Posts Tagged functional electric stimulation (FES)

[Abstract] Gait rehabilitation using functional electrical stimulation induces changes in ankle muscle coordination in stroke survivors: a preliminary study

Background: Previous studies have demonstrated that post-stroke gait rehabilitation combining functional electrical stimulation applied to the ankle muscles during fast treadmill walking (FastFES) improves gait biomechanics and clinical walking function. However, there is considerable inter-individual variability in response to FastFES. Although FastFES aims to sculpt ankle muscle coordination, whether changes in ankle muscle activity underlie observed gait improvements is unknown. The aim of this study was to investigate three cases illustrating how FastFES modulates ankle muscle recruitment during walking.

Methods: We conducted a preliminary case series study on three individuals (53-70y; 2M; 35-60 months post-stroke; 19-22 lower extremity Fugl-Meyer) who participated in 18 sessions of FastFES (3 sessions/week; NCT01668602). Clinical walking function (speed, six-minute walk test, and Timed-Up-and-Go test), gait biomechanics (paretic propulsion and ankle angle at initial-contact), and plantarflexor (soleus) / dorsiflexor (tibialis anterior) muscle recruitment were assessed pre- and post-FastFES while walking without stimulation.
Results: Two participants (R1, R2) were categorized as responders based on improvements in clinical walking function. Consistent with heterogeneity of clinical and biomechanical changes commonly observed following gait rehabilitation, how muscle activity was altered with FastFES differed between responders.R1 exhibited improved plantarflexor recruitment during stance accompanied by increased paretic propulsion. R2 exhibited improved dorsiflexor recruitment during swing accompanied by improved paretic ankle angle at initial-contact. In contrast, the third participant (NR1), classified as a non-responder, demonstrated increased ankle muscle activity during inappropriate phases of the gait cycle. Across all participants, there was a positive relationship between increased walking speeds after FastFES and reduced SOL/TA muscle coactivation.
Conclusion: Our preliminary case series study is the first to demonstrate that improvements in ankle plantarflexor and dorsiflexor muscle recruitment (muscles targeted by FastFES) accompanied improvements in gait biomechanics and walking function following FastFES in individuals post-stroke. Our results also suggest that inducing more appropriate (i.e., reduced) ankle plantar/dorsi-flexor muscle coactivation may be an important neuromuscular mechanism underlying improvements in gait function after FastFES training, suggesting that pre-treatment ankle muscle status could be used for inclusion into FastFES. The findings of this case-series study, albeit preliminary, provide the rationale and foundations for larger-sample studies using similar methodology.


via Frontiers | Gait rehabilitation using functional electrical stimulation induces changes in ankle muscle coordination in stroke survivors: a preliminary study | Neurology

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[ARTICLE] Improving Hand Function of Severely Impaired Chronic Hemiparetic Stroke Individuals Using Task-Specific Training With the ReIn-Hand System: A Case Series – Full Text


Purpose: In this study, we explored whether improved hand function is possible in poststroke chronic hemiparetic individuals with severe upper limb motor impairments when they participate in device-aided task-specific practice.

Subjects: Eight participants suffering from chronic stroke (>1-year poststroke, mean: 11.2 years) with severely impaired upper extremity movement (Upper Extremity Subscale of the Fugl-Meyer Motor Assessment (UEFMA) score between 10 and 24) participated in this study.

Methods: Subjects were recruited to participate in a 20-session intervention (3 sessions/7 weeks). During each session, participants performed 20–30 trials of reaching, grasping, retrieving, and releasing a jar with the assistance of a novel electromyography-driven functional electrical stimulation (EMG-FES) system.

This EMG-FES system allows for Reliable and Intuitive use of the Hand (called ReIn-Hand device) during multi-joint arm movements. Pre-, post-, and 3-month follow-up outcome assessments included the UEFMA, Cherokee McMaster Stroke Assessment, grip dynamometry, Box and Blocks Test (BBT), goniometric assessment of active and passive ranges of motion (ROMs) of the wrist and the metacarpophalangeal flexion and extension (II, V fingers), Nottingham Sensory Assessment–Stereognosis portion (NSA), and Cutaneous Sensory Touch Threshold Assessment.

Results: A nonparametric Friedman test of differences found significant changes in the BBT scores (χ2 = 10.38, p < 0.05), the passive and active ROMs (χ2 = 11.31, p < 0.05 and χ2 = 12.45, p < 0.01, respectively), and the NSA scores (χ2 = 6.42, p < 0.05) following a multi-session intervention using the ReIn-Hand device.

Conclusions: These results suggest that using the ReIn-Hand device during reaching and grasping activities may contribute to improvements in gross motor function and sensation (stereognosis) in individuals with chronic severe UE motor impairment following stroke.


Stroke is the second most common cause of mortality and the third most common cause of disability worldwide (12). More than two-thirds of people who have had a stroke have difficulties with arm function, which contributes considerably in limiting the ability to perform activities of daily living (ADLs) (34). Though various studies have reported positive outcomes following multiple types of interventions in more mildly impaired individuals (56), regaining hand function in individuals with moderate-to-severe impairments still remains a challenge. This is largely due to impairments, such as the loss of volitional finger extension (78), muscle coactivation (7), involuntary coupling of wrist and finger flexion with certain shoulder and elbow movements (9), and somatosensory deficits (10).

Several studies have suggested that repetitive task-specific training can improve upper extremity (UE) function (1114) in mildly impaired stroke survivors when the practice is functionally relevant and of sufficient intensity. Intervention-induced gains have been reported for up to 6 months after intervention (15). In particular, interventions focusing on reach and grasp movements have been shown to be relevant because these movements are essential for ADLs and are viewed by subjects as high priority rehabilitative goals (1617). This approach has often been used in individuals in both the acute and subacute stage (1820) and with mild-to-moderate impairments after stroke (61821).

There is limited research targeting chronic stroke individuals with severely impaired UE. These individuals are less able to participate in task-specific training because of minimal volitional activation of the impaired arm (16). Furthermore, during ADLs, concurrent use of hand and arm are required. However, the presence of the flexion synergy after stroke (2224), coupled with shoulder abduction with elbow/wrist and fingers flexion (9), decreases the ability to generate volitional or functional electrical stimulation (FES)-assisted finger extension while lifting against gravity (2526). This creates a major challenge to rehabilitation clinicians and limits opportunities for this population to participate in programs focused on hand recovery (16).

The purpose of this study is to determine the effect of device-assisted task-specific training on hand motor function and sensation (stereognosis and cutaneous sensory touch threshold) in individuals with chronic stroke and severe UE impairment. An electromyography-driven functional electrical stimulation (EMG-FES) with an intelligent detection software that detects the hand opening intention even with the presence of flexion synergies was used to assist the hand opening while subjects were performing required reaching and grasping tasks. We expected that by training a functional activity that involves arm-lifting, reaching and grasping, retrieving and releasing, poststroke participants with severely impaired UE would improve their arm/hand motor function and sensation.

Some parts of the results from various assessments [i.e., pre- to post-changes in an active range of motion (AROM) and Box and Blocks Test (BBT)] have been briefly reported in a previous publication (27) that focused on brain plasticity introduced by this ReIn-Hand assisted reaching and grasping intervention. Compared to the previous publication, this paper provides a complete overall report on various intervention-induced clinical changes.[…]


Continue —> Frontiers | Improving Hand Function of Severely Impaired Chronic Hemiparetic Stroke Individuals Using Task-Specific Training With the ReIn-Hand System: A Case Series | Neurology

Figure 1. Rein-Hand device and the experimental set up. FES parameters: Amplitude sufficient for maximal hand opening without discomfort, biphasic waveform, frequency 50 Hz ± 20%, and 300 μs pulse width, and duration time 3 s. Adapted from Wilkins et al. (27).

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