Posts Tagged Electric stimulation therapy

[Abstract] Effectiveness of electrical stimulation therapy in improving arm function after stroke: a systematic review and a meta-analysis of randomised controlled trials

The aim of this study is to investigate the effectiveness of electrical stimulation in arm function recovery after stroke.

Data were obtained from the PubMed, Cochrane Library, Embase, and Scopus databases from their inception until 12 January 2019. Only randomized controlled trials (RCTs) reporting the effects of electrical stimulation on the recovery of arm function after stroke were selected.

Forty-eight RCTs with a total of 1712 patients were included in the analysis. The body function assessment, Upper-Extremity Fugl-Meyer Assessment, indicated more favorable outcomes in the electrical stimulation group than in the placebo group immediately after treatment (23 RCTs (n = 794): standard mean difference (SMD) = 0.67, 95% confidence interval (CI) = 0.51–0.84) and at follow-up (12 RCTs (n = 391): SMD = 0.66, 95% CI = 0.35–0.97). The activity assessment, Action Research Arm Test, revealed superior outcomes in the electrical stimulation group than those in the placebo group immediately after treatment (10 RCTs (n = 411): SMD = 0.70, 95% CI = 0.39–1.02) and at follow-up (8 RCTs (n = 289): SMD = 0.93, 95% CI = 0.34–1.52). Other activity assessments, including Wolf Motor Function Test, Box and Block Test, and Motor Activity Log, also revealed superior outcomes in the electrical stimulation group than those in the placebo group. Comparisons between three types of electrical stimulation (sensory, cyclic, and electromyography-triggered electrical stimulation) groups revealed no significant differences in the body function and activity.

Electrical stimulation therapy can effectively improve the arm function in stroke patients.

via Effectiveness of electrical stimulation therapy in improving arm function after stroke: a systematic review and a meta-analysis of randomised controlled trials – Jheng-Dao Yang, Chun-De Liao, Shih-Wei Huang, Ka-Wai Tam, Tsan-Hon Liou, Yu-Hao Lee, Chia-Yun Lin, Hung-Chou Chen, 2019

, , , , , , ,

Leave a comment

[Abstract] Electromyogram-Related Neuromuscular Electrical Stimulation for Restoring Wrist and Hand Movement in Poststroke Hemiplegia: A Systematic Review and Meta-Analysis

Background. Clinical trials have demonstrated some benefits of electromyogram-triggered/controlled neuromuscular electrical stimulation (EMG-NMES) on motor recovery of upper limb (UL) function in patients with stroke. However, EMG-NMES use in clinical practice is limited due to a lack of evidence supporting its effectiveness.

Objective. To perform a systematic review and meta-analysis to determine the effects of EMG-NMES on stroke UL recovery based on each of the International Classification of Functioning, Disability, and Health (ICF) domains.

Methods. Database searches identified clinical trials comparing the effect of EMG-NMES versus no treatment or another treatment on stroke upper extremity motor recovery. A meta-analysis was done for outcomes at each ICF domain (Body Structure and Function, Activity and Participation) at posttest (short-term) and follow-up periods. Subgroup analyses were conducted based on stroke chronicity (acute/subacute, chronic phases). Sensitivity analysis was done by removing studies rated as poor or fair quality (PEDro score <6).

Results. Twenty-six studies (782 patients) met the inclusion criteria. Fifty percent of them were considered to be of high quality. The meta-analysis showed that EMG-NMES has a robust short-term effect on improving UL motor impairment in the Body Structure and Function domain. No evidence was found in favor of EMG-NMES for the Activity and Participation domain. EMG-NMES had a stronger effect for each ICF domain in chronic (≥3 months) compared to acute/subacute phases.

Conclusion. EMG-NMES is effective in the short term in improving UL impairment in individuals with chronic stroke.

 

via Electromyogram-Related Neuromuscular Electrical Stimulation for Restoring Wrist and Hand Movement in Poststroke Hemiplegia: A Systematic Review and Meta-Analysis – Katia Monte-Silva, Daniele Piscitelli, Nahid Norouzi-Gheidari, Marc Aureli Pique Batalla, Philippe Archambault, Mindy F. Levin, 2019

, , , , , , , , , , ,

Leave a comment

[Abstract] Repetitive Peripheral Sensory Stimulation and Upper Limb Performance in Stroke: A Systematic Review and Meta-analysis

Background. Enhancement of sensory input in the form of repetitive peripheral sensory stimulation (RPSS) can enhance excitability of the motor cortex and upper limb performance.

Objective. To perform a systematic review and meta-analysis of effects of RPSS compared with control stimulation on improvement of motor outcomes in the upper limb of subjects with stroke.

Methods. We searched studies published between 1948 and December 2017 and selected 5 studies that provided individual data and applied a specific paradigm of stimulation (trains of 1-ms pulses at 10 Hz, delivered at 1 Hz). Continuous data were analyzed with means and standard deviations of differences in performance before and after active or control interventions. Adverse events were also assessed.

Results. There was a statistically significant beneficial effect of RPSS on motor performance (standard mean difference between active and control RPSS, 0.67; 95% CI, 0.09-1.24; I2= 65%). Only 1 study included subjects in the subacute phase after stroke. Subgroup analysis of studies that only included subjects in the chronic phase showed a significant effect (1.04; 95% CI, 0.66-1.42) with no heterogeneity. Significant results were obtained for outcomes of body structure and function as well as for outcomes of activity limitation according to the International Classification of Function, Disability and Health, when only studies that included subjects in the chronic phase were analyzed. No serious adverse events were reported.

Conclusions. RPSS is a safe intervention with potential to become an adjuvant tool for upper extremity paresis rehabilitation in subjects with stroke in the chronic phase.

 

via Repetitive Peripheral Sensory Stimulation and Upper Limb Performance in Stroke: A Systematic Review and Meta-analysis – Adriana Bastos Conforto, Sarah Monteiro dos Anjos, Wanderley Marques Bernardo, Arnaldo Alves da Silva, Juliana Conti, André G. Machado, Leonardo G. Cohen, 2018

, , , , , , , , , ,

Leave a comment

[Abstract] Repetitive Peripheral Sensory Stimulation and Upper Limb Performance in Stroke: A Systematic Review and Meta-analysis

Background. Enhancement of sensory input in the form of repetitive peripheral sensory stimulation (RPSS) can enhance excitability of the motor cortex and upper limb performance.

Objective. To perform a systematic review and meta-analysis of effects of RPSS compared with control stimulation on improvement of motor outcomes in the upper limb of subjects with stroke.

Methods. We searched studies published between 1948 and December 2017 and selected 5 studies that provided individual data and applied a specific paradigm of stimulation (trains of 1-ms pulses at 10 Hz, delivered at 1 Hz). Continuous data were analyzed with means and standard deviations of differences in performance before and after active or control interventions. Adverse events were also assessed.

Results. There was a statistically significant beneficial effect of RPSS on motor performance (standard mean difference between active and control RPSS, 0.67; 95% CI, 0.09-1.24; I2 = 65%). Only 1 study included subjects in the subacute phase after stroke. Subgroup analysis of studies that only included subjects in the chronic phase showed a significant effect (1.04; 95% CI, 0.66-1.42) with no heterogeneity. Significant results were obtained for outcomes of body structure and function as well as for outcomes of activity limitation according to the International Classification of Function, Disability and Health, when only studies that included subjects in the chronic phase were analyzed. No serious adverse events were reported.

Conclusions. RPSS is a safe intervention with potential to become an adjuvant tool for upper extremity paresis rehabilitation in subjects with stroke in the chronic phase.

via Repetitive Peripheral Sensory Stimulation and Upper Limb Performance in Stroke: A Systematic Review and Meta-analysis – Adriana Bastos Conforto, Sarah Monteiro dos Anjos, Wanderley Marques Bernardo, Arnaldo Alves da Silva, Juliana Conti, André G. Machado, Leonardo G. Cohen, 2018

, , , , , , , , , ,

Leave a comment

[Abstract] Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study

 

Abstract

Objective

To evaluate the effects of electrically assisted movement therapy (EAMT) in which patients use functional electrical stimulation, modulated by a custom device controlled through the patient’s unaffected hand, to produce or assist task-specific upper limb movements, which enables them to engage in intensive goal-oriented training.

Design

Randomized, crossover, assessor-blinded, 5-week trial with follow-up at 18 weeks.

Setting

Rehabilitation university hospital.

Participants

Patients with chronic, severe stroke (N=11; mean age, 47.9y) more than 6 months poststroke (mean time since event, 46.3mo).

Interventions

Both EAMT and the control intervention (dose-matched, goal-oriented standard care) consisted of 10 sessions of 90 minutes per day, 5 sessions per week, for 2 weeks. After the first 10 sessions, group allocation was crossed over, and patients received a 1-week therapy break before receiving the new treatment.

Main Outcome Measures

Fugl-Meyer Motor Assessment for the Upper Extremity, Wolf Motor Function Test, spasticity, and 28-item Motor Activity Log.

Results

Forty-four individuals were recruited, of whom 11 were eligible and participated. Five patients received the experimental treatment before standard care, and 6 received standard care before the experimental treatment. EAMT produced higher improvements in the Fugl-Meyer scale than standard care (P<.05). Median improvements were 6.5 Fugl-Meyer points and 1 Fugl-Meyer point after the experimental treatment and standard care, respectively. The improvement was also significant in subjective reports of quality of movement and amount of use of the affected limb during activities of daily living (P<.05).

Conclusions

EAMT produces a clinically important impairment reduction in stroke patients with chronic, severe upper limb paresis.

Source: Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study – Archives of Physical Medicine and Rehabilitation

, , , , , , ,

Leave a comment

[ARTICLE] The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study

Introduction: Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints and greater displacements of the trunk, compared to healthy subjects. The importance of an appropriate and specific contraction of the interscapular and upper limb (UL) muscles is crucial to achieving proper reaching movements. Functional electrical stimulation (FES) is used to activate the paretic muscles using short-duration electrical pulses.

Objective: To evaluate whether the application of FES in the UL and interscapular muscles of stroke patients with motor impairments of the UL modifies patients’ reaching patterns, measured using instrumental movement analysis systems.

Design: A cross-sectional study was carried out.

Setting: The VICON Motion System® was used to conduct motion analysis.

Participants: Twenty-one patients with chronic stroke.

Intervention: The Compex® electric stimulator was used to provide muscle stimulation during two conditions: a placebo condition and a FES condition.

Main outcome measures: We analyzed the joint kinematics (trunk, shoulder, and elbow) from the starting position until the affected hand reached the glass.

Results: Participants receiving FES carried out the movement with less trunk flexion, while shoulder flexion elbow extension was increased, compared to placebo conditions.

Conclusion: The application of FES to the UL and interscapular muscles of stroke patients with motor impairment of the UL has improved reaching movements.

Introduction

Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints compared to healthy subjects (16). The movement pattern of patients with stroke is highly related to their level of motor function impairment, which becomes modified due to the lack of inter-articular coordination (1). There is a decrease in the range of motion at the elbow joint with a tendency toward flexion, which avoids correct extension of the upper limb (UL), hampering the ability to perform appropriate reaching movements. Excessive shoulder abduction is also observed as a compensatory movement when there is a lack of appropriate shoulder flexion (7).

In the case of the trunk, greater trunk displacements have been observed in patients with stroke, forward displacements, and torsion movements, which are related to deficits in elbow extension, and shoulder flexion and adduction, as compensatory mechanisms that occur during reaching movements or other activity. Patients are able to develop new motor strategies to achieve their goal despite UL deficits (17). There is a greater involvement of the trunk and scapula during the execution of reaching movements due to the creation of new movement strategies to compensate for the deficiencies (8).

The scientific literature has shown that stroke patients need to create new movement strategies. This involves the development of pathological synergies to carry out the desired movements. An example of this is the excessive movements of the trunk and scapula to compensate the deficiencies resulting from the pathology (7). Proper activation of the interscapular muscles depends on the position of the trunk. Stroke patients, due to the deficits affecting their trunk and scapular movement patterns, are under unfavorable conditions for being able to perform appropriate and selective activation of these muscles, which has a negative impact on the movement of the UL (911).

Regarding the UL muscles involved in reaching movements, a deficit in muscle control and activation has been observed (51213). The synergistic contraction of the shoulder flexor and extensor muscles during reach becomes deteriorated due to muscle weakness and; therefore, the resulting movement is deficient (14). Furthermore, spastic muscle patterns may also prevent the correct performance of UL movements (1518).

Functional electrical stimulation (FES) is a form of treatment that seeks to activate the paretic muscles using short-duration electrical pulses applied via surface electrodes through the skin (19). The use of FES and neuroprostheses has spanned almost four decades (2021). The use of FES as a neuroprosthesis consists of self-treatment at home by means of a neuroprosthetic neuromuscular stimulation system. The objective of this modality is to assist the performance of an activity of daily living (ADL) (22). Recently, functional and clinical improvements have been reported with the therapeutic application of FES, in which stimulation was used to increase voluntary movement after stroke (2223). Therapeutic FES modalities have been used to recruit UL muscles, improving weakness, the dyscoordination of single and multiple joints movements, and spasticity (24).

Most studies employing therapeutic FES for paretic UL rehabilitation are based on stimulation of the shoulder, elbow, and wrist muscles without recruitment of the interscapular muscles (2528). The importance of an appropriate and specific contraction of the interscapular musculature during UL movement is necessary to adapt the position of the scapulothoracic joint to the degree of movement of the glenohumeral joint. This musculature has a stabilizing function upon the entire glenohumeral complex, which is necessary for a correct reaching movement (2931). In healthy subjects, the posture of the trunk has been shown to influence changes in scapular movement and interscapular muscle activity during UL elevation (2932). The motor control of shoulder movement influences the correct and proper activation and synchronization of these muscles (33).

In this study, we tested the ability of a FES system to assist the UL movement of stroke patients based on the stimulation of interscapular, shoulder, elbow, wrist, and finger muscles. To our knowledge, no empirical study to date directly addresses this question. The authors hypothesized that participants receiving FES to the UL and interscapular muscles would be able to perform the movement with less trunk anteroposterior tilt and major shoulder flexion and elbow extension. The aim of this feasibility study was to evaluate whether the application of FES to the UL and interscapular muscles of stroke patients with UL motor impairment would be able to modify their reaching patterns, measured using instrumental movement analysis systems.[…]

Continue —> Frontiers | The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study | Neurology

Figure 1. Patient with the functional electrical stimulation device.

, , , , , , , , , , , ,

Leave a comment

[Abstract] Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study  

Abstract

Objective

To evaluate the effects of electrically assisted movement therapy (EAMT) in which patients use functional electrical stimulation, modulated by a custom device controlled through the patient’s unaffected hand, to produce or assist task-specific upper limb movements, which enables them to engage in intensive goal-oriented training.

Design

Randomized, crossover, assessor-blinded, 5-week trial with follow-up at 18 weeks.

Setting

Rehabilitation university hospital.

Participants

Patients with chronic, severe stroke (N=11; mean age, 47.9y) more than 6 months poststroke (mean time since event, 46.3mo).

Interventions

Both EAMT and the control intervention (dose-matched, goal-oriented standard care) consisted of 10 sessions of 90 minutes per day, 5 sessions per week, for 2 weeks. After the first 10 sessions, group allocation was crossed over, and patients received a 1-week therapy break before receiving the new treatment.

Main Outcome Measures

Fugl-Meyer Motor Assessment for the Upper Extremity, Wolf Motor Function Test, spasticity, and 28-item Motor Activity Log.

Results

Forty-four individuals were recruited, of whom 11 were eligible and participated. Five patients received the experimental treatment before standard care, and 6 received standard care before the experimental treatment. EAMT produced higher improvements in the Fugl-Meyer scale than standard care (P<.05). Median improvements were 6.5 Fugl-Meyer points and 1 Fugl-Meyer point after the experimental treatment and standard care, respectively. The improvement was also significant in subjective reports of quality of movement and amount of use of the affected limb during activities of daily living (P<.05).

Conclusions

EAMT produces a clinically important impairment reduction in stroke patients with chronic, severe upper limb paresis.

Source: Electrically Assisted Movement Therapy in Chronic Stroke Patients With Severe Upper Limb Paresis: A Pilot, Single-Blind, Randomized Crossover Study – Archives of Physical Medicine and Rehabilitation

, , , , , , , , , , , ,

Leave a comment

[Abstract] Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop

Abstract

Objective

To investigate the feasibility of unsupervised community use of an array-based automated setup functional electrical stimulator for current foot-drop functional electrical stimulation (FES) users.

Design

Feasibility study.

Setting

Gait laboratory and community use.

Participants

Participants (N=7) with diagnosis of unilateral foot-drop of central neurologic origin (>6mo) who were regular users of a foot-drop FES system (>3mo).

Intervention

Array-based automated setup FES system for foot-drop (ShefStim).

Main Outcome Measures

Logged usage, logged automated setup times for the array-based automated setup FES system and diary recording of problems experienced, all collected in the community environment. Walking speed, ankle angles at initial contact, foot clearance during swing, and the Quebec User Evaluation of Satisfaction with Assistive Technology version 2.0 (QUEST version 2.0) questionnaire, all collected in the gait laboratory.

Results

All participants were able to use the array-based automated setup FES system. Total setup time took longer than participants’ own FES systems, and automated setup time was longer than in a previous study of a similar system. Some problems were experienced, but overall, participants were as satisfied with this system as their own FES system. The increase in walking speed (N=7) relative to no stimulation was comparable between both systems, and appropriate ankle angles at initial contact (N=7) and foot clearance during swing (n=5) were greater with the array-based automated setup FES system.

Conclusions

This study demonstrates that an array-based automated setup FES system for foot-drop can be successfully used unsupervised. Despite setup’s taking longer and some problems, users are satisfied with the system and it would appear as effective, if not better, at addressing the foot-drop impairment. Further product development of this unique system, followed by a larger-scale and longer-term study, is required before firm conclusions about its efficacy can be reached.

Source: Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop – Archives of Physical Medicine and Rehabilitation

, , , , , , , ,

Leave a comment

[Review] Systematic review of adjunct therapies to improve outcomes following botulinum toxin injection for treatment of limb spasticity.

Abstract

Objective: To determine the quality of evidence from randomized controlled trials on the efficacy of adjunct therapies following botulinum toxin injections for limb spasticity.

Data sources: MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials electronic databases were searched for English language human studies from 1980 to 21 May 2015.

Study selection: Randomized controlled trials assessing adjunct therapies postbotulinum toxin injection for treatment of spasticity were included. Of the 268 studies screened, 17 met selection criteria.

Data extraction: Two reviewers independently assessed risk of bias using the Physiotherapy Evidence Database (PEDro) scale and graded according to Sackett’s levels of evidence.

Data synthesis: Ten adjunct therapies were identified. Evidence suggests that adjunct use of electrical stimulation, modified constraint-induced movement therapy, physiotherapy (all Level 1), casting and dynamic splinting (both Level 2) result in improved Modified Ashworth Scale scores by at least 1 grade. There is Level 1 and 2 evidence that adjunct taping, segmental muscle vibration, cyclic functional electrical stimulation, and motorized arm ergometer may not improve outcomes compared with botulinum toxin injections alone. There is Level 1 evidence that casting is better than taping, taping is better than electrical stimulation and stretching, and extracorporeal shock wave therapy is better than electrical stimulation for outcomes including the Modified Ashworth Scale, range of motion and gait. All results are based on single studies.

Conclusion: There is high level evidence to suggest that adjunct therapies may improve outcomes following botulinum toxin injection. No results have been confirmed by independent replication. All interventions would benefit from further study.

 

Source: Systematic review of adjunct therapies to improve outcomes following botulinum toxin injection for treatment of limb spasticity

, , ,

Leave a comment

[ARTICLE] Full-movement neuromuscular electrical stimulation improves plantar flexor spasticity and ankle active dorsiflexion in stroke patients: A randomized controlled study

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).

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.

Source: Full-movement neuromuscular electrical stimulation improves plantar flexor spasticity and ankle active dorsiflexion in stroke patients: A randomized controlled study

, , ,

Leave a comment

%d bloggers like this: