Posts Tagged electrical stimulation therapy
[ARTICLE] Effect of repetitive wrist extension with electromyography-triggered stimulation after stroke: a preliminary randomized controlled study – Full Text PDF
Objective: The purpose of this study was to explore the effect of repetitive wrist extension task training with electromyography (EMG)-triggered neuromuscular electrical stimulation (NMES) for wrist extensor muscle recovery in patients with stroke.
Design: Randomized controlled trial.
Methods: Fifteen subjects who had suffered a stroke were randomly assigned to an EMG-triggered NMES group (n=8) or control group (n=7); subjects in both groups received conventional therapy as usual. Subjects in the experimental group received application of EMG-triggered NMES to the wrist extensor muscles for 20 minutes, twice per day, five days per week, for a period of four weeks, and were given a task to make a touch alarm go off by activity involving extension of their wrist. In the control group, subjects
performed wrist self-exercises for the same duration and frequency as those in the experimental group. Outcome measures included muscle reaction time and spectrum analysis. Assessments were performed during the pre- and post-treatment periods.
Results: In the EMG-triggered NMES group, faster muscle reaction time was observed, and median frequency also showed improvement, from 68.2 to 75.3 Hz, after training (p<0.05). Muscle reaction time was significantly faster, and median frequency was significantly higher in the experimental group than in the experimental group after training.
Conclusions: EMG-triggered NMES is beneficial for patients with hemiparetic stroke in recovery of upper extremity function.
According to a clinical trial, a new form of electrical stimulation therapy can help rewire the brain and restore some dexterity to a hand that’s been paralyzed by stroke. In the experimental therapy, patients use their good hand to help their brain regain control over the paralyzed hand. A sensored glove, worn on the patient’s good hand, sends signals to electric stimulators attached to the paralyzed hand. The inert muscles are then prompted to mirror the movements of the functioning hand while patients think about opening both hands at the same time,
Research is still underway, but so far almost all patients who received the new therapy have felt an improvement.
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Electrical stimulation of the arms and hands affected by a stroke is one rehab technique that can provide a lot of benefits if done right. One major problem is having a reliable method of activating stimulation at just the right time so that the patient feels in control and gets the most out of the therapy.
Researchers in Ohio at the MetroHealth System, Case Western Reserve University, and the Cleveland Functional Electrical Stimulation Center developed an electrical stimulation system that uses the strong hand to control the grip of the weakened one. An electronic sensing glove is worn by the hand on the stronger side of the body. Every time the person squeezes the hand with the glove, it sends an appropriate signal to an electrical stimulator connected to electrodes on the other arm that in turn make that hand create a grip. The same happens when the grip is opened, just that different muscles are stimulated as a result.
To test the new system in comparison to the existing stimulation method, the research team enrolled 80 patients post stroke for a three month program. Half of the people received the traditional stimulation therapy, while the other half used the new system. Most of it was performed by patients on their own at home in addition to three hours spent with a therapist at the rehab lab.
Here are the promising findings shown in the study:
- Patients who received the new therapy had greater improvement on the dexterity test (4.6 blocks) than the common group (1.8 blocks).
- Patients who had the greatest improvements in hand dexterity following the new therapy were less than two years post-stroke and had at least some finger movement when they started the study. These patients saw an improvement of 9.6 blocks on the dexterity test, compared to 4.1 blocks in the common group.
- Patients with no finger movement also saw improvements in arm movement after the new therapy.
- At treatment end, 97 percent of the participants who received the new therapy agreed that they could use their hand better than at the start of the study.
Adults with chronic hand impairment after suffering a stroke improved their manual dexterity when they received 12 weeks of contralaterally controlled functional electrical stimulation (CCFES).
The benefits of CCFES were superior to equivalent doses of cyclic neuromuscular electrical stimulation (cNMES), although the researchers said the differences fell short of the minimum detectable change threshold and were not clinically relevant.
Lead researcher Jayme S. Knutson, PhD, of Case Western Reserve University in Cleveland, and colleagues published their results online in Stroke on Sept. 8.
With cNMES, the researchers noted that therapists set the cycle timing, repetitions and intensity of stimulation, so patients do not need to actively participate. Meanwhile, with CCFES, patients open their paretic hand and perform functional tasks. They control the stimulation to their paretic hand by opening and closing their strong hand.
For this study, the researchers enrolled 80 patients from March 2009 to October 2014 at an academic medical center in Cleveland and randomized them to receive 12 weeks of treatment with cNMES or CCFES. All of the patients had a stroke and had moderate to severe upper extremity hemiparesis.
Of the 80 participants, 72 completed the treatment. The other eight withdrew within the first three weeks of the treatment period. All eight participants were from the CCFES group.The treatments lasted 12 weeks and consisted of 20 sessions of therapist-guided functional task practice in the laboratory and 10 sessions per week of self-administered repetitive hand opening exercise at home.Six months after the treatment, participants in the CCFES group had greater improvement on the Box and Block Test (BBT), a measure of manual dexterity in which participants pick up one block at a time, move it over a partition and release it in a target area within 60 seconds. The researchers mentioned that participants who had the largest improvements on the BBT had their strokes within two years and had moderate hand impairment at baseline.
There were no differences between the CCFES and cNMES groups on the upper extremity Fugl-Meyer and Arm Motor Abilities Test (AMAT). The Fugl-Meyer assesses functional ability, while the AMAT measures upper limb impairment.
“Future trials should include validated patient reported outcomes and outcomes that are sensitive to participation and quality of life,” the researchers wrote. “Also, the translatability of CCFES therapy to other research sites and to clinical practice still needs to be established. A future multisite study is needed to confirm the findings of this study and to demonstrate generalizability across different rehabilitation centers.”
[WEB SITE] New Electrical Stimulation Therapy Shows Promise Improving Hand Function In Stroke Patients : HEALTH : Tech Times
Stroke survivors showed improved hand dexterity more when using a new electrical stimulation therapy compared to an existing stimulation technique, said researchers from the MetroHealth System, Cleveland Functional Electrical Stimulation Center and the Case Western Reserve University.
Every year, some 800,000 individuals experience strokes in the U.S. The medical condition is characterized by reduced blood flow to the brain and usually results in paralysis or partial paralysis on one side of the body, making it difficult for survivors to open a hand. To address this, low-level electric currents are applied to the affected hand to stimulate paralyzed muscles, with intensity, repetitions and timing set by therapists.
For a study published in the journal Stroke, the researchers developed a new electrical stimulation therapy that involved stroke survivors wearing a glove with sensors on their unaffected hand to control stimulation applied to their weak hand. As the unaffected hand is opened, a corresponding level of stimulation is applied to the weak hand, opening it.
Positive results from earlier studies carried out by the researchers encouraged them to compare the electrical stimulation therapy they developed with what’s commonly used to rehabilitate stroke survivors. Specifically, they wanted to determine which one is more effective for patients who are over six months past their stroke.
For the study, the researchers worked with 80 stroke survivors, half of which were administered the new electrical stimulation therapy and the other half provided with the common therapy. Hand function in all the subjects were also assessed before and after the therapy with a standard dexterity test involving moving blocks across a barrier within 60 seconds.
Based on their findings, the researchers saw that those who were on the receiving end of the new electrical stimulation therapy had better dexterity test scores (4.6 blocks) compared to the group that was given the common therapy (1.8 blocks). Additionally, those with no finger movement in the new therapy group prior to the study showed arm movement improvements.
At the end of the study, 97 percent of subjects from the new therapy group said that they have better usage in their affected hand than before the experiment began.
Aside from registering better treatment results, the study was also able to demonstrate that self-administered home therapy can be effective for stroke survivors.
“The more therapy a patient can get the better potential outcome they will get,” said Jayme Knutson, Ph.D., the study’s senior author.
Knutson is joined by John Chae, M.D., Richard Wilson, M.D. and Douglas Gunzler, Ph.D. in the study.
For their next step, the researchers are looking at carrying out a multi-site study not only to confirm results from the study but also to measure improvements in quality of life experienced by stroke survivors using the new electrical stimulation method.
THURSDAY, Sept. 8, 2016
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That’s what Irish motivational speaker Mark Pollock says when he agrees to a proposal or signs off of a conversation. But for Pollock, who’s been blind for 16 years and paralyzed from the waist down since 2010, “good stuff” doesn’t even begin to capture his feelings about being “Iron ElectriRx Man” in a robotics lab at UCLA.
In the spring of 2014, Pollock became the first subject in an experiment that set out to meld electrical stimulation therapy with a robotic exoskeleton that in effect walks for paralyzed patients. The study’s aim: to help those with spinal cord injuries learn to walk again.
A fall from a second-story window caused Pollock’s catastrophic spinal cord injury in 2010, and doctors told him any return of sensation or function below his waist was out of the question. Pollock took the news with the same combination of acceptance and defiance that led him to participate in endurance trials and adventure races across some of Earth’s harshest terrain, including the South Pole.
He would learn to make a meaningful life using a wheelchair. But he also resolved to “keep the paralyzed bits in good enough shape that I’d be ready for any innovation that came down the track,” he said.
When Pollock first arrived at UCLA, he had nearly four years of aggressive rehabilitation under his belt and had mastered the use of a battery-powered bionic suit, called an Ekso. The sensors and motors on the robotic exoskeleton are programmed to detect how much “help” a patient is capable of giving, and then to do the rest of the stepping.
Pollock’s injury was so extensive — broken bones had nicked and pierced his spinal cord in two places — that he was, essentially, a passenger in the Ekso.
That was about to change. In the lab of V. Reggie Edgerton, a neuromuscular researcher at UCLA, therapists attached electrical patches to the skin over Pollock’s spinal cord. Over the course of a week, he got five hours of electrical stimulation.
After that, when Pollock strapped on the Ekso, “it felt like I was moving up to the ‘sport’ version of the device,” he said.
His heart rate increased. He felt perspiration burst from his brow. And he felt another sensation he had missed for four years: tension in his legs, which turned to tingling as his limbs “joined in with the movement” of the Ekso, he said.
He could walk up to his fiancee and hug her. He could engage others from an active, standing position. The tension in his hips eased. His legs felt looser, and his digestion improved.
“It felt, like, right,” said Pollock, who has since returned to his native Dublin, continues his rehabilitation with the Ekso and serves on the Christopher and Dana Reeve Foundation. “It felt like it used to feel.”
Edgerton, who described Pollock’s case last week in Milan, Italy, at a meeting of the world’s largest international society of biomedical engineers, said the electrical stimulation to the spinal cord appears to reawaken neurons there. Once abuzz, those spinal neurons seem to recognize sensations sent up by the moving lower limbs and respond by ordering muscles to pitch in to aid the movement.
Even if the brain is out of the loop, the spinal cord appears to retain some of the “automaticity” that allows people with full motor function to initiate and make movements with little to no conscious effort, Edgerton said.
“After the injury there’s a lot of functional capability that remains,” Edgerton said. “But it has to do some relearning” — a process that appears to get a jump-start from electrical stimulation, he added.
By providing the legs with a natural stepping movement, the Ekso essentially reminds the spinal cord what walking “feels” like. And as the spinal cord responds by initiating muscle movement, the Ekso’s sensors and motors adjust to provide less stepping power.
Challenged to do more, the reawakened spinal cord neurons may continue to relearn their old ways — to a point.
“We think the future in robotics and rehabilitation is that the device will assist but will not completely take over,” Edgerton said. “The robot will do less and less and the subject will do more and more.
”Whether that process leads a paralyzed patient to walk again depends on the extent and location of the spinal cord injury, Edgerton said. “If they practice and regain 50% of control, that’s highly significant,” he said.
The work on Pollock’s case was published by the IEEE Engineering in Medicine and Biolog
[ ARTICLE] Neuroplasticity in post-stroke gait recovery and noninvasive brain stimulation – Full Text PDF
Gait disorders drastically affect the quality of life of stroke survivors, making post-stroke rehabilitation an important research focus. Noninvasive brain stimulation has potential in facilitating neuroplasticity and improving post-stroke gait impairment. However, a large inter-individual variability in the response to noninvasive brain stimulation interventions has been increasingly recognized. We first review the neurophysiology of human gait and post-stroke neuroplasticity for gait recovery, and then discuss how noninvasive brain stimulation techniques could be utilized to enhance gait recovery. While post-stroke neuroplasticity for gait recovery is characterized by use-dependent plasticity, it evolves over time, is idiosyncratic, and may develop maladaptive elements. Furthermore, noninvasive brain stimulation has limited reach capability and is facilitative-only in nature. Therefore, we recommend that noninvasive brain stimulation be used adjunctively with rehabilitation training and other concurrent neuroplasticity facilitation techniques. Additionally, when noninvasive brain stimulation is applied for the rehabilitation of gait impairment in stroke survivors, stimulation montages should be customized according to the specific types of neuroplasticity found in each individual. This could be done using multiple mapping techniques.
The American Heart Association estimates that approximately 795,000 individuals in the United States have a stroke each year (Go et al., 2014). A lack of mobility is the main obstacle for stroke survivors seeking to regain daily living independence and social integration. Thus, restoring impaired gait is one of the major goals of post-stroke rehabilitation. Recently, traditional rehabilitation techniques have been augmented by the use of a new methodology, noninvasive brain stimulation (NIBS), which facilitates neuroplasticity. To better understand the use of NIBS, this paper reviews literature regarding the neurophysiology of human gait, poststroke neuroplasticity in the motor control system underlying gait, and finally, approaches for using NIBS to enhance gait recovery.
Neurophysiology of Human Gait
Involvement of the cerebral cortices: In functional neuroimaging studies of human walking, the premotor cortex (PMC) and the supplementary motor cortex (SMC) are activated prior to step onset (Huppert et al., 2013). However, lesions in these two areas often lead to problems with gait initiation and the negotiation of narrow passages (Jahn et al., 2004), indicating their importance in the initiation and planning of walking. Furthermore, corticospinal inputs significantly facilitate muscular responses in the lower limbs, especially during the swing phase of the step cycle (Pijnappels et al., 1998). These observations suggest that cortical outputs play a critical role in the modulation of lower limb locomotion…