Posts Tagged Functional electrical stimulation
[ARTICLE] Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot – Full Text
Central drop foot is a common problem in patients with stroke or multiple sclerosis (MS). For decades, it has been treated with orthotic devices, keeping the ankle in a fixed position. It has been shown recently that semi-implantable functional electrical stimulation (siFES) of the peroneal nerve can lead to a greater gait velocity increase than orthotic devices immediately after being switched on. Little is known, however, about long-term outcomes over 12 months, and the relationship between quality of life (QoL) and gait speed using siFES has never been reported applying a validated tool. We provide here a report of short (3 months) and long-term (12 months) outcomes for gait speed and QoL.
Forty-five consecutive patients (91% chronic stroke, 9% MS) with central drop foot received siFES (Actigait®). A 10 m walking test was carried out on day 1 of stimulation (T1), in stimulation ON and OFF conditions, and repeated after 3 (T2) and 12 (T3) months. A 36-item Short Form questionnaire was applied at all three time points.
We found a main effect of stimulation on both maximum (p < 0.001) and comfortable gait velocity (p < 0.001) and a main effect of time (p = 0.015) only on maximum gait velocity. There were no significant interactions. Mean maximum gait velocity across the three assessment time points was 0.13 m/s greater with stimulation ON than OFF, and mean comfortable gait velocity was 0.083 m/s faster with stimulation ON than OFF. The increase in maximum gait velocity over time was 0.096 m/s, with post hoc testing revealing a significant increase from T1 to T2 (p = 0.012), which was maintained but not significantly further increased at T3. QoL scores showed a main effect of time (p < 0.001), with post hoc testing revealing an increase from T1 to T2 (p < 0.001), which was maintained at T3 (p < 0.001). Finally, overall absolute QoL scores correlated with the absolute maximum and comfortable gait speeds at T2 and T3, and the increase in overall QoL scores correlated with the increase in comfortable gait velocity from T1 to T3. Pain was reduced at T2 (p < 0.001) and was independent of gait speed but correlated with overall QoL (p < 0.001).
Peroneal siFES increased maximal and comfortable gait velocity and QoL, with the greatest increase in both over the first three months, which was maintained at one year, suggesting that 3 months is an adequate follow-up time. Pain after 3 months correlated with QoL and was independent of gait velocity, suggesting pain as an independent outcome measure in siFES for drop foot.
Drop foot is a common symptom in patients suffering from first motor neuron lesions, such as due to stroke and multiple sclerosis (MS). It is characterized by impaired lifting of the forefoot from the ground during the swing phase of walking and by a lack of stability during the early stance phase. Drop foot results in an altered gait pattern  and increased risk of falls . Application of an ankle foot orthosis (AFO) is the traditional approach to improving gait pattern and reducing falls. However, it is not well-tolerated in all patients . In recent years, gait improvement has been achieved using functional electrical stimulation (FES) [1, 10, 16, 23, 25], which combines the orthotic benefits of an AFO with a more physiological approach that involves muscle contraction and the related sensory feedback [10, 25]. Transcutaneous FES (tcFES) of the peroneal nerve has been associated with significantly reduced falls compared to intensive physiotherapy . Indeed, 69% of the falls in this FES group occurred when the system was not used. Moreover, a systematic review of FES in MS patients indicates increased gait speed using FES . Semi-implantable FES (siFES) of the peroneal nerve has been found to increase gait speed and improve gait patterns compared with a baseline without stimulation [6, 10, 17], compared to orthotic devices [1, 23], and also compared to tcFES . The findings of a systematic review, including predominantly chronic stroke patients, however, did not suggest a difference between tcFES and siFES in terms of walking speed . An implantable stimulator does, however, offer the advantage of avoiding the need for daily optimization of stimulator location  and potential skin lesions associated with surface stimulation electrodes. Moreover, the possibility of using a 4-channel implantable system, with independent control of each channel, means that the volume of tissue activated within the nerve can be individually selected, in order to optimize dorsiflexion of the foot while avoiding stimulation of the sensory fascicles of the common peroneal nerve . Here we retrospectively hypothesised that increases in gait speed are associated with improvements in quality of life (QoL). Furthermore, we assumed pain scores had improved under therapy and expected them to be related to the overall QoL, and we hypothesised that increased gait velocity would have resulted in improvement of both physical and emotional subscores of the QoL. To address these hypotheses, we evaluated improvement in gait velocity in the largest cohort of patients to date, with stimulation ON and OFF, at three time points over 1 year, to assess the short- and long-term effects of siFES, examining correlation between gait speed and QoL, as well as between changes in these factors, over a year of continuous treatment.
Most studies of implantable systems for stroke to date cover observation periods of 3 to 6 months post-surgery and suggest siFES provides a promising approach to managing drop foot. An increase in gait velocity and endurance, as well as an improvement in QoL, was observed 3–6 weeks post-operatively in a cohort of 27 patients receiving siFES . Trials applying tcFES, which has been available since the early seventies , have tended to employ standardized and stratified re-examination, with early and long-term follow-up periods, such as 6 and 12 weeks , 3 and 12 months , and 24 days and 3 years . A recent long-term multi-centre study applying siFES reported an improved gait pattern in a cohort of 10 stroke patients 6 months following siFES activation and in a separate cohort of 12 stroke patients 1 year after activation . Their findings suggested greater knee stability, ankle plantarflexion power, and propulsion than that provided by an AFO. Here, we examined both the short- and long-term effects of using multichannel peroneal siFES in the largest patient group thus far reported, including both stroke and MS patients. The independent association between slow gait velocity and an increased risk of falls  renders gait velocity a valid surrogate parameter for the orthotic functionality of devices aiming to improve the limitations of drop foot. We aimed to investigate whether gait velocity improvements translate into QoL changes. Long-term follow-up (one year or longer) has been reported for large cohorts (more than 20 patients) using tcFES [25, 28], and for a smaller cohort (N = 12) using siFES . Long-term follow-up in a large cohort of patients receiving siFES and evaluating QoL has not yet been reported. The particular strengths of the current study are the large cohort, the inclusion of short- and long-term follow-up, and the evaluation of QoL and its correlation with gait speed.[…]
Functional Electrical Stimulation (FES): Best and latest treatment for Neurological rehabilitation/ Physiotherapy
FES is a technique that utilizes patterned electrical stimulation of neural tissue with the purpose of restoring or enhancing a lost or diminished function. It produces contractions in paralysed muscles by the application of small pulses of electrical stimulation to nerves that supply the paralysed muscle. The stimulation is controlled in such a way that the movement produced provides useful function.
FES is used as a tool to assist walking and also as a means of practicing various functional movements for therapeutic benefit. FES may be used to replace the natural electrical signals from the brain, helping the weak or paralyzed limbs move again. With continued stimulation over time, the brain may even be able to recapture and relearn this movement without the stimulation.
Use of “FES (Functional Electrical Stimulation) System India” for treatment of Foot Drop due to Hemiplegia. FES is a novel device for treatment/ rehabilitation of Neurological diseases. FES System India has many applications like
- Sit to stand training
- Pre Gait Training
- Correction of Foot Drop,
Correction of Circumductory Gait
for Paraplegia (Incomplete SCI) using FES unit on both sides
Shoulder subluxation and shoulder rehabilitation
Hand Function (Grasp and release)
This novel treatment is useful for all type of UMN disorders like hemiplegia (Cerebro Vascular Accident, Head Injury, Traumatic Brain injury, Brain tumor ), multiple scerosis, cerebral palsy, incomplete paraplegia etc.
contact “FES Center India” to buy FES System.
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Combo video including patients participating in contralaterally controlled FES therapy followed by a patient performing a grasp-release test before CCFES therapy and the same patient performing the same test after 12 weeks of CCFES therapy. All patients were participating in research studies at MetroHealth Medical Center in Cleveland.
PhysioFunction are recognised as international experts in the use of Functional Electrical Stimulation (FES). We ensure our clients receive the most clinically correct rehabilitation technology suited to their needs. Jon Graham, Clinical Director at PhysioFunction talks about Foot Drop and Functional Electrical Stimulation.
Functional electrical stimulation is a biophysical technology that have seen increased use in the management of neurological disorders. This talk will discuss principles of use with specific therapeutic cases and would be of primary interest to occupational and physical therapists. The participant will develop skills necessary to choose appropriately and apply electrotherapy in the rehabilitation setting. Various new technologies using electrotherapy will also be demonstrated.
[Abstract] The comparative efficacy of theta burst stimulation or functional electrical stimulation when combined with physical therapy after stroke: a randomized controlled trial
Objective: To study the long-term effectiveness of Theta Burst Stimulation (TBS) or Functional Electrical Stimulation (FES) combined with Physical therapy (PT) as compared to PT alone for improving arm functions in patients with acute stroke.
Interventions: 60 patients were randomized into three groups of 20 each: TBS+PT; FES+PT; and PT alone. TBS group received intermittent TBS of ipsilesional hemisphere and continuous TBS of contralesional hemisphere while FES group received FES of paretic limb, both for four weeks. All groups received supervised physical therapy for four weeks followed by home physiotherapy for one year.
Outcome measures: Fugl Meyer Assessment upper limb score (FMA-UL) was primary outcome measure. Patients were evaluated at baseline and subsequently at one, three and six months and one year.
Results: Compared to PT group, mean FMA-UL scores were higher in TBS and FES groups at all follow-ups (P < 0.001). From baseline to one year, mean (SD) FMA-UL scores increased from 14.9(2.1) to 55.55(2.46) in TBS group, 15.5(1.99) to 55.85(2.46) in FES group, and 14.3(2.2) to 43.3(4.22) in PT group indicating an increase of 273%, 260%, and 203% respectively. There was no difference between FES and TBS groups.
via The comparative efficacy of theta burst stimulation or functional electrical stimulation when combined with physical therapy after stroke: a randomized controlled trial – Fayaz Khan, Chaturbhuj Rathore, Mahesh Kate, Josy Joy, George Zachariah, P C Vincent, Ravi Prasad Varma, Kurupath Radhakrishnan, 2019
[VIDEO] Split-Crank Functional Electrical Stimulation Cycling: An Adapting Admitting Rehabilitation Robot – YouTube
[ARTICLE] Speed-adaptive control of functional electrical stimulation for dropfoot correction – Full Text
Functional electrical stimulation is an important therapy technique for dropfoot correction. In order to achieve natural control, the parameter setting of FES should be associated with the activation of the tibialis anterior.
This study recruited nine healthy subjects and investigated the relations of walking speed with the onset timing and duration of tibialis anterior activation. Linear models were built for the walking speed with respect to these two parameters. Based on these models, the speed-adaptive onset timing and duration were applied in FES-assisted walking for nine healthy subjects and ten subjects with dropfoot. The kinematic performance of FES-assisted walking triggered by speed-adaptive stimulation were compared with those triggered by the heel-off event, and no-stimulation walking at different walking speeds.
Higher ankle dorsiflexion angle was observed in heel-off stimulation and speed-adaptive stimulation conditions than that in no-stimulation walking condition at all the speeds. For subjects with stroke, the ankle plantarflexion angle in speed-adaptive stimulation condition was similar to that in no-stimulation walking condition, and it was significant larger than that in heel-off stimulation condition at all speeds.
The improvement in ankle dorsiflexion without worsening ankle plantarflexion in speed-adaptive stimulation condition could be attributed to the appropriate stimulation timing and duration. These results provide evidence that the proposed stimulation system with speed-related parameters is more physiologically appropriate in dropfoot correction, and it may have great potential value in future clinical applications.
About three quarters of stroke survivors experience different levels of brain dysfunction and movement disorder , which result in lower living quality and limited ability in social activities . Of these subjects, 20% suffer from impaired motor function in the lower extremities. One of such impairments is dropfoot, which is characterized by poor ankle dorsiflexion during the swing phase and an inability to achieve heel strike at the initial contact [3, 4]. Abnormal gaits such as circumduction gait and abnormal foot clearance on the affected side are often found as a method of compensating for excessive hip abduction and pelvis elevation on the unaffected side . This results in gait asymmetry and slow walking speed .
Functional electrical stimulation was a representative intervention to correct dropfoot and Liberson et al. first introduced functional electrical stimulation (FES) to correct dropfoot for chronic hemiplegic subjects in the 1960s . An electrical charge is delivered via a pair of electrodes to activate the tibialis anterior (TA), which results in ankle dorsiflexion. Yan et al. applied two dual-channel stimulators to the quadriceps, hamstring, gastrocnemius, and TA to recover motor function of the lower extremities in an early stage after stroke . The stimulation was followed by a predetermined sequence of muscle activations that mimic a healthy gait cycle . The duration of stimulation was five seconds in Yan et al.’s study. However, subjects with different severities of impairment might have different walking speeds , which means that a fixed stimulation duration might not be able to account for different walking patterns.
Liberson et al. used the heel-off event detected by a footswitch to trigger the stimulation . However, the reliability of the footswitch controller was significantly reduced when subjects who dragged their feet during walking encountered a slope or an obstacle . Bhadra et al. proposed a manual switch to trigger stimulation as a walking aid for subjects with spinal cord injury (SCI) . However, manual control may distract subjects from maintaining balance and lead to an increased risk of falls [13, 14]. Furthermore, the cable between the control sensor and stimulator was inconvenient for walking .
Instead of a footswitch, Mansfield et al.  and Monaghan et al.  detected the heel event of the gait cycle in FES-assisted walking using an accelerometer and a uniaxial gyroscope, respectively. The commercially available product WalkAide also uses an accelerometer for this purpose . Electromyography (EMG) signal is also applied as a control source in FES-assisted walking for the detection of volitional intent of muscle . Yeom et al. amplified the EMG signal of the TA and modulated the stimulation intensity in proportion to the integrated EMG envelope. The electrical pulses are then sent to the common peroneal nerve for dropfoot correction .
In these studies, FES applied to the TA was mainly triggered by the heel-off event. However, this event occurs during the push-off phase and before TA activation . An earlier start of TA stimulation results in reduced ankle plantarflexion . Spaich et al. suggested implementing a constant time interval before the onset timing of TA stimulation to extend the push-off phase before the ankle dorsiflexion . Some studies have found that walking speed can affect the activation of TA [22, 23]. Shiavi et al. found that the duration of EMG activity decreased as speed increased . In Winter et al.’s study, the shape of the EMG patterns generally remained similar at the different walking speeds and the duration of EMG activity was closely related to the normalized stride time . Although the duration of TA activation changes with the walking speeds has been reported , the selection of speed-adaptive FES parameters for TA has not been investigated.
The objective of this study is to find a more physiologically appropriate FES design for dropfoot correction. Firstly, speed-related changes in onset timing and the duration of TA activation were examined. Next, linear models were built for the walking speed and time interval from the heel-off event to the onset timing of TA activation, as well as for the walking speed and the duration of the TA activation. The speed-adaptive stimulation (SAS) timing and duration were then calculated based on the two models and applied for FES-assisted walking. Finally, the performance of stimulation triggered by SAS, heel-off event (HOS) and no stimulation (NS) were compared during FES-assisted walking on both subjects with stroke and healthy subjects at different walking speeds.[…]
Community Regional Medical Center is currently part of the first study on the west coast working with a device that helps stimulate muscles when a patient is not able to do it themselves.
Smart Functional Electrical Stimulation System.
Treatment for foot drop patient.
It can be used when an upper motor neuron injury has caused a foot injury.
- – Multiple sclerosis (MS)
- – Stroke (CVA)
- – Incomplete spinal cord injury (SCI)
- – Cerebral palsy (CP)
- – Traumatic brain injury (TBI)