahirul, M., Megat, A., Baharom, R., Huzaifah, A.: Comparison Between Cascade Forward and Multi-Layer Perceptron Neural Networks for NARX Functional Electrical Stimulation (FES) -Based Muscle Model, vol. 7, no. 1, pp. 215–221 (2017)Google Scholar
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    Yilei, W., Qing, S., Xulei, Y., Li, L.: Recurrent Neural Network Control of Functional Electrical Stimulation Systems, pp. 400–404 (2006)Google Scholar
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    Ferrarin, M., D’Acquisto, E.: An experimental PID controller for knee movement restoration with closed loop FES system. In: Proceedings of 18th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, pp. 453–454 (1996)Google Scholar
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    Qiu, S., He, F., Tang, J., Xu, J., Zhang, L., Zhao, X., Qi, H., Zhou, P., Cheng, X., Wan, B., Ming, D.: Intelligent algorithm tuning PID method of function electrical stimulation using knee joint angle. In: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Annual Conference, vol. 2014, pp. 2561–2564 (2014)Google Scholar
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    Basith, A.L., Arifin, A., Arrofiqi, F., Watanabe, T., Nuh, M.: Embedded fuzzy logic controller for functional electrical stimulation system. In: 2016 International Seminar on Intelligent Technology and Its Applications (ISITIA), pp. 89–94 (2016)Google Scholar
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    Quintern, J., Riener, R., Rupprecht, S.: Comparison of simulation and experiments of different closed-loop strategies for functional electrical stimulation: experiments in paraplegics. Artif. Organs 21(3), 232–235 (1997)CrossRefGoogle Scholar
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    Tu, X., Li, J., Li, J., Su, C., Zhang, S., Li, H., Cao, J., He, J.: Model-based hybrid cooperative control of hip-knee exoskeleton and FES induced ankle muscles for gait rehabilitation. Int. J. Pattern Recognit. Artif. Intell. 31(09), 1759019 (2017)CrossRefGoogle Scholar

via Functional Electrical Stimulation for Gait Rehabilitation | SpringerLink

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[WEB SITE] About Mollii – Mollii

What is Mollii?


Mollii is a suit consisting of a pair of trousers, a jacket and a detachable control unit. The Mollii garments includes 58 imbedded electrodes, positioned to stimulate 40 key muscles in the body. Through a low frequency electro-stimulation therapy, Mollii relaxes spastic, tense and aching muscles safely and simply. Programmed after each person’s needs, Mollii prevents and counteracts different forms of muscle shortening and rigidity, helps the user regain control over muscular tension, and reduces pain related to spasticity. In addition, through electro-stimulation settings, Mollii may facilitate the activation of muscles, and thereby may facilitate muscle contractions, which in turn enable movements.

Who uses Mollii?


MG_8180_Svart_OK-1024x683Mollii is used by people who suffer from spasticity and spasticity-related pain, which is typically found in people with cerebral palsy, stroke, multiple sclerosis, spinal cord injury, acquired brain damages and other neurological injuries that result from or create motor disabilities, and generally induce pain. Mollii is used both by adults and children; and is available in men and women sizes starting from 104 cm. up to XXXL.

Mollii can be used in both a home and clinic environment; and is simple to use for all ages. Users dress-up with a Mollii the same way they would with an ordinary garment. There is a button for on/off and a button for play/ pause. A single push of the button starts the muscle stimulation, which proceeds automatically for 60 minutes, and has a lasting positive effect for up to 48 hours.”

How does it work?


Mollii stimulates the antagonist to the spastic muscle. If the bicep is spastic, the tricep is stimulated, which in turn makes the bicep relaxed. Relaxing the muscle enables active movements and a gradual improvement in function, while the body keeps this positive effect for up to 48 hours. The physiological mechanism is called reciprocal inhibition.

Mollii also reduces pain related to spasticity, both through the reciprocal inhibition, and via the gate control theory of pain, which asserts that non-painful input such as the electric stimulation of skin-nerves closes the nerve-gates to painful input, which prevents pain sensation from traveling to the central nervous system.

Moreover, Mollii may facilitate the sub-threshold stimulation of a muscle by preparing the muscle for contraction before generating a shortening of the muscle, thereby reducing the nerve signal-strength required by the patient to actually generate a muscle contraction.

It is a safe and simple assistive device that can increase quality of life and help recover faster motor functions. The device is used for one hour every second day. For optimum effect, Mollii should be used together with physiotherapy, training, activity and movement. The positive effect is individual and remains for up to 48 hours.

Want more information?


Mollii Product Sheet

Frequently asked questions

Who is Mollii for? Mollii is an assistive device for people with spasticity and other forms of motor impairment due to cerebral palsy, stroke, brain damage, spinal cord injury or other neurological injuries. Molli can also be used to alleviate spasticity related pain.
How does the Mollii suit work? Molli is a functional garment that consists of a pair of trousers, a jacket and a detachable control unit which sends electrical signals to the user via electrodes on the inside of the garment. The suit has 58 electrodes which can be combined in various ways. Mollii has a control unit which is individually programmed for each user. The person prescribing Mollii uses a computer program to adapt the active electrodes and the intensity (which muscles are to be activated by means of current). The settings are then saved in the Mollii control unit, making it simple for the device to be used at home.
What happens in the body when Mollii is used? Mollii uses low level electric current to produce basic tension in the musculature. The current stimulates the antagonist to the spastic muscle. If, for example, the biceps is spastic, the triceps is stimulated which in turn makes the biceps relax. Relaxing the muscle enables active movement and a gradual improvement in function. The physiological mechanism is called reciprocal inhibition.
What sizes are available for the Mollii suit? Available in 24 sizes for children from size CL 104 to ladies and mens sizes. Children (CL): 104, 110, 116, 122, 128, 134, 140, 146, 152 Ladies: XS, S, M, L, XL, XXL, XXXL, SXL Mens: XS, S, M, L, XL, XXL, XXXL
Is the Mollii suit User-friendly? Mollii is a functional assistive device that is designed to be used in the home environment. It is simple to use. If a person can put on an ordinary garment him/herself, then he/she can put Mollii on him/herself. There is a button for on/off and a button for play/ pause. A single push of the button starts muscle stimulation, which proceeds automatically for 60 minutes. The device is used for one hour every second day.
How often should the Mollii suit be used? The device is used for approximately one hour on 3-4 occasions per week. For optimum effect, Mollii should be used together with physiotherapy, training, activity and movement. The effect is individual and remains for up to 48 hours.
Mollii suit Safety Mollii is not to be used with electrical implanted devices or medical devices that are affected by magnets, such as shunts. Consult a doctor at: cardiovascular disease, malignancy (cancer), infectious disease, fever, pregnancy, rashes or skin problems and if Mollii is intended for use with other medical devices or other medical treatment. The product is to be used according to the user manual.
What is included with the mollii suit Supplied with: Jacket, trousers, control unit (with bag), belt, laundry bag and user manual.
Mollii suit Washing instructions 40 degrees delicate wash once per month. In between the garment can be hand washed in lukewarm water.
10 Mollii Technical information Power supply: 4 batteries (AAA) Voltage: 20 V Pulse width: 25-175 us Frequency: 20 Hz Pulse apperance: Square wave Channels: 40 Electrodes: 58 Electrode material: Silicone rubber Fabric material: Nylon 82 %, Spandex 18 %

via About Mollii – Mollii

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[WEB PAGE] Treatments for foot drop compared

 

Continue —> Treatments for foot drop compared | MS Trust

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[Wikipedia audio article] Electrical stimulation

This is an audio version of the Wikipedia Article: https://en.wikipedia.org/wiki/Functio…

00:01:21 1 Principles

00:09:14 2 History

00:10:01 3 Common applications

00:10:11 3.1 Spinal cord injury

00:11:09 3.1.1 Walking in spinal cord injury

00:15:01 3.2 Stroke and upper limb recovery

00:16:21 3.3 Drop foot

00:18:08 3.4 Stroke

00:18:58 3.5 Multiple sclerosis

00:20:06 3.6 Cerebral palsy

00:21:07 3.7 National Institute for Health and Care Excellence Guidelines (NICE) (UK)

00:21:47 4 In popular culture

00:22:10 5 See also

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“I cannot teach anybody anything, I can only make them think.” – Socrates

SUMMARY 

Functional electrical stimulation (FES) is a technique that uses low-energy electrical pulses to artificially generate body movements in individuals who have been paralyzed due to injury to the central nervous system. More specifically, FES can be used to generate muscle contraction in otherwise paralyzed limbs to produce functions such as grasping, walking, bladder voiding and standing. This technology was originally used to develop neuroprostheses that were implemented to permanently substitute impaired functions in individuals with spinal cord injury (SCI), head injury, stroke and other neurological disorders. In other words, a person would use the device each time he or she wanted to generate a desired function. FES is sometimes also referred to as neuromuscular electrical stimulation (NMES).FES technology has been used to deliver therapies to retrain voluntary motor functions such as grasping, reaching and walking. In this embodiment, FES is used as a short-term therapy, the objective of which is restoration of voluntary function and not lifelong dependence on the FES device, hence the name functional electrical stimulation therapy, FES therapy (FET or FEST). In other words, the FEST is used as a short-term intervention to help the central nervous system of the person to re-learn how to execute impaired functions, instead of making the person dependent on neuroprostheses for the rest of her or his life.

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[VIDEO] Stroke Rehabilitation: Use of electrical stimulation to help arm and hand recovery

This video demonstrates how to use FES, Functional Electrical Stimulation, to engage the muscles of the arm to extend the fingers.

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[Abstract] Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke

Background. Upper-limb chronic stroke hemiplegia was once thought to persist because of disproportionate amounts of inhibition imposed from the contralesional on the ipsilesional hemisphere. Thus, one rehabilitation strategy involves discouraging engagement of the contralesional hemisphere by only engaging the impaired upper limb with intensive unilateral activities. However, this premise has recently been debated and has been shown to be task specific and/or apply only to a subset of the stroke population. Bilateral rehabilitation, conversely, engages both hemispheres and has been shown to benefit motor recovery. To determine what neurophysiological strategies bilateral therapies may engage, we compared the effects of a bilateral and unilateral based therapy using transcranial magnetic stimulation.

Methods. We adopted a peripheral electrical stimulation paradigm where participants received 1 session of bilateral contralaterally controlled functional electrical stimulation (CCFES) and 1 session of unilateral cyclic neuromuscular electrical stimulation (cNMES) in a repeated-measures design. In all, 15 chronic stroke participants with a wide range of motor impairments (upper extremity Fugl-Meyer score: 15 [severe] to 63 [mild]) underwent single 1-hour sessions of CCFES and cNMES. We measured whether CCFES and cNMES produced different effects on interhemispheric inhibition (IHI) to the ipsilesional hemisphere, ipsilesional corticospinal output, and ipsilateral corticospinal output originating from the contralesional hemisphere.

Results. CCFES reduced IHI and maintained ipsilesional output when compared with cNMES. We found no effect on ipsilateral output for either condition. Finally, the less-impaired participants demonstrated a greater increase in ipsilesional output following CCFES.

Conclusions. Our results suggest that bilateral therapies are capable of alleviating inhibition on the ipsilesional hemisphere and enhancing output to the paretic limb.

 

via Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke – David A. Cunningham, Jayme S. Knutson, Vishwanath Sankarasubramanian, Kelsey A. Potter-Baker, Andre G. Machado, Ela B. Plow, 2019

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