Posts Tagged Functional electrical stimulation

[WEB PAGE] Treatments for foot drop compared

 

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[Wikipedia audio article] Electrical stimulation

This is an audio version of the Wikipedia Article: https://en.wikipedia.org/wiki/Functio…

00:01:21 1 Principles

00:09:14 2 History

00:10:01 3 Common applications

00:10:11 3.1 Spinal cord injury

00:11:09 3.1.1 Walking in spinal cord injury

00:15:01 3.2 Stroke and upper limb recovery

00:16:21 3.3 Drop foot

00:18:08 3.4 Stroke

00:18:58 3.5 Multiple sclerosis

00:20:06 3.6 Cerebral palsy

00:21:07 3.7 National Institute for Health and Care Excellence Guidelines (NICE) (UK)

00:21:47 4 In popular culture

00:22:10 5 See also

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“I cannot teach anybody anything, I can only make them think.” – Socrates

SUMMARY 

Functional electrical stimulation (FES) is a technique that uses low-energy electrical pulses to artificially generate body movements in individuals who have been paralyzed due to injury to the central nervous system. More specifically, FES can be used to generate muscle contraction in otherwise paralyzed limbs to produce functions such as grasping, walking, bladder voiding and standing. This technology was originally used to develop neuroprostheses that were implemented to permanently substitute impaired functions in individuals with spinal cord injury (SCI), head injury, stroke and other neurological disorders. In other words, a person would use the device each time he or she wanted to generate a desired function. FES is sometimes also referred to as neuromuscular electrical stimulation (NMES).FES technology has been used to deliver therapies to retrain voluntary motor functions such as grasping, reaching and walking. In this embodiment, FES is used as a short-term therapy, the objective of which is restoration of voluntary function and not lifelong dependence on the FES device, hence the name functional electrical stimulation therapy, FES therapy (FET or FEST). In other words, the FEST is used as a short-term intervention to help the central nervous system of the person to re-learn how to execute impaired functions, instead of making the person dependent on neuroprostheses for the rest of her or his life.

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[VIDEO] Stroke Rehabilitation: Use of electrical stimulation to help arm and hand recovery

This video demonstrates how to use FES, Functional Electrical Stimulation, to engage the muscles of the arm to extend the fingers.

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[Abstract] Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke

Background. Upper-limb chronic stroke hemiplegia was once thought to persist because of disproportionate amounts of inhibition imposed from the contralesional on the ipsilesional hemisphere. Thus, one rehabilitation strategy involves discouraging engagement of the contralesional hemisphere by only engaging the impaired upper limb with intensive unilateral activities. However, this premise has recently been debated and has been shown to be task specific and/or apply only to a subset of the stroke population. Bilateral rehabilitation, conversely, engages both hemispheres and has been shown to benefit motor recovery. To determine what neurophysiological strategies bilateral therapies may engage, we compared the effects of a bilateral and unilateral based therapy using transcranial magnetic stimulation.

Methods. We adopted a peripheral electrical stimulation paradigm where participants received 1 session of bilateral contralaterally controlled functional electrical stimulation (CCFES) and 1 session of unilateral cyclic neuromuscular electrical stimulation (cNMES) in a repeated-measures design. In all, 15 chronic stroke participants with a wide range of motor impairments (upper extremity Fugl-Meyer score: 15 [severe] to 63 [mild]) underwent single 1-hour sessions of CCFES and cNMES. We measured whether CCFES and cNMES produced different effects on interhemispheric inhibition (IHI) to the ipsilesional hemisphere, ipsilesional corticospinal output, and ipsilateral corticospinal output originating from the contralesional hemisphere.

Results. CCFES reduced IHI and maintained ipsilesional output when compared with cNMES. We found no effect on ipsilateral output for either condition. Finally, the less-impaired participants demonstrated a greater increase in ipsilesional output following CCFES.

Conclusions. Our results suggest that bilateral therapies are capable of alleviating inhibition on the ipsilesional hemisphere and enhancing output to the paretic limb.

 

via Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke – David A. Cunningham, Jayme S. Knutson, Vishwanath Sankarasubramanian, Kelsey A. Potter-Baker, Andre G. Machado, Ela B. Plow, 2019

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[Abstract] Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke

Background. Upper-limb chronic stroke hemiplegia was once thought to persist because of disproportionate amounts of inhibition imposed from the contralesional on the ipsilesional hemisphere. Thus, one rehabilitation strategy involves discouraging engagement of the contralesional hemisphere by only engaging the impaired upper limb with intensive unilateral activities. However, this premise has recently been debated and has been shown to be task specific and/or apply only to a subset of the stroke population. Bilateral rehabilitation, conversely, engages both hemispheres and has been shown to benefit motor recovery. To determine what neurophysiological strategies bilateral therapies may engage, we compared the effects of a bilateral and unilateral based therapy using transcranial magnetic stimulation.

Methods. We adopted a peripheral electrical stimulation paradigm where participants received 1 session of bilateral contralaterally controlled functional electrical stimulation (CCFES) and 1 session of unilateral cyclic neuromuscular electrical stimulation (cNMES) in a repeated-measures design. In all, 15 chronic stroke participants with a wide range of motor impairments (upper extremity Fugl-Meyer score: 15 [severe] to 63 [mild]) underwent single 1-hour sessions of CCFES and cNMES. We measured whether CCFES and cNMES produced different effects on interhemispheric inhibition (IHI) to the ipsilesional hemisphere, ipsilesional corticospinal output, and ipsilateral corticospinal output originating from the contralesional hemisphere.

Results. CCFES reduced IHI and maintained ipsilesional output when compared with cNMES. We found no effect on ipsilateral output for either condition. Finally, the less-impaired participants demonstrated a greater increase in ipsilesional output following CCFES.

Conclusions. Our results suggest that bilateral therapies are capable of alleviating inhibition on the ipsilesional hemisphere and enhancing output to the paretic limb.

via Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke – David A. Cunningham, Jayme S. Knutson, Vishwanath Sankarasubramanian, Kelsey A. Potter-Baker, Andre G. Machado, Ela B. Plow,

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[ARTICLE] Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot – Full Text

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

 

Introduction

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 [3] and increased risk of falls [8]. 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 [10]. In recent years, gait improvement has been achieved using functional electrical stimulation (FES) [110162325], which combines the orthotic benefits of an AFO with a more physiological approach that involves muscle contraction and the related sensory feedback [1025]. Transcutaneous FES (tcFES) of the peroneal nerve has been associated with significantly reduced falls compared to intensive physiotherapy [7]. 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 [19]. 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 [61017], compared to orthotic devices [123], and also compared to tcFES [17]. 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 [13]. An implantable stimulator does, however, offer the advantage of avoiding the need for daily optimization of stimulator location [28] 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 [10]. 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 [17]. Trials applying tcFES, which has been available since the early seventies [27], have tended to employ standardized and stratified re-examination, with early and long-term follow-up periods, such as 6 and 12 weeks [16], 3 and 12 months [25], and 24 days and 3 years [28]. 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 [1]. 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 [8] 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 [2528], and for a smaller cohort (N = 12) using siFES [1]. 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.[…]

 

Continue —>  Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1Gait speed (m/s) in relation to duration of therapy with stimulation ON and OFF. a. Maximum gait velocity. Main effect of stimulation and time. Post hoc testing: significant difference from day 1 to month 3 (*). b. Comfortable gait velocity. Main effect of stimulation only. Error bars = standard error of the mean

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[VIDEO] FES (Functional Electrical Stimulation) System by FES Center India – YouTube

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

  1. Sit to stand training
  2. Pre Gait Training
  3. Correction of Foot Drop,
  4. Correction of Circumductory Gait

  5. for Paraplegia (Incomplete SCI) using FES unit on both sides

  6. Shoulder subluxation and shoulder rehabilitation

  7. 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.

mail: fescenterindia@gmail.com

For more details visit: http://www.fescenterindia.com

via FES (Functional Electrical Stimulation) System by FES Center India – YouTube

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[VIDEO] Functional Electrical Stimulation for Stroke Rehab – YouTube

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.

via  Functional Electrical Stimulation for Stroke Rehab – YouTube

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[VIDEO] Foot Drop and Functional Electrical Stimulation (FES) – YouTube

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.

via Foot Drop and Functional Electrical Stimulation (FES) – YouTube

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[VIDEO] Using Functional Electrical Stimulation For Patients With Neurological Deficits – YouTube

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.

via Using Functional Electrical Stimulation For Patients With Neurological Deficits – YouTube

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