Posts Tagged Functional electrical stimulation

[Abstract] Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation

Abstract:

Hybrid rehabilitation robotics combine neuro-prosthetic devices (close-loop functional electrical stimulation systems) and traditional robotic structures and actuators to explore better therapies and promote a more efficient motor function recovery or compensation. Although hybrid robotics and ankle neuroprostheses (NPs) have been widely developed over the last years, there are just few studies on the use of NPs to electrically control both ankle flexion and extension to promote ankle recovery and improved gait patterns in paretic limbs. The aim of this work is to develop an ankle NP specifically designed to work in the field of hybrid robotics. This article presents early steps towards this goal and makes a brief review about motor NPs and Functional Electrical Stimulation (FES) principles and most common devices used to aid the ankle functioning during the gait cycle. It also shows a current sources analysis done in this framework, in order to choose the best one for this intended application.

Source: Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation – IEEE Xplore Document

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[ARTICLE] Robot Assisted Training for the Upper Limb after Stroke (RATULS): study protocol for a randomised controlled trial – Full Text

Abstract

Background

Loss of arm function is a common and distressing consequence of stroke. We describe the protocol for a pragmatic, multicentre randomised controlled trial to determine whether robot-assisted training improves upper limb function following stroke.

Methods/design

Study design: a pragmatic, three-arm, multicentre randomised controlled trial, economic analysis and process evaluation.

Setting: NHS stroke services.

Participants: adults with acute or chronic first-ever stroke (1 week to 5 years post stroke) causing moderate to severe upper limb functional limitation.

Randomisation groups:

1. Robot-assisted training using the InMotion robotic gym system for 45 min, three times/week for 12 weeks

2. Enhanced upper limb therapy for 45 min, three times/week for 12 weeks

3. Usual NHS care in accordance with local clinical practice

Randomisation: individual participant randomisation stratified by centre, time since stroke, and severity of upper limb impairment.

Primary outcome: upper limb function measured by the Action Research Arm Test (ARAT) at 3 months post randomisation.

Secondary outcomes: upper limb impairment (Fugl-Meyer Test), activities of daily living (Barthel ADL Index), quality of life (Stroke Impact Scale, EQ-5D-5L), resource use, cost per quality-adjusted life year and adverse events, at 3 and 6 months.

Blinding: outcomes are undertaken by blinded assessors.

Economic analysis: micro-costing and economic evaluation of interventions compared to usual NHS care. A within-trial analysis, with an economic model will be used to extrapolate longer-term costs and outcomes.

Process evaluation: semi-structured interviews with participants and professionals to seek their views and experiences of the rehabilitation that they have received or provided, and factors affecting the implementation of the trial.

Sample size: allowing for 10% attrition, 720 participants provide 80% power to detect a 15% difference in successful outcome between each of the treatment pairs. Successful outcome definition: baseline ARAT 0–7 must improve by 3 or more points; baseline ARAT 8–13 improve by 4 or more points; baseline ARAT 14–19 improve by 5 or more points; baseline ARAT 20–39 improve by 6 or more points.

Discussion

The results from this trial will determine whether robot-assisted training improves upper limb function post stroke.

Background

Stroke is the commonest cause of complex adult disability in high-income countries [1]. Loss of arm function affects 69% of people who have a stroke [2]. Only 12% of people with arm weakness at the onset of stroke make a full recovery [3]. Improving arm function has been identified as a research priority by stroke survivors, carers and health professionals who report that current rehabilitation pays insufficient attention to arm recovery [4].

Robot-assisted training enables a greater number of repetitive tasks to be practised in a consistent and controllable manner. Repetitive task training is known to drive Hebbian plasticity, where wiring of pathways that are coincidently active is strengthened [5, 6]. A dose of greater than 20 h of repetitive task training improves upper limb motor recovery following a stroke [7] and, therefore, robot-assisted training has the potential to improve arm motor recovery after stroke. We anticipate that Hebbian neuroplasticity, which is learning dependent, will operate regardless of the post-stroke phase.

A Cochrane systematic review of electromechanical and robot-assisted arm training after stroke reported outcomes from a total of 1160 patients who participated in 34 randomised controlled trials (RCTs). Improvements in arm function (standardised mean difference (SMD) 0.35, 95% confidence interval (CI), 0.18–0.51) and activities of daily living (SMD 0.37, 95% CI, 0.11–0.64) were found in patients who received this treatment, but studies were often of low quality [8]. In the UK there is currently insufficient evidence to justify the use of this technology in routine clinical practice.

In addition, studies which suggest that robot-assisted training may improve upper limb function after stroke should be treated with caution as participants who were randomised to receive robot-assisted training may have also received an increased intensity of rehabilitation sessions (e.g. frequency or duration) compared to participants in the control groups. Greater intensity of upper limb rehabilitation sessions has been shown to improve upper limb functional outcomes [7], and a meta-analysis of robot-assisted training RCTs reported that if control group therapy sessions were delivered at the same frequency and duration, there was no additional functional improvement [9]. Studies are required which provide further direct evidence of the effectiveness of robot-assisted training without the confounding effect of therapy dose.

The aim of the Robot Assisted Training for the Upper Limb after Stroke (RATULS) trial is to evaluate the clinical and cost-effectiveness of robot-assisted training compared to an upper limb therapy programme of the same frequency and duration, and usual post-stroke care.

The null hypothesis is that there is no difference in upper limb function at 3 months between study participants who receive robot-assisted training and those who receive an enhanced upper limb therapy programme and those who receive usual post-stroke care. The RATULS trial will be making comparisons of the effectiveness of rehabilitation on upper limb function between all three pairs of trial arms.

Source: Robot Assisted Training for the Upper Limb after Stroke (RATULS): study protocol for a randomised controlled trial | Trials | Full Text

 

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[BLOG POST] Foot Drop Implants Market Analysis and Forecasts 2025

Foot drop can be defined as an abnormality in the gait where the forefoot drops due to factors such as weakness of the ankle and toe dorsiflexion. The abnormality is also caused by paralysis of the muscles in the anterior portion of the lower leg or damage to the fibular nerve. Foot drop can be associated with various conditions, including peripheral nerve injuries, neuropathies, drug toxicities, dorsiflexor injuries, and diabetes. Anatomic, muscular, and neurologic are the three categories of foot drop.

Functional electrical stimulation technology is employed in the foot drop implant to improve the gait of patients and avoid foot drop or tripping while walking. Functional electric stimulators (FES) can either be implanted within the patient’s body or employed externally. External FES is tested on the patient prior to its implantation. Implant FES involves a surgery in which the electrodes are directly placed on the nerves of the patient, which are controlled by the implant placed under the skin. The FES device activates the implant through a wireless antenna that is worn outside the body. Sensors are also associated with FES which trigger events in the walking pattern such as lifting of the heel, thereby stimulating the nerves.

The advantages of implant FES include reduction in sensation that is associated with external stimulation. In addition, it eliminates the need to adjust the electrodes on the skin on a daily basis. Rise in number of foot drop disorders due to nerve injuries, growth in knee and hip replacement therapies that lead to foot drop disorders, and increase in the number of sports related injuries contribute to the growth of the foot drop implants market. Foot drop disorders are commonly observed in diabetic retinopathy patients and this prevalence is growing due to increase in incidence of diabetes, which is propelling the growth of the market. Furthermore, the market players are focus on research and development to increase the number of foot drop implant products available in the market, driving the market growth. However, lack of reimbursement, high cost of the implants, and low awareness among the people are likely to hinder the growth of the foot drop implants market in the near future.

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The global foot drop implants market can be segmented on the basis of product, end-user, and region. On the basis of product, the market is categorized into functional electrical stimulators and internal fixation devices. The internal fixation devices segment is anticipated to record a significant growth during the forecast period owing to increasing demand for the devices and advantages offered by these devices such as elimination of the need to stimulate the electrodes daily. Based on end-user, the market can be segmented into hospitals, orthopedic centers, and palliative care centers, among others. The orthopedic centers segment is anticipated to record a high growth during the forecast period due to the increasing number of foot drop cases due to injuries.

Geographically, the foot drop implants market is distributed over North America, Latin America, Europe, Asia Pacific, and Middle East & Africa. North America dominated the market in 2016 and is anticipated to continue its dominance during the forecast period. The significant growth of the market in the region can be attributed to the strong focus on research and development, increase in health care spending, and growth in awareness about the abnormality. The sluggish economy might have a negative impact on the market growth of Europe. Asia Pacific is anticipated to record a high CAGR during the forecast period, primarily driven by India and China. The rising disposable income is anticipated to contribute to the growth of the Asia Pacific market. In addition, a factor contributing to the market growth is rise in prevalence of diabetes that leads to diabetic retinopathy, which is one of the primary causes of foot drop.

View Report @ http://www.transparencymarketresearch.com/foot-drop-implants-market.html

Key players operating in the foot drop implants market include Finetech Medical, Arthrex, Inc., Zimmer Biomet, Bioness Inc., Stryker Corporation, Wright Medical Group N.V., Ottobock, Narang Medical Limited, PONTiS Orthopaedics, LLC, and Shanghai MicroPort Orthopedics.

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Source: Foot Drop Implants Market Analysis and Forecasts 2025 | Medgadget

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[ARTICLE] Neural Plasticity in Moderate to Severe Chronic Stroke Following a Device-Assisted Task-Specific Arm/Hand Intervention – Full Text

Currently, hand rehabilitation following stroke tends to focus on mildly impaired individuals, partially due to the inability for severely impaired subjects to sufficiently use the paretic hand. Device-assisted interventions offer a means to include this more severe population and show promising behavioral results. However, the ability for this population to demonstrate neural plasticity, a crucial factor in functional recovery following effective post-stroke interventions, remains unclear. This study aimed to investigate neural changes related to hand function induced by a device-assisted task-specific intervention in individuals with moderate to severe chronic stroke (upper extremity Fugl-Meyer < 30). We examined functional cortical reorganization related to paretic hand opening and gray matter (GM) structural changes using a multimodal imaging approach. Individuals demonstrated a shift in cortical activity related to hand opening from the contralesional to the ipsilesional hemisphere following the intervention. This was driven by decreased activity in contralesional primary sensorimotor cortex and increased activity in ipsilesional secondary motor cortex. Additionally, subjects displayed increased GM density in ipsilesional primary sensorimotor cortex and decreased GM density in contralesional primary sensorimotor cortex. These findings suggest that despite moderate to severe chronic impairments, post-stroke participants maintain ability to show cortical reorganization and GM structural changes following a device-assisted task-specific arm/hand intervention. These changes are similar as those reported in post-stroke individuals with mild impairment, suggesting that residual neural plasticity in more severely impaired individuals may have the potential to support improved hand function.

Introduction

Nearly 800,000 people experience a new or recurrent stroke each year in the US (1). Popular therapies, such as constraint-induced movement therapy (CIMT), utilize intense task-specific practice of the affected limb to improve arm/hand function in acute and chronic stroke with mild impairments (2, 3). Neuroimaging results partially attribute the effectiveness of these arm/hand interventions to cortical reorganization in the ipsilesional hemisphere following training in acute and mild chronic stroke (4). Unfortunately, CIMT requires certain remaining functionality in the paretic hand to execute the tasks, and only about 10% of screened patients are eligible (5), thus disqualifying a large population of individuals with moderate to severe impairments. Recently, studies using device-assisted task-specific interventions specifically targeted toward moderate to severe chronic stroke reported positive clinical results (68). However, these studies primarily focus on clinical measures, but it is widely accepted that neural plasticity is a key factor for determining outcome (911). Consequently, it remains unclear whether moderate to severe chronic stroke [upper extremity Fugl-Meyer Assessment (UEFMA) < 30] maintains the ability to demonstrate neural changes following an arm/hand intervention.

Neural changes induced by task-specific training have been investigated widely using animal models (12). For instance, monkeys or rodents trained on a skilled reach-to-grasp task express enlarged representation of the digits of the hand or forelimb in primary motor cortex (M1) following training as measured by intracortical microstimulation (13, 14). Additionally, rapid local structural changes in the form of dendritic growth, axonal sprouting, myelination, and synaptogenesis occur (1518). Importantly, both cortical and structural reorganization corresponds to motor recovery following rehabilitative training in these animals (19, 20).

The functional neural mechanisms underlying effective task-specific arm/hand interventions in acute and chronic stroke subjects with mild impairments support those seen in the animal literature described above. Several variations of task-specific combined arm/hand interventions, including CIMT, bilateral task-specific training, and hand-specific robot-assisted practice, have shown cortical reorganization such as increased sensorimotor activity and enlarged motor maps in the ipsilesional hemisphere related to the paretic arm/hand (2124). These results suggest increased recruitment of residual resources from the ipsilesional hemisphere and/or decreased recruitment of contralesional resources following training. Although the evidence for a pattern of intervention-driven structural changes remains unclear in humans, several groups have shown increases in gray matter (GM) density in sensorimotor cortices (25), along with increases in fractional anisotropy in ipsilesional corticospinal tract (CST) (26) following task-specific training in acute and chronic stroke individuals with mild impairments.

The extensive nature of neural damage in moderate to severe chronic stroke may result in compensatory mechanisms, such as contralesional or secondary motor area recruitment (27). These individuals show increased contralesional activity when moving their paretic arm, which correlates with impairment (28, 29) and may be related to the extent of damage to the ipsilesional CST (30). This suggests that more impaired individuals may increasingly rely on contralesional corticobulbar tracts such as the corticoreticulospinal tract to activate the paretic limb (29). These tracts lack comparable resolution and innervation to the distal parts of the limb, thus sacrificing functionality at the paretic arm/hand (31). Since this population is largely ignored in current arm/hand interventions, it is unknown whether an arm/hand intervention for these more severely impaired post-stroke individuals will increase recruitment of residual ipsilesional corticospinal resources. These ipsilesional CSTs maintain the primary control of hand and finger extensor muscles (32) and are thus crucial for improved hand function. Task-specific training assisted by a device may reengage and strengthen residual ipsilesional corticospinal resources by training distal hand opening together with overall arm use.

The current study seeks to determine whether individuals with moderate to severe chronic stroke maintain the ability to show cortical reorganization and/or structural changes alongside behavioral improvement following a task-specific intervention. We hypothesize that following a device-assisted task-specific intervention, moderate to severe chronic stroke individuals will show similar functional and structural changes as observed in mildly impaired individuals, demonstrated by (i) a shift in cortical activity related to paretic hand opening from the contralesional hemisphere toward the ipsilesional hemisphere and (ii) an increase in GM density in sensorimotor cortices in the ipsilesional hemisphere.[…]

Continue —> Frontiers | Neural Plasticity in Moderate to Severe Chronic Stroke Following a Device-Assisted Task-Specific Arm/Hand Intervention | Neurology

Figure 5. Statistical maps of gray matter (GM) density changes across all patients. Significant increases (red/yellow) and decreases (Blue) in GM density are depicted on sagittal, coronal, and axial sections (left to right) on Montreal Neurological Institute T1 slices. Sections show the maximum effect on (A) ipsilesioned M1/S1, (B) contralesional M1/S1, and (C) ipsilesional thalamus. Les indicates the side of the lesioned hemisphere. Color maps indicate the t values at every voxel. A statistical threshold was set at p < 0.001 uncorrected.

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[VIDEO] Ottobock ActiGait Explained Functional Electrical Stimulation FES – YouTube

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[WEB SITE] Restorative Therapies, Inc. Offers Expanded Options for RT300 at Home Functional Electrical Stimulation Cycling

Restorative Therapies, Inc. advances its new era in physical and occupational therapy systems for neurological injury and paralysis, announcing new options for home-based use of the groundbreaking RT300 functional electrical stimulation (FES) cycling system.

(PRWEB) June 05, 2017

FES is a physical and occupational therapy modality used to evoke functional movements and exercise not otherwise possible for individuals with a neurological impairment such as a spinal cord injury, stroke, multiple sclerosis, cerebral palsy, brain injury or transverse myelitis.

Restorative Therapies is the developer of FES medical devices for clinic and at home activity-based therapies. RT300 FES cycle is the result of Restorative Therapies’ ongoing commitment to the research and development of FES powered physical and occupational therapy systems. RT300 is the FES cycle chosen by all leading neurological rehabilitation clinics. RT300 has been used by over 65,000 individuals with neurological impairments.

RT300 is available for home use with an entry level system starting at $10,995. This 6 channel leg and trunk FES system includes multiple therapy options including standard, isokinetic and interval therapies and access to our FES therapy database RTILink.com which tracks outcomes motivating patients. RT300 is also unique in being easily expanded to include arms, additional channels of FES and ability to target any impaired leg, arm, shoulder or trunk muscle group.

Many people can also benefit from the use of FES separate from cycling, as a therapy for functional activities such as standing, transfers, feeding, brushing hair etc. Restorative Therapies’ new Xcite system evokes coordinated muscle contractions to assist with a wide range of task specific, strengthening and gross motor activities. RT300 home systems are expanding to include Xcite at home so patients can benefit not only from cycling but also these other activities.

Restorative Therapies’ commitment to RT300 home use is supported by our acclaimed insurance reimbursement process and dedicated clinical and technical support teams.

“Very impressed with the ownership Restorative Therapies took of the insurance appeal process. Meredith our installer was wonderful during the install process and I appreciate her knowledge and patience,” said Maryann Murphy, RT300 at home rider. “The quality of RT300 is excellent and the user manuals and website are very helpful. I had an excellent experience with Restorative Therapies and I appreciate the resources and customer support that I have access to as a customer.”

“RT300 is the most practical FES cycle because its flexibility and expandability allow it to cater to the varied needs of people with a neurological injury or paralysis. Reaching over 65,000 individuals is the result of a huge team effort between Restorative Therapies and our clinic partners,” says Andrew Barriskill, CEO of Restorative Therapies. “Together we have worked to make RT300 easy to use at home. Our new entry level systems with important therapy options including Xcite will help us assist more people with neurological impairments at home.”

“The continued growth of home FES cycling is enormously motivating to me and my team,” said Wendy Warfield MSHA, OTR/L, Clinical Manager of Restorative Therapies. “This level of at-home FES use completes the continuum of care for people with weak or paralyzed muscles due to a variety of conditions, diseases, and events,” concludes Warfield.

About Restorative Therapies
Restorative Therapies’ mission is to help people with a neurological impairment or in critical care achieve their full recovery potential. Restorative Therapies combines activity-based physical therapy and Functional Electrical Stimulation as a rehabilitation therapy for those with impaired mobility associated with conditions including but not limited to stroke, multiple sclerosis, cerebral palsy, brain injury, transverse myelitis, and spinal cord injury or for patients in critical care.

Restorative Therapies is a privately held company headquartered in Baltimore. To learn more about Restorative Therapies please visit us at http://www.restorative-therapies.com 

For the original version on PRWeb visit: http://www.prweb.com/releases/2017/06/prweb14388936.htm

Source: Restorative Therapies, Inc. Offers Expanded Options for RT300 at Home Functional Electrical Stimulation Cycling | Benzinga

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[Abstract] A motor rehabilitation BCI with multi-modal feedback in chronic stroke patients (P5.300)

ABSTRACT

Objective: Apply BCI technology to improve stroke rehabilitation therapy

Background: Brain-computer interfaces (BCI) measure brain activity to generate control signals for external devices in real-time. BCIs are especially well suited for motor rehabilitation. Motor imagery BCIs can analyze patients’ sensorimotor regions and control conditionally gated feedback devices that allow the patient to regain motor functions.

Design/Methods: Patients with sub-acute stroke were trained for 25 30-minute sessions in which they imagined left or right hand movement. A computer avatar indicated which hand the patient should imagine moving (80 trials left hand; 80 trials right). The BCI system analyzed EEG in real time, deciphered intention for left or right hand movement, and triggered functional electrical stimulation that elicited movement in the corresponding hand and in the computer avatar only when the patient produced the correct corresponding EEG pattern. Motor function improvements were assessed with a 9-hole PEG test.

Results: In a chronic stroke patient the 9-hole PEG test showed an improvement in affected left hand movement from 1 min 30 seconds to 52 sec after 24 training sessions (healthy right hand: 26 sec). BCI accuracy increased from 70% to 98.5 % across sessions. Mean accuracy for the first 3 sessions was 81%; 88% for the last 3. Before training, the patient could not lift his affected arm. After training the patient could reach his mouth to feed himself.

Conclusions: BCI accuracy is an objective marker of a patient’s participation in the task; 50% means that patient doesn’t follow (or cannot follow) the task. This patient’s continued improvement and high final accuracy indicates motivated participation. Most importantly, there was objective improvement in motor function within only 25 training sessions. We attribute these results to the conditionally gated reward from the BCI (inducing Hebbian plasticity), and mirror neuron system activation by the avatar.

Disclosure: Dr. Guger has received personal compensation for activities with g.tec Medical Engineering GmbH as an employee. Dr. Coon has nothing to disclose. Dr. Swift has nothing to disclose.

Source: A motor rehabilitation BCI with multi-modal feedback in chronic stroke patients (P5.300)

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[VIDEO] Difference Between EMS Electrical Muscle Stimulation and TENS – YouTube

TENS vs EMS: the main difference between the two: TENS stimulates the nerves – the rationale being that the simulation keeps pain signals from reaching the brain. EMS causes the muscles to contract – by mimicking the action potential that comes from the central nervous system.Muscle Stimulation EMS stands for electronic muscle stimulation. These units are designed to provide relief by stimulating the muscles …Transcutaneous Electrical Nerve Stimulators (TENS) use electrotherapy to stimulate the nerves and active therapeutic healing. Electronic Muscle Stimulators (EMS), on the other hand, sends electric impulses that cause muscle contraction.EMS, or Electrical Muscle Stimulation, is the use of electrical pulses to generate a muscle contraction. EMS is typically used to enhance muscle …Neuromuscular Electrical Stimulation for Skeletal Muscle Function … nerve stimulation (TENS), and functional electrical stimulation (FES). ….. withdrawal of ES are present across different types of applications, such as …EMS (Electrical Muscle Stimulation) vs TENS. EMS or Electrical Muscle Stimulation, which is also referred to as neuromuscular electrical …The biggest difference between TENS and EMS is that TENS is designed to stimulate … The electrical muscle stimulation of an EMS device induces muscle …A TENS unit stimulates the nerve endings while the EMS unit stimulates the muscles. Amazingly enough, electrical stimulation of the nerves dates back to ancient Rome … pain reduction begins to last longer and the time between sessions lengthens. … The EMS units are specifically used to prevent atrophied muscles or for …Whether looking for a tool to boost your fitness and strength or recover from an injury quickly, electric muscle stimulation (EMS or NMES) can …

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[WEB SITE] Stroke rehabilitation device lets the patient do the shocking

 

When a person’s arm has become paralyzed due to a stroke, therapists often try to get it moving again using what’s known as functional electrical stimulation – this involves delivering electric shocks to the arm, causing its muscles to move. Studies have shown, however, that it works better when the patient is in charge of delivering those shocks themselves. A new device lets them do so, and it has met with promising results.

The system was developed by Intento, a company affiliated with Switzerland’s EPFL research institute. It consists of three parts: electrodes that the patient places on their arm, a controller that is operated by their “good” hand, and a tablet running custom software.

The therapist starts by selecting a desired arm movement on the tablet, and then loading it into the controller. A display on the tablet’s screen then shows the patient where the electrodes should be placed. Once those are attached, the patient sets about using the controller to deliver shocks to their arm muscles, resulting in the targeted movement – this could be something like pressing a button or picking up an object.

Ideally, once the action has been repeated enough times, the muscles will be “trained” and it will be possible for the patient to perform the movement without any external stimulation.

In a clinical trial performed at Lausanne University Hospital, 11 severely stroke-paralyzed patients – for whom other therapies hadn’t worked – used for the device for 1.5-hour daily sessions, over a course of 10 days. A claimed 70 percent of them subsequently “showed a significant improvement in their motor functions,” as opposed to just 30 percent who were undergoing conventional occupational therapy.

A larger clinical study is now being planned, after which the device will hopefully be commercialized. The research is described in a paper that was recently published in the journal Archives of Physical Medicine and Rehabilitation.

Source: EPFL

Source: Stroke rehabilitation device lets the patient do the shocking

 

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[BLOG POST] Stroke, MS patients walk significantly better with neural stimulation

Robert Bush has multiple sclerosis (MS), which sapped his ability to walk five years ago. Joseph McGlynn suffered a stroke that seriously impaired his left side, also five years ago.

Using technology designed by Case Western Reserve University and the Advanced Platform Technology and Functional Electrical Stimulation centers at the Louis Stokes Cleveland Veterans Affairs Medical Center, the two men got their feet back under them.

Two studies, published in the American Journal of Physical Medicine and Rehabilitation, show that functional electrical stimulation (FES) significantly helped McGlynn and Bush to effectively walk at the medical center.

“I went in there and I could barely take two steps,” said Bush, 42, who researchers believe is the world’s first MS patient to “test-drive” an implanted FES system. The proof-of-feasibility test lasted 90 days. “At the end,” said Bush, of Columbus, Ohio, “I was walking down the hallway. To me, it was monumental.” A video of him walking with and without the system can be found at: https://youtu.be/17JYaKkdRYs.

McGlynn, 69, of North Royalton, Ohio, could walk with a cane, but not easily. With the technology switched on, he covered far more ground and his pace was twice as fast during his 30-week study.

“It’s helped with balance and confidence,” said McGlynn, who used to tread a lot of stairs maintaining equipment at a steel plant. “I’m confident now that I can walk without stumbling and falling.” A video of him walking with and without aid of the system can be found here: https://youtu.be/3CYq-FSFQLM.

Nathan Makowski, an investigator at the Cleveland FES Center, created by Case Western Reserve and the Cleveland VA, said that FES technology has been used primarily for therapy in stroke patients in the past. “This, though, is a more long-term assistive system,” he said.

Addressing needs

The researchers hope these studies will lay the foundation for implanted systems that restore some independence to people with MS or who have suffered a stroke.

Their numbers are substantial. The National Multiple Sclerosis Society estimates that more than 2.3 million people have the disease worldwide. Surveys have found that 93 percent suffer gait impairment within 10 years of diagnosis and 13 percent report they are unable to walk twice a week. Other research has found that 6 million to 7 million people live with stroke nationally and nearly 30 percent require assistance to walk.

“In both cases, there is a disconnect between the brain and muscles,” said Stephen Selkirk, MD, a neurologist at the VA’s Spinal Cord Injury Division and assistant professor of neurology at Case Western Reserve School of Medicine. “This system replaces the lost connection.”

The system includes implanted electrodes that tie into nerves that control muscles collectively, called hip and knee flexors and ankle dorsoflexors. In healthy people, the muscles work in seamless coordination each step they take.

When Bush or McGlynn walks, he pushes a button on an external controller, which sends signals to a pulse generator, which then sends electrical pulses to the electrodes. The pulses stimulate the nerves, which in turn stimulate the muscles in both of Bush’s legs and McGlynn’s left leg.

“Both guys were taking steps the first time we turned the systems on,” said Ron Triolo, a professor of orthopaedics and biomedical engineering at Case Western Reserve and executive director of the Advanced Platform Technology (APT) Center. “When Robert Bush took a step, it wasn’t’ pretty, but we saw the potential.”

In each patient, “the pulses are sent in a pattern that is close to how normal muscles work,” said Rudi Kobetic, a principal investigator at the Stokes Cleveland VA and APT Center. “We try to time the pattern to stimulation so that it’s integrated with their ability. Similar to regular physical therapy, we can see results.”

Significant improvement

Both men gained strength and endurance through repeated use of the systems and fine-tuning by the researchers.

Bush went from the two steps to consistently walking more than 30 yards during the trial. In that time, he used a walker to help maintain his balance.

“When they turned it on the first time, I was surprised how well it worked,” said Bush, who had to give up his construction career due to the disease. “I lifted my knee like I was high-stepping. Once we got it fine-tuned and I got walking, I thought it was amazing. I still think it’s amazing.”

McGlynn’s gait became noticeably more symmetrical and energetic, the researchers said. His gait without the system was about 19 yards per minute; with the system, 47 yards per minute. Training with the system improved McGlynn’s speed when it was turned off to 23 yards per minute, indicating therapeutic benefit.

“Distance is a challenge,” he said. Initially, he could walk 83 yards but improved to 1,550 yards–nearly a mile–at the faster gait. “I work up a good sweat and that makes me feel good,” he said.

Due to his improvements, the research team is developing a system that McGlynn can use at home and outside.

“I’ll be able to walk for exercise and hopefully be able to walk into church and into a restaurant,” McGlynn said.

When Bush’s trial ended, surgeons removed his implanted electrodes. The researchers are seeking funding to fit him with a permanent FES system in a clinical trial.

In the meantime, Bush is now back to using a wheelchair but working to maintain his strength and flexibility, repeatedly standing and sitting while holding onto a rail or standing for long periods of time. “I’m keeping things ready for when they get the green light,” he said.

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Other researchers who contributed to the two studies are the APT Center’s Lisa Lombardo, physical therapist; Kevin Foglyano, biomedical engineer; and Gilles Pinault, MD, a surgeon and co-director of the center.

Source: Stroke, MS patients walk significantly better with neural stimulation | EurekAlert! Science News

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