Posts Tagged Functional electrical stimulation (FES)

[VIDEO] Testing Functional Electrical Stimulation (FES) – YouTube

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[Abstract] A three-site clinical investigation and feasibility study of a flexible functional electrical stimulation system to support functional task practice for upper limb recovery in people with stroke.

Introduction: Of those people who survive a stroke, only between 40% and 70% regain upper limb dexterity. A number of reviews have suggested that functional electrical stimulation (FES) may have a beneficial effect on upper limb motor recovery. In light of the promise offered by FES and the limitations with current systems a new system was developed (FES-UPP) to support people with stroke (PwS) to practice a range of voluntary controlled, FES-assisted functional activities.

Objective: This paper reports on a three centre clinical investigation with the primary aim of demonstrating compliance of the new FES system with relevant essential requirements of the EU Medical Device Directive, namely to evaluate whether use of the FES-UPP enables PwS to perform a wider range of functional activities, and/or perform the same activities in an improved way.

Design: Clinical investigation and feasibility study

Settings: An in-patient stroke unit, a combined Early Supported Discharge (ESD) and community service, and an outpatient clinic and in-patient stroke unit.
Participants: Nine therapists and 22 PwS with an impaired upper limb.
Intervention: Every PwS was offered up to 8 sessions of FES-UPP therapy, each lasting approximately one hour, over a period of up to six weeks.
Primary and secondary outcome measures: The operation, acceptability and feasibility of the interventions were assessed using video rating and the Wolf Motor Function Test Functional Ability Scale (WMF-FAS), direct observations of sessions and questionnaires for therapists and PwS.

Results: The system enabled 24% (Rater A) and 28% (Rater B) of PwS to carry out a wider range of functional tasks and improved the way in which the tasks were performed (mean scores of 2.6 and 2.2 (with FES) versus mean scores 1.5 and 1.3 (without FES) (p<.05).

Conclusion: The FES-UP proved feasible to use in three different clinical environments, with PwS who varied widely in their impairment levels and time since stroke. Therapists and therapy assistants from a wide range of backgrounds, with varying degrees of computer and/or FES knowledge, were able to use the system without on-site technical support.

via Frontiers | A three-site clinical investigation and feasibility study of a flexible functional electrical stimulation system to support functional task practice for upper limb recovery in people with stroke. | Neurology

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[Abstract + References] Synergy-Based FES for Post-Stroke Rehabilitation of Upper-Limb Motor Functions

Abstract

Functional electrical stimulation (FES) is capable of activating muscles that are under-recruited in neurological diseases, such as stroke. Therefore, FES provides a promising technology for assisting upper-limb motor functions in rehabilitation following stroke. However, the full benefits of FES may be limited due to lack of a systematic approach to formulate the pattern of stimulation. Our preliminary work demonstrated that it is feasible to use muscle synergy to guide the generation of FES patterns.In this paper, we present a methodology of formulating FES patterns based on muscle synergies of a normal subject using a programmable multi-channel FES device. The effectiveness of the synergy-based FES was tested in two sets of experiments. In experiment one, the instantaneous effects of FES to improve movement kinematics were tested in three patients post ischemic stroke. Patients performed frontal reaching and lateral reaching tasks, which involved coordinated movements in the elbow and shoulder joints. The FES pattern was adjusted in amplitude and time profile for each subject in each task. In experiment two, a 5-day session of intervention using synergy-based FES was delivered to another three patients, in which patients performed task-oriented training in the same reaching movements in one-hour-per-day dose. The outcome of the short-term intervention was measured by changes in Fugl–Meyer scores and movement kinematics. Results on instantaneous effects showed that FES assistance was effective to increase the peak hand velocity in both or one of the tasks. In short-term intervention, evaluations prior to and post intervention showed improvements in both Fugl–Meyer scores and movement kinematics. The muscle synergy of patients also tended to evolve towards that of the normal subject. These results provide promising evidence of benefits using synergy-based FES for upper-limb rehabilitation following stroke. This is the first step towards a clinical protocol of applying FES as therapeutic intervention in stroke rehabilitation.

I. Introduction

Muscle activation during movement is commonly disrupted due to neural injuries from stroke. A major challenge for stroke rehabilitation is to re-establish the normal ways of muscle activation through a general restoration of motor control, otherwise impairments may be compensated by the motor system through a substitution strategy of task control [1]. In post-stroke intervention, new technologies such as neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES) offer advantages for non-invasively targeting specific groups of muscles [2]–[4] to restore the pattern of muscle activation. Nevertheless, their effectiveness is limited by lack of a systematic methodology to optimize the stimulation pattern, to implement the optimal strategy in clinical settings, and to design a protocol of training towards the goal of restoring motor functions. This pioneer study addresses these issues in clinical application with a non-invasive FES technology.

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34. R. S. Razavian, B. Ghannadi, N. Mehrabi, M. Charlet, and J. McPhee, “Feedback control of functional electrical stimulation for 2-D arm reaching movements,” IEEE Trans. Neural Syst. Rehabil. Eng., vol. 26, no. 10, pp. 2033–2043, Oct. 2018.

35. C. M. Niu, C. Zhuang, Y. Bao, S. Li, N. Lan, and Q. Xie, “Synergy-based NMES intervention accelerated rehabilitation of post-stroke hemiparesis,” in Proc. Assoc. Acad. Physiatrists Annu. Conf., Las Vegas, NV, USA, 2017.

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38. T. Wang, “Customization of synergy-based FES for post-stroke rehabilitation of upper-limb motor functions,” in Proc. IEEE 40th Annu. Int. Conf. Eng. Med. Biol. Soc. (EMBS), Jul. 2018, 3541–3544.

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[WEB SITE] Technology helps stroke patients get moving again

Electronic devices are helping stroke patients walk and move their hands again.
Provided

Electronic devices are helping stroke patients walk and move their hands again.

This may bode well for the 20 percent of survivors that have foot drop, and 87 percent of stroke survivors that have lost the use of their hands.

When a person has a stroke, multiple sclerosis or brain injury, most of the neurons that help signal muscles to move are broken. This keeps the brain from being able to send signals to certain muscle groups telling them to move.

A stroke, for example, can destroy millions of brain cells that you need to tie your shoes, pick up a grandchild or reach into your closet. To gain lost function, rehabilitation used to focus on teaching patients how to compensate for their physical deficits.

Today, research shows that neural plasticity (the ability of the brain to repair itself) can be applied effectively for improved outcomes and enhanced functional abilities.

To do this successfully, the central nervous system must seek other neural pathways and find new connections that bypass the damaged areas. With a little help from functional electrical stimulation (FES), which is low energy electrical pulses, the process to find the new connections is a bit easier.

New electrical orthotics target muscles with FES and can help accelerate muscle-nerve recovery. The electronic orthosis and its control unit transmit synchronized electric pulses to the peripheral nerves through electrodes built into the orthosis — these pulses are driven in precise sequence and accurately activate five muscles in the forearm.

“Muscles relearn when electrical stimulation provides feedback to the brain that can facilitate neuro re-education and promote neuroplasticity, which is the ability of the central nervous system to remodel itself,” says physical therapist Imelda Ungos, director of rehabilitation for Melbourne Terrace, a facility that specializes in the active and aging population. “And patients can learn a better way to function just by having new input, regardless of age.”

Ungos reports that the ultimate goal with this method of therapy is to restore voluntary movement. Patients with a history of brain lesions, such as stroke conditions and movement disorders, may have the most to gain with the neuro-orthotics and the rehab to learn how to use them.

“The latest therapy equipment from Bioness can drive the brain to new connections, and newer technology and techniques encourage the neuronal changes necessary for improved function,” says Ungos. “This kind of therapy is very specialized, and we’re the only sub-acute facility in the Space Coast area with the Bioness FES technologies,” says Ungos.

For improved hand function, the orthosis fits to the forearm and wrist, and communicates wirelessly with the control unit. Inside the orthosis, electrodes deliver mild pulses to stimulate muscle contraction.

The level of stimulation can be adjusted toward each function. With an intuitive interface, clinicians are better able to help their patients obtain simple control of desired hand activation.

The wireless device is portable and allows for quick detection of the best electrode position for each individual. A control unit enables easy programming of functional modes and training regimens.

For patients with poor safety and balance due to foot drop, which is the inability to lift the foot during walking, there’s an electronic orthosis that fits below the knee. The unit has stimulating electrodes placed over the correct nerve and fits below the knee. A heel sensor sends a muscle-contracting signal during the correct step phase to enable the foot to lift.

After the initial custom fitting of the orthosis, patients can enhance their abilities to perform daily activities, and the carry-over results from continued use will improve voluntary movement.

Ungos adds that the other benefits of interacting with the device include a reduction in muscle spasm, an increase in range of motion, and improved blood circulation. “That all goes towards retarding disuse atrophy,” she says.

“Efforts must be directed towards preventing complications and learning how to use affected limb along with active rehabilitation… especially when the use is started early in post stroke rehabilitation,” says online Bioness reports from Harold Weingarden, MD, Director of Rehabilitation Day Hospital Sheba Medical Center in Israel.

“An early start to rehab gives patients hope of what is possible in terms of present and future improvement,” says Ungos. She adds that the devices allow patients to move in more natural ways.

Feeling “normal” again can improve mood, function, and quality of life.

For more information, call Melbourne Terrace Rehabilitation Center at 321-725-3990. They offer comprehensive rehabilitative outpatient and inpatient services for short or long term care located at 251 East Florida Ave., Melbourne, FL 32901

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[VIDEO] What is Functional Electrical Stimulation Billy Woods from Active Linx – YouTube

Functional Electrical Stimulation (FES) is an innovation in the field of muscle stimulation, which allows people with a complete spinal cord injury and paralyzed muscles to move again. It can be combined with a BerkelBike or EasyLegs. The technology allows patients with a spinal cord injury to bike using their own leg muscles.

 

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[VIDEO] Kid getting treatment with foot drop system – YouTube

Slow motion shot of a child receiving treatment with functional electrical stimulation. He wearing foot drop system

 

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[Abstract] sEMG Bias-driven Functional Electrical Stimulation System for Upper Limb Stroke Rehabilitation

Abstract:

It is evident that the dominant therapy of functional electrical stimulation (FES) for stroke rehabilitation suffers from heavy dependency on therapists experience and lack of feedback from patients status, which decrease the patients’ voluntary participation, reducing the rehabilitation efficacy. This paper proposes a closed loop FES system using surface electromyography (sEMG) bias feedback from bilateral arms for enhancing upper-limb stroke rehabilitation. This wireless portable system consists of sEMG data acquisition and FES modules, the former is used to measure and analyze the subject’s bilateral arm motion intention and neuromuscular states in terms of their sEMG, the latter of multi-channel FES output is controlled via the sEMG bias of the bilateral arms. The system has been evaluated with experiments proving that the system can achieve 39.9 dB signal-to-noise ratio (SNR) in the lab environment, outperforming existing similar systems. The results also show that voluntary and active participation can be effectively employed to achieve different FES intensity for FES-assisted hand motions, demonstrating the potential for active stroke rehabilitation.
Published in: IEEE Sensors Journal ( Early Access ) Date of Publication: 18 June 2018

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[ARTICLE] Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke – Full Text

Abstract

Brain-computer interfaces (BCI) are used in stroke rehabilitation to translate brain signals into intended movements of the paralyzed limb. However, the efficacy and mechanisms of BCI-based therapies remain unclear. Here we show that BCI coupled to functional electrical stimulation (FES) elicits significant, clinically relevant, and lasting motor recovery in chronic stroke survivors more effectively than sham FES. Such recovery is associated to quantitative signatures of functional neuroplasticity. BCI patients exhibit a significant functional recovery after the intervention, which remains 6–12 months after the end of therapy. Electroencephalography analysis pinpoints significant differences in favor of the BCI group, mainly consisting in an increase in functional connectivity between motor areas in the affected hemisphere. This increase is significantly correlated with functional improvement. Results illustrate how a BCI–FES therapy can drive significant functional recovery and purposeful plasticity thanks to contingent activation of body natural efferent and afferent pathways.

Introduction

Despite considerable efforts over the last decades, the quest for novel treatments for arm functional recovery after stroke remains a priority1. Synergistic efforts in neural engineering and restoration medicine are demonstrating how neuroprosthetic approaches can control devices and ultimately restore body function2,3,4,5,6,7. In particular, non-invasive brain-computer interfaces (BCI) are reaching their technological maturity8,9 and translate neural activity into meaningful outputs that might drive activity-dependent neuroplasticity and functional motor recovery10,11,12. BCI implies learning to modify the neuronal activity through progressive practice with contingent feedback and reward —sharing its neurobiological basis with rehabilitation13.

Most attempts to use non-invasive BCI systems for upper limb rehabilitation after stroke have coupled them with other interventions, although not all trials reported clinical benefits. The majority of these studies are case reports of patients who operated a BCI to control either rehabilitation robots14,15,16,17,18,19 or functional electrical stimulation (FES)20,21,22,23. A few works have described changes in functional magnetic resonance imaging (fMRI) that correlate with motor improvements17,18,22.

Recent controlled trials have shown the potential benefit of BCI-based therapies24,25,26,27. Pichiorri et al.26recruited 28 subacute patients and studied the efficacy of motor imagery with or without BCI support via visual feedback, reporting a significant and clinically relevant functional recovery for the BCI group. As a step forward in the design of multimodal interventions, BCI-aided robotic therapies yielded significantly greater motor gains than robotic therapies alone24,25,27. In the first study, involving 30 chronic patients24, only the BCI group exhibited a functional improvement. In the second study, involving 14 subacute and chronic patients, both groups improved, probably reflecting the larger variance in subacute patients’ recovery and a milder disability25. The last study27 showed that in a mixed population of 74 subacute and chronic patients, the percentage of patients who achieved minimally clinical important difference in upper limb functionality was higher in the BCI group. The effect in favor of the BCI group was only evident in the sub-population of chronic patients. Moreover, the conclusions of this study are limited due to differences between experimental and control groups prior to the intervention, such as number of patients and FMA-UE scores, which were always in favor of the BCI group.

In spite of promising results achieved so far, BCI-based stroke rehabilitation is still a young field where different works report variable clinical outcomes. Furthermore, the efficacy and mechanisms of BCI-based therapies remain largely unclear. We hypothesize that, for BCI to boost beneficial functional activity-dependent plasticity able to attain clinically important outcomes, the basic premise is contingency between suitable motor-related cortical activity and rich afferent feedback. Our approach is designed to deliver associated contingent feedback that is not only functionally meaningful (e.g., via virtual reality or passive movement of the paretic limb by a robot), but also tailored to reorganize the targeted neural circuits by providing rich sensory inputs via the natural afferent pathways28, so as to activate all spare components of the central nervous system involved in motor control. FES fulfills these two properties of feedback contingent on appropriate patterns of neural activity; it elicits functional movements and conveys proprioceptive and somatosensory information, in particular via massive recruitment of Golgi tendon organs and muscle spindle feedback circuits. Moreover, several studies suggest that FES has an impact on cortical excitability29,30.

To test our hypothesis, this study assessed whether BCI-actuated FES therapy targeting the extension of the affected hand (BCI–FES) could yield stronger and clinically relevant functional recovery than sham-FES therapy for chronic stroke patients with a moderate-to-severe disability, and whether signatures of functional neuroplasticity would be associated with motor improvement. Whenever the BCI decoded a hand-extension attempt, it activated FES of the extensor digitorum communis muscle that elicited a full extension of the wrist and fingers. Patients in the sham-FES group wore identical hardware and received identical instructions as BCI–FES patients, but FES was delivered randomly and not driven by neural activity.

As hypothesized, our results confirm that only the BCI group exhibit a significant functional recovery after the intervention, which is retained 6–12 months after the end of therapy. Besides the main clinical findings, we have also attempted to shed light on possible mechanisms underlying the proposed intervention. Specifically, electroencephalography (EEG) imaging pinpoint significant differences in favor of the BCI group, mainly an increase in functional connectivity between motor areas in the affected hemisphere. This increase is significantly correlated with functional improvement. Furthermore, analysis of the therapeutic sessions substantiates that contingency between motor-related brain activity and FES occurs only in the BCI group and contingency-based metrics correlate with the functional improvement and increase in functional connectivity, suggesting that our BCI intervention might have promoted activity-dependent plasticity.[…]

Continue —> Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke | Nature Communications

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[WEB SITE] Electrically Stimulating the Brain May Restore Movement After Stroke

Findings Suggest Potential for Brain Implants to Treat Stroke Patients

UC San Francisco scientists have improved mobility in rats that had experienced debilitating strokes by using electrical stimulation to restore a distinctive pattern of brain cell activity associated with efficient movement. The researchers say they plan to use the new findings to help develop brain implants that might one day restore motor function in human stroke patients.

After a stroke, roughly one-third of patients recover fully, one-third have significant lingering movement problems, and one-third remain virtually paralyzed, said senior author Karunesh Ganguly, MD, PhD, associate professor of neurology and a member of the UCSF Weill Institute for Neurosciences. Even patients who experience partial recovery often continue to struggle with “goal-directed” movements of the arms and hands, such as reaching and manipulating objects, which can be crucial in the workplace and in daily living.

Headshot of Karunesh Ganguly, MD, PhD, associate professor of neurology, study's senior author.
Karunesh Ganguly, MD, PhD, associate professor of neurology, study’s senior author.

 

“Our main impetus was to understand how we can develop implantable neurotechnology to help stroke patients,” said Ganguly, who conducts research at the San Francisco VA Health Care System. “There’s an enormous field growing around the idea of neural implants that can help neural circuits recover and improve function. We were interested in trying to understand the circuit properties of an injured brain relative to a healthy brain and to use this information to tailor neural implants to improve motor function after stroke.”

Over the past 20 years, neuroscientists have presented evidence that coordinated patterns of neural activity known as oscillations are important for efficient brain function.  More recently, low-frequency oscillations (LFOs)—which were first identified in studies of sleep—have been specifically found to help organize the firing of neurons in the brain’s primary motor cortex. The motor cortex controls voluntary movement, and LFOs chunking the cells’ activity together to ensure that goal-directed movements are smooth and efficient.

In the new study, published in the June 18, 2018 issue of Nature Medicine, the researchers first measured neural activity in rats while the animals reached out to grab a small food pellet, a task designed to emulate human goal-directed movements. They detected LFOs immediately before and during the action, which inspired the researchers to investigate how these activity patterns might change after stroke and during recovery.

To explore these questions, they caused a stroke in the rats that impaired the animals’ movement ability, and found that LFOs diminished. In rats that were able to recover, gradually making faster and more precise movements, the LFOs also returned. There was a strong correlation between recovery of function and the reemergence of LFOs: animals that fully recovered had stronger low-frequency activity than those that partially recovered, and those that didn’t recover had virtually no low-frequency activity at all.

To try to boost recovery, the researchers used electrodes to both record activity and to deliver a mild electrical current to the rats’ brains, stimulating the area immediately surrounding the center of the stroke damage. This stimulation consistently enhanced LFOs in the damaged area and appeared to improve motor function: when the researchers delivered a burst of electricity right before a rat made a movement, the rat was up to 60 percent more accurate at reaching and grasping for a food pellet.

“Interestingly, we observed this augmentation of LFOs only on the trials where stimulation was applied,” said Tanuj Gulati, PhD, a postdoctoral researcher in the Ganguly lab who is co-first author of the study, along with Dhakshin Ramanathan, MD, PhD, now assistant professor of psychiatry at UC San Diego, and Ling Guo, a neuroscience graduate student at UCSF.

“We are not creating a new frequency, we are amplifying the existing frequency,” added Ganguly. “By amplifying the weak low-frequency oscillations, we are able to help organize the task-related neural activity. When we delivered the electrical current in step with their intended actions, motor control actually got better.”

The researchers wanted to know whether their findings might also apply to humans, so they analyzed recordings made from the surface of the brain of an epilepsy patient who had suffered a stroke that had impaired the patient’s arm and hand movements. The recordings revealed significantly fewer LFOs than recordings made in two epilepsy patients who hadn’t had a stroke. These findings suggest that, just like in rats, the stroke had caused a loss of low-frequency activity that impaired the patient’s movement.

Physical therapy is the only treatment currently available to aid stroke patients in their recovery. It can help people who are able to recover neurologically get back to being fully functional more quickly, but not those whose stroke damage is too extensive. Ganguly hopes that electrical brain stimulation can offer a much-needed alternative for these latter patients, helping their brain circuits to gain better control of motor neurons that are still functional. Electrical brain stimulation is already widely used to help patients with Parkinson’s disease and epilepsy, and Ganguly believes stroke patients may be the next to benefit.

Other UCSF contributors to the work included Gray Davidson; April Hishinuma; Seok-Joon Won, PhD, associate adjunct professor of neurology; Edward Chang, MD, professor of neurosurgery and William K. Bowes Jr. Biomedical Investigator; and Raymond Swanson, MD, professor of neurology. They were joined by Robert T. Knight, MD, professor of psychology and neuroscience at UC Berkeley.

The research was supported in part by funding from the National Institute of Neurological Disorders and Stroke; the National Institute of Mental Health; the Agency for Science, Technology, and Research (A*STAR), in Singapore; the U.S. Department of Veterans Affairs, and the Burroughs Wellcome Fund.

 

via Electrically Stimulating the Brain May Restore Movement After Stroke | UC San Francisco

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[VIDEO] Functional electrical stimulation after stroke – YouTube

Published on Jan 25, 2018

After a stroke, patients may no longer be able to correctly perform simple everyday movements, such as drinking from a glass.
Drinking is still realized as a task, but the impulse sent to the brain is not sufficient to trigger the proper movement.
This process can be practiced with functional electrical stimulation to improve motion sequences on a long-term basis.
The EMG function of the STIWELL electrostimulator measures and enhances the patient’s motion impulse to enable successful movement. Multi-channel electrical impulses support motion control.
For more than 20 years STIWELL has leased and sold electrostimulation devices to provide comprehensive therapy after stroke and other neurological diseases. For more information please visit http://www.stiwell.com/
This video is for demonstration purposes only. The products, applications and performance characteristics are subject to approval by the responsible national authorities. Not all components may be available in your country or provided by MED-EL for sale in your country.
© MED-EL, technical realization: https://zeitraum.com/

 

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