Archive for category Functional Electrical Stimulation (FES)

[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.

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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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[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,

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[Abstract] Bi-cephalic transcranial direct current stimulation combined with functional electrical stimulation for upper-limb stroke rehabilitation: A double-blind randomized controlled trial

Highlights

Bi-cephalic transcranial direct current stimulation (tDCS) plus functional electrical stimulation (FES) slightly improves reaching motor performance after stroke.

Bi-cephalic tDCS plus FES does not enhance reaching movement quality after stroke.

Bi-cephalic tDCS plus FES improves handgrip strength after stroke.

Abstract

Background

Stroke survivors often present poor upper-limb (UL) motor performance and reduced movement quality during reaching tasks. Transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) are widely used strategies for stroke rehabilitation. However, the effects of combining these two therapies to rehabilitate individuals with moderate and severe impairment after stroke are still unknown.

Objective

Our primary aim was to evaluate the effects of concurrent bi-cephalic tDCS and FES on UL kinematic motor performance and movement quality. Our secondary aim was to verify the effects of the combined therapies on handgrip force and UL motor impairment.

Methods

We randomized 30 individuals with moderate and severe chronic hemiparesis after stroke into tDCS plus FES (n = 15) and sham tDCS plus FES (n = 15) groups. Participants were treated 5 times a week for 2 weeks. Kinematic UL motor performance (movement cycle time, velocity profile) and movement quality (smoothness, trunk contribution, joint angles), handgrip force and motor impairment were assessed before and after the intervention.

Results

For those participants allocated to the tDCS plus FES group, therapy was effective to improve movement cycle time (P = 0.039), mean reaching phase velocity (P = 0.022) and handgrip force (P = 0.034). Both groups showed improved mean returning phase velocity (P = 0.018), trunk contribution (P = 0.022), and movement smoothness (P = 0.001) as well as alleviated UL motor impairment (P = 0.002).

Conclusions

Concurrent bi-cephalic tDCS and FES slightly improved reaching motor performance and handgrip force of individuals with moderate and severe UL impairment after stroke.

via Bi-cephalic transcranial direct current stimulation combined with functional electrical stimulation for upper-limb stroke rehabilitation: A double-blind randomized controlled trial – ScienceDirect

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[ARTICLE] Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot – Full Text

Abstract

Background

Central drop foot is a common problem in patients with stroke or multiple sclerosis (MS). For decades, it has been treated with orthotic devices, keeping the ankle in a fixed position. It has been shown recently that semi-implantable functional electrical stimulation (siFES) of the peroneal nerve can lead to a greater gait velocity increase than orthotic devices immediately after being switched on. Little is known, however, about long-term outcomes over 12 months, and the relationship between quality of life (QoL) and gait speed using siFES has never been reported applying a validated tool. We provide here a report of short (3 months) and long-term (12 months) outcomes for gait speed and QoL.

Methods

Forty-five consecutive patients (91% chronic stroke, 9% MS) with central drop foot received siFES (Actigait®). A 10 m walking test was carried out on day 1 of stimulation (T1), in stimulation ON and OFF conditions, and repeated after 3 (T2) and 12 (T3) months. A 36-item Short Form questionnaire was applied at all three time points.

Results

We found a main effect of stimulation on both maximum (p < 0.001) and comfortable gait velocity (p < 0.001) and a main effect of time (p = 0.015) only on maximum gait velocity. There were no significant interactions. Mean maximum gait velocity across the three assessment time points was 0.13 m/s greater with stimulation ON than OFF, and mean comfortable gait velocity was 0.083 m/s faster with stimulation ON than OFF. The increase in maximum gait velocity over time was 0.096 m/s, with post hoc testing revealing a significant increase from T1 to T2 (p = 0.012), which was maintained but not significantly further increased at T3. QoL scores showed a main effect of time (p < 0.001), with post hoc testing revealing an increase from T1 to T2 (p < 0.001), which was maintained at T3 (p < 0.001). Finally, overall absolute QoL scores correlated with the absolute maximum and comfortable gait speeds at T2 and T3, and the increase in overall QoL scores correlated with the increase in comfortable gait velocity from T1 to T3. Pain was reduced at T2 (p < 0.001) and was independent of gait speed but correlated with overall QoL (p < 0.001).

Conclusions

Peroneal siFES increased maximal and comfortable gait velocity and QoL, with the greatest increase in both over the first three months, which was maintained at one year, suggesting that 3 months is an adequate follow-up time. Pain after 3 months correlated with QoL and was independent of gait velocity, suggesting pain as an independent outcome measure in siFES for drop foot.

 

Introduction

Drop foot is a common symptom in patients suffering from first motor neuron lesions, such as due to stroke and multiple sclerosis (MS). It is characterized by impaired lifting of the forefoot from the ground during the swing phase of walking and by a lack of stability during the early stance phase. Drop foot results in an altered gait pattern [3] and increased risk of falls [8]. Application of an ankle foot orthosis (AFO) is the traditional approach to improving gait pattern and reducing falls. However, it is not well-tolerated in all patients [10]. In recent years, gait improvement has been achieved using functional electrical stimulation (FES) [110162325], which combines the orthotic benefits of an AFO with a more physiological approach that involves muscle contraction and the related sensory feedback [1025]. Transcutaneous FES (tcFES) of the peroneal nerve has been associated with significantly reduced falls compared to intensive physiotherapy [7]. Indeed, 69% of the falls in this FES group occurred when the system was not used. Moreover, a systematic review of FES in MS patients indicates increased gait speed using FES [19]. Semi-implantable FES (siFES) of the peroneal nerve has been found to increase gait speed and improve gait patterns compared with a baseline without stimulation [61017], compared to orthotic devices [123], and also compared to tcFES [17]. The findings of a systematic review, including predominantly chronic stroke patients, however, did not suggest a difference between tcFES and siFES in terms of walking speed [13]. An implantable stimulator does, however, offer the advantage of avoiding the need for daily optimization of stimulator location [28] and potential skin lesions associated with surface stimulation electrodes. Moreover, the possibility of using a 4-channel implantable system, with independent control of each channel, means that the volume of tissue activated within the nerve can be individually selected, in order to optimize dorsiflexion of the foot while avoiding stimulation of the sensory fascicles of the common peroneal nerve [10]. Here we retrospectively hypothesised that increases in gait speed are associated with improvements in quality of life (QoL). Furthermore, we assumed pain scores had improved under therapy and expected them to be related to the overall QoL, and we hypothesised that increased gait velocity would have resulted in improvement of both physical and emotional subscores of the QoL. To address these hypotheses, we evaluated improvement in gait velocity in the largest cohort of patients to date, with stimulation ON and OFF, at three time points over 1 year, to assess the short- and long-term effects of siFES, examining correlation between gait speed and QoL, as well as between changes in these factors, over a year of continuous treatment.

Most studies of implantable systems for stroke to date cover observation periods of 3 to 6 months post-surgery and suggest siFES provides a promising approach to managing drop foot. An increase in gait velocity and endurance, as well as an improvement in QoL, was observed 3–6 weeks post-operatively in a cohort of 27 patients receiving siFES [17]. Trials applying tcFES, which has been available since the early seventies [27], have tended to employ standardized and stratified re-examination, with early and long-term follow-up periods, such as 6 and 12 weeks [16], 3 and 12 months [25], and 24 days and 3 years [28]. A recent long-term multi-centre study applying siFES reported an improved gait pattern in a cohort of 10 stroke patients 6 months following siFES activation and in a separate cohort of 12 stroke patients 1 year after activation [1]. Their findings suggested greater knee stability, ankle plantarflexion power, and propulsion than that provided by an AFO. Here, we examined both the short- and long-term effects of using multichannel peroneal siFES in the largest patient group thus far reported, including both stroke and MS patients. The independent association between slow gait velocity and an increased risk of falls [8] renders gait velocity a valid surrogate parameter for the orthotic functionality of devices aiming to improve the limitations of drop foot. We aimed to investigate whether gait velocity improvements translate into QoL changes. Long-term follow-up (one year or longer) has been reported for large cohorts (more than 20 patients) using tcFES [2528], and for a smaller cohort (N = 12) using siFES [1]. Long-term follow-up in a large cohort of patients receiving siFES and evaluating QoL has not yet been reported. The particular strengths of the current study are the large cohort, the inclusion of short- and long-term follow-up, and the evaluation of QoL and its correlation with gait speed.[…]

 

Continue —>  Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1Gait speed (m/s) in relation to duration of therapy with stimulation ON and OFF. a. Maximum gait velocity. Main effect of stimulation and time. Post hoc testing: significant difference from day 1 to month 3 (*). b. Comfortable gait velocity. Main effect of stimulation only. Error bars = standard error of the mean

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[ARTICLE] Contralaterally controlled functional electrical stimulation improves wrist dorsiflexion and upper limb function in patients with early-phase stroke: A randomized controlled trial – Full Text HTML

Abstract

Objectives: To investigate the effectiveness of contra-laterally controlled functional

electrical stimulation (CCFES) on the recovery of active wrist dorsiflexion and upper limb function in patients with early-phase stroke (<15 days post-stroke).

Methods: Patients in the CCFES group were treated with routine rehabilitation combined with CCFES, while those in the conventional neuromuscular electrical stimulation (NMES) group were treated with routine rehabilitation combined with NMES. Time intervals from stroke onset to appearance of wrist dorsiflexion, and from onset of treatment to appearance of wrist dorsiflexion were recorded (in days). Functional assessments were also performed at baseline and endpoint.

Results: Nineteen out of 21 patients in the CCFES group and 12 out of 20 patients in the NMES group regained active wrist dorsiflexion during the treatment and follow-up period (90.5% vs 60%, p = 0.025). The mean time interval from onset of treatment to appearance of active wrist dorsiflexion was signifcantly shorter in the CCFES group than in the NMES

group (p < 0.001). The CCFES group had signifcantly higher scores for upper extremity

function (p = 0.001), strength of extensor carpi (p = 0.002), active ROM for wrist dorsiflexion (p = 0.003), activities of daily living score (p = 0.023) and ICF score (p < 0.001) than the NMES group at the endpoint.

Conclusion: CCFES signifcantly shortened the time for regaining wrist dorsiflexion, and improved the upper extremity function and general health of patients with early-phase stroke. CCFES therefore has potential as a clinical intervention.

 

Lay Abstract

After a stroke, it is essential that recovery of function of the upper limb is maximized in order to enable activities of daily living. The hand plays an important role in the function of the upper limb. This study examined the effectiveness of contralaterally controlled functional electrical stimulation (CCFES) on recovery of active dorsiflexion of the wrist and upper limb functioning in patients in the early-phase after stroke (<15 days post-stroke). CCFES significantly shortened the time for regaining wrist dorsiflexion, and improved the upper extremity function and general health of patients with early-phase stroke, compared with conventional neuro-muscular electrical stimulation. CCFES therefore has potential as a clinical intervention.

Introduction

Stroke is a leading cause of disability with high morbidity and mortality. Approximately 75% of patients with stroke have upper extremity dysfunction (1). Impaired motor function of the upper extremity is a major factor in preventing patients returning to their usual activities. In addition to routine medical treatment, early-phase rehabilitation helps improve motor function and activities of daily living (ADL) (2). Moreover, well-prescribed rehabilitation may shorten the course of recovery from stroke, help patients return to the community earlier, improve their quality of life, and reduce the cost of medication (3).

Recovery of upper extremity functioning is essential for improving ADL ability in patients with stroke (4). The hands play an important role in functioning of the upper extremities. Hand function and, in particular, extensor function, is difficult to recover once impaired, Therefore, specific rehabilitation interventions, which are considered the first step in re-gaining full extension of the hand, are essential in the recovery of wrist dorsiflexion (WD). Early recovery of active WD contributes not only to a better outcome for upper extremity functioning, but also to improved outcome for ADL.

Over the past decades, neuromuscular electrical stimulation (NMES), an electrical stimulation that provides passive training for the wrist dorsi-extensor, has been integrated into certain specific rehabilitation prescriptions (5–7). NMES triggers the movement using electrical stimulation. The frequency and amplitude of biphasic rectangular current pulses are pre-set and fixed during the whole training course.

In contrast, controlled functional electrical stimulation (CCFES) is an intervention technique developed recently to improve the function of the paretic upper extremity after stroke. One of the characteristics of CCFES is that it requires active participation from patients, and not merely electrical stimulation of the paretic muscle or extremity. As described by Knutson et al., “CCFES uses a control signal from the non-paretic side of the body to regulate the intensity of electrical stimulation delivered to the paretic muscles of the homologous limb on the opposite side of the body” (8). In separate studies, Knutson et al. (9) and Shen et al. (10) compared the effectiveness of CCFES and NMES in patients with sub-acute stoke, and found greater improvements with CCFES. Nonetheless, its effectiveness in the early-phase (i.e. within 15 days) after stroke is unclear. The aim of this study was therefore to investigate the effectiveness of CCFES compared with NMES on upper extremity function, particularly WD, in patients with early-phase stroke.

MATERIAL AND METHODS

Subjects

Patients admitted to the Department of Neurology, Jiangsu Province People’s Hospital, Nanjing, China, between March and September 2015 were recruited to this study. All subjects provided written informed consent prior to the study, and the ethics committee of the First Affiliated Hospital of Nanjing Medical University approved the study protocol.

Inclusion criteria were: (i) diagnosed with stroke using computed tomography (CT) or magnetic resonance imaging (MRI); (ii) stable vital signs 48 h post-stroke; (iii) single-side injury; (iv) age 20–80 years; (v) within 15 days post-stroke; (vi) Brunnstrom recovery stage of III or less; (vii) score of Fugl-Meyer assessment (FMA) for upper extremity ≤ 22; and (viii) no active WD detected.

Exclusion criteria were: (i) progressive stroke with non-stable condition; (ii) stroke-like symptoms due to subdural haematoma, tumour, encephalitis or trauma; (iii) unable to follow treatment instructions due to severe cognitive and communication deficiency; (iv) implanted with a pacemaker; and (v) no informed consent (11).

Randomization

Patients were assigned to either the NMES or the CCFES group based on a computer-generated randomization list and allocation (1:1) concealed by consecutively numbered, sealed opaque envelopes. An envelope was opened once a patient had consented to participate in the trial, the administrator then informed the doctor about the allocated intervention regimen via phone calls.

Electrical stimulation system

In the NMES group, 2 stimulating electrodes (4 × 4 cm) were placed at the motor points of the forearm extensor muscles (specifically the ulnar margin of the extensor aspect of the forearm) to produce WD (Fig. 1a). The stimulators (Weisi Corporation, Nanjing, China) used in this study delivered biphasic rectangular current pulses; the pulse frequency was set at 35 Hz, and the pulse amplitude was set at 40 mA. The electrical stimulation intensity was set at a sustainable level with full balanced WD with tetanic contraction.

In the CCFES group, 3 recording electrodes (4 × 4 cm) were placed on the motor points of the forearm extensor muscles (the ulnar margin of the extensor aspect of the forearm) on the non-paretic side, while 2 stimulating electrodes (4 × 4 cm) were attached on the paretic side (Fig 1b). For each patient, the intensity of the electrical stimulation to WD of the paretic side was determined by the strength of contralateral forearm extensor muscles contraction. Subjects were asked to voluntarily extend their unaffected wrist to 10% of ROM or less and maintain that position without moving. The electromyography value of the movement was then recorded. Meanwhile, the therapist adjusted the electric intensity until the same degree of movement appeared on the paretic side. The intensity value was then recorded. The same practice and recording process was also applied, with the patients extending their unaffected wrist to 50% and 100% of ROM. The electrical stimulation intensity that produced balanced WD was determined empirically for each patient and programmed into the stimulator.

Fig. 1. Patients treated with different strategies. (a) The patient underwent neuromuscular electrical stimulation (NMES) with the stimulator in Model I; (b) the patient underwent contralaterally controlled functional electrical stimulation (CCFES) with the stimulator in Model II.

[…]

Continue —> Journal of Rehabilitation Medicine – Contralaterally controlled functional electrical stimulation improves wrist dorsiflexion and upper limb function in patients with early-phase stroke: A randomized controlled trial – HTML

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[VIDEO] FES (Functional Electrical Stimulation) System by FES Center India – YouTube

Functional Electrical Stimulation (FES): Best and latest treatment for Neurological rehabilitation/ Physiotherapy

FES is a technique that utilizes patterned electrical stimulation of neural tissue with the purpose of restoring or enhancing a lost or diminished function. It produces contractions in paralysed muscles by the application of small pulses of electrical stimulation to nerves that supply the paralysed muscle. The stimulation is controlled in such a way that the movement produced provides useful function.

FES is used as a tool to assist walking and also as a means of practicing various functional movements for therapeutic benefit. FES may be used to replace the natural electrical signals from the brain, helping the weak or paralyzed limbs move again. With continued stimulation over time, the brain may even be able to recapture and relearn this movement without the stimulation.

Use of “FES (Functional Electrical Stimulation) System India” for treatment of Foot Drop due to Hemiplegia. FES is a novel device for treatment/ rehabilitation of Neurological diseases. FES System India has many applications like

  1. Sit to stand training
  2. Pre Gait Training
  3. Correction of Foot Drop,
  4. Correction of Circumductory Gait

  5. for Paraplegia (Incomplete SCI) using FES unit on both sides

  6. Shoulder subluxation and shoulder rehabilitation

  7. Hand Function (Grasp and release)

This novel treatment is useful for all type of UMN disorders like hemiplegia (Cerebro Vascular Accident, Head Injury, Traumatic Brain injury, Brain tumor ), multiple scerosis, cerebral palsy, incomplete paraplegia etc.

contact “FES Center India” to buy FES System.

mail: fescenterindia@gmail.com

For more details visit: http://www.fescenterindia.com

via FES (Functional Electrical Stimulation) System by FES Center India – YouTube

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