Posts Tagged Neuromuscular electrical stimulation
While everyday objects like clothespins and cups still play crucial roles in most patients’ journeys toward recovery, new technology is constantly changing the rehabilitation game. From video chats with doctors to robotic gloves and interactive video games, stroke recovery and rehabilitation tools have come a long way in the past decade. This new stroke recovery technology is helping link neuroplasticity and learning. A key part in recovery from a stroke.
This new stroke technology gives patients more repetitions, practice time and intensity compared to previous movement trainings. Not to mention this new technology is also more interactive, attention grabbing and really helps motivate the patient. These new technologies are really helping harness the brain’s ability to repair itself in ways that haven’t been seen before.
How Technology Kick-Starts Stroke Recovery
Just like the simple exercises that caregivers have used for years, the latest stroke recovery tools revolve around the concept of neuroplasticity. Though researchers have known about the brain’s ability to “retrain” itself for years, they now understand how crucial it is to begin this process as early as possible. That’s because the destruction of brain tissue during stroke is actually a temporary trigger for the rest of the brain.
“The tissue death that results from stroke appears to trigger a self-repair program in the brain,” says Karen Russell from The New Yorker.
After stroke, healthy brain tissue reverts to a more malleable stage for one to three months. Neuroplasticity allows healthy brain tissue to create new connections to the affected muscles and nerves for years, but during these early months of recovery, the brain is especially open to forming these connections. Unfortunately, this is also when patients’ bodies face their most extreme limitations, preventing them from taking full advantage of their healthy brain tissue’s malleability.
That’s where modern technology comes in. Today’s stroke survivors have more recovery options than ever before, and many of them are designed to capitalize on this early recovery stage. Others allow doctors and caregivers to closely monitor patients’ progress and prevent common complications as they regain movement and retrain their brains in the months and years following stroke.
Video Games for Stroke Survivors
Perhaps one of the most innovative and exciting examples of stroke rehabilitation technology is in the video game space. Traditional low-tech stroke therapy options can be difficult and repetitive, making it less likely that patients follow through at home. Doctors are already noticing that video games are more engaging, exciting, and easy to incorporate into an at-home healing regimen.
One example of a new emerging video game gear toward stroke recovery is Bandit’s Shark Showdown. This is an interactive video game that allows players to control an animated dolphin’s movements. The version for stroke survivors incorporates a robotic sling, which patients wear to control the shark. This simulation synchronizes patients’ muscle movements with the dolphin’s leaps and dives, stimulating their brain and body simultaneously.
When you consider the brain itself, it’s not so unusual that a video game could recreate and reconnect key functions. John Krakauer, a neurologist who co-created the video game with a handpicked think tank, reminded The New Yorker that every simple muscle movement “requires an incredibly sophisticated set of computations“. His shark game is designed to break down “the physical-mental distinction” and restore function to impaired limbs.
“There’s no right and wrong when you’re playing as a dolphin,” John Krakauer told The New Yorker. “You’re learning the ABCs again—the building blocks of action. You’re not thinking about your arm’s limitations. You’re learning to control a dolphin. In the process, you’re going to experiment with many movements you’d never try in conventional therapy.”
Another example of this is a new therapeutic device that NYU Langone Medical Center has developed that creates an interactive canoe trip.
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Though the video game and device is still in the early stages of development and testing, doctors from NYU Langone say that they are seeing patients be more motivated and engaging that with current standard therapies. They also have shown to be another promising therapeutic option for stroke survivors who are too injured for traditional therapy.
Similar to the NYU Langone Medical Center’s device is the SaeboReJoyce workstation. Saebo’s ReJoyce workstation is a computerized task-oriented training system that involves a range of activity-based games that test speed, endurance, coordination, range of motion, strength, timing and cognitive demand. This helps patients practice repetitive gross motor and fine motor tasks with fun and motivating activities.
Because the games are customizable and incorporate a wide variety of grasp patterns, this workstation is useful for patients at each stage of recovery.
Among the newest therapeutic tools used for stroke victims, those most commercially available are robotics and robotic exoskeletons, which attach directly to the affected part of the body to facilitate or enable movement. Therapeutic robotic devices include leg and arm supports that actually lift and support the limbs while reorganizing the pathways between the muscles, nerves, and healthy brain tissue. Like the robotic arm sling that researchers integrated into Bandit’s Shark Showdown robotic arm and leg devices contain sensors that track the limbs’ movements and monitor changes in force and terrain.
(Source: Bio Robotics)
The Wall Street Journal explains that robotic exoskeletons are especially useful because they are adjustable. As patients need less support, their therapists may adjust the robotic devices to let the patients’ muscles gradually resume more control. Because these exoskeletons can actually move the patients’ affected limbs until they regain movement, caregivers spend less time doing this themselves. When caregivers are free to observe patients’ movements – instead of manually moving their limbs – they can pay closer attention to the quality of each movement.
Body Weight Support Systems
Robots aren’t the only options for patients who need extra support for weak or paralyzed limbs. Because the force of gravity can turn patient’s’ own body weight into an obstacle, some of the most useful recovery devices like the SaeboMAS are designed to counteract this force. Support systems designed for the arms, legs and overall body, help support and facilitate movement to make task-oriented exercises possible. Motion that this is a much more affordable option as well.
Support systems like the SaeboMAS aren’t used just to speed up the therapy process. One study found that stroke survivors who receive extra weight support actually walk better than patients who must support their own weight during rehabilitation. This makes sense, because gait training is more effective when patients are able to move their joints and muscles more quickly after stroke.
Neuromuscular Electrical Stimulation
Our everyday voluntary movements are made possible by connections between the brain and the body’s nerves, but after this connection is severed due to stroke, the affected nerves and muscles can no longer send or receive the sensory stimulation necessary to move. This is where neuromuscular electrical stimulation can be helpful. Neuromuscular electrical stimulation applies small electrical pulses to paralyzed muscles to restore or improve their function.
Devices like the Saebo MyoTrac Infiniti uses EMG Triggered Stimulation which is a combination of biofeedback and electrical stimulation. Stimulation by devices like these are triggered to the desired muscle group (i.e., finger extensors, elbow extensors etc.) once the client deactivates or relaxes the opposite spastic muscle group (i.e., spastic finger flexors, elbow flexors etc.)
With Sensory Electrical Stimulation (SES), it is believed to enhance the neural plasticity and activate brain areas, helping with stroke rehabilitation. Studies show that providing SES to an impaired nervous system can prime the cortex ultimately leading to improve neuroplasticity, motor recovery and function. Using a Sensory Electrical Stimulation tool like the SaeboStim Micro is perfect for SES.
Research suggests that sensory electrical stimulation (SES) can be an effective treatment strategy for improving sensory and motor function. By providing low-level stimulation, increased signals are delivered to the brain and can lead to improved function and cortical reorgainzation.
Innovative Stroke Recovery Devices
Not all stroke recovery devices need electrical stimulation to aid in task-oriented training. Neurorehabilitation researchers have also incorporated mechanical features into lightweight gloves that simply ease the burden on the hands and fingers. For example, the SaeboGlove includes an innovative tension system that connects and controls the fingers, thumb, wrist, and forearm.
Devices like the SaeboGlove and and the P5 Glove, a digital rehab glove designed to induce neural plasticity in the patient through specific and customized exercises with gamification, helps clients suffering from neurological and orthopedic injuries incorporate their hand functionally in therapy and at home.
Video Conferences with Doctors
Your odds of regaining movement after stroke are highly dependent on the speed with which you receive treatment. When stroke occurs, every second without proper diagnosis and treatment may cause more oxygen loss and damage to your brain cells. And after stroke, every moment of recovery is critical.
Ideally, all stroke patients would have immediate access to caregivers when stroke occurs, and then enjoy continuous access to rehabilitative and medical experts after they leave the hospital. In addition to caregivers who provide constant supervision, it’s important for patients’ healthcare providers to respond quickly to any concerns or questions as they monitor the patient’s progress.
Unfortunately, this isn’t always possible. Stroke is the country’s leading cause of long-term disability, and consistent, supervised therapy is one of the best ways to minimize complications and reduce a patient’s risks of suffering permanent mobility loss. But if patients can’t get to their therapist regularly – or get a proper diagnosis and treatment as soon as stroke occurs – they can face preventable setbacks. Now, the Internet is making it possible to maintain communication throughout the diagnosis, treatment, and recovery process.
Alabama’s Madison Hospital is one of many healthcare facilities that now use computers and cameras to connect neurologists with stroke patients. Patients who may be suffering a stroke – or complications during recovery – can now seek diagnosis and treatment through live conference calls with stroke experts at other hospitals. This makes incorrect diagnoses less likely, and ensures that stroke patients get the help they need immediately instead of waiting while more damage is done and experts are called in.
After patients return home, they may also conduct video chats with their physical therapists as they perform at-home stroke exercises. Virtual supervision may not be a substitute for the real thing, but it’s far more useful than unsupervised exercises that could do more harm than good, and it keeps patients accountable and their progress consistent. In fact, video conferencing is so useful that some insurance companies now cover virtual checkups.
Technology for The Greater Good
As video conferencing, video games, virtual reality, and robotics take off in the consumer sphere, medicine continues to come along for the ride, and our solutions for battling debilitating disabilities grow stronger. Whether our latest technology is infused into wearables, or whether it creates new categories of products, dollars spent researching, development, testing and distributing new solutions is a major key to improving healthcare in the 21st century.
Whether you are a caregiver, occupational therapist or a stroke survivor yourself, Saebo provides stroke survivors young or old, access to transformative and life changing products. We pride ourselves on providing affordable, easily accessible, and cutting-edge solutions to people suffering from impaired mobility and function. We have several products to help with the stroke recovery and rehabilitation process. From the SaeboFlex, which allows clients to incorporate their hand functionally in therapy or at home, to the SaeboMAS, an unweighting device used to assist the arm during daily living tasks and exercise training, we are commitment to helping create innovative products for stroke recovery. Check out all of our product offerings or let us help you find which product is right for you.
[Abstract] BCI controlled neuromuscular electrical stimulation enables sustained motor recovery in chronic stroke victims – PDF
R. Leeb1,2,#, A. Biasiucci2,#, T. Schmidlin1 , T. Corbet2 , P. Vuadens3 , JdR. Millán2,*
- Center for Neuroprosthetics (CNP), École Polytechnique Fédérale de Lausanne, Sion, Switzerland;
- Chair in Brain-Machine Interface (CNBI), École Polytechnique Fédérale de Lausanne, Geneva, Switzerland;
- SUVACare – Clinique Romande de Réadaptation, Sion, Switzerland
Equal contributions; * Campus Biotech, Chemin des Mines 9, CH-1202 Geneva, Switzerland; E-mail: firstname.lastname@example.org
Introduction: Recently, it has been shown that brain-computer interfaces (BCI) can be used in stroke rehabilitation to decode motor attempts from brain signals and to trigger movements of the paralyzed limb . Among other available practices in rehabilitation, neuromuscular electrical stimulation (NMES) is often used to directly engage muscles on the affected parts of the body during physical therapy. Nevertheless, the benefits of a combined approach, to directly link the brain intention with a muscular response, are not yet fully validated. In this abstract, we report first results of a BCI-NMES system for stroke rehabilitation.
Material and Methods: Up to now, we enrolled 18 chronic stroke victims (minimum 10 months past the incident) suffering from an impairment of the upper limb in a randomized controlled clinical trial. Half of the subjects were assigned to the BCI group and half to a “sham” group, whereby the criteria such as motor impairment –measured via the Fugl-Meyer scale for upper extremity (FM) score–, age, time since incident and lesion location were balanced. Generally, the experimental protocol consisted of three different phases: (i) patients underwent a preevaluation to check the motor capabilities, to characterize the initial state of the brain and to calibrate the BCI classifier (see BCI details in ). (ii) In the following weeks, they were trained with an online BCI twice a week for 10 sessions (45 to 90 minutes including setup). (iii) Finally, they performed a post-experimental screening to determine changes in EEG patterns and in motor functions following the treatment, and a 6-month follow-up to evaluate the sustainment. Patients in the BCI group received NMES of the extensor digitorum muscles triggered by the BCI detecting the intention of movement at the cortical level (modulation of the sensorimotor rhythm in the contralateral motor cortex). For patients in the sham group the NMES was not correlated with the brain activity. All subjects were asked to attempt to open their paretic hand (full sustained finger extension) with the aim of activating the NMES upon detection of a suitable sensorimotor rhythms (Fig. 1-a). Subjects in the two groups (BCI and sham) received comparable amount of NMES.
Results: Remarkably, subjects in the BCI group improved their motor function (post minus pre) by 8.6±5.0 FM points (which is more than the minimal clinical change of 5.25 FM points), while those in the sham group improved only by 2.4±3.4 FM points (Fig. 1-b). As expected, the features used by the BCI classifier were mostly located over the affected hemisphere and the motor cortex (see topographic presentation in Fig. 1-c).
Discussion: We hypothesize that the motor improvement in the BCI group (in contrast to the sham group) is triggered by the tight timed and functional link between the intended action in the brain, and the executed and perceived motor action, through the activation of the body’s natural efferent and afferent pathways.
Significance: In our randomized controlled trial, we demonstrate that the modulation of sensorimotor rhythms driving contingent neuromuscular stimulation is more effective than sham stimulation with active motor attempt, and that the proposed therapy dosage produces a clinically important recovery in chronic stroke survivors having a moderate-to-severe motor impairment.
References:  Ramos-Murguialday A, et al. Brain-machine interface in chronic stroke rehabilitation. Ann Neurol, 74(1):100-108, 2013.  Leeb R, et al. Transferring brain-computer interfaces beyond the laboratory: Successful application control for motor-disabled users. Artif Intell Med, 59: 121-132, 2013.
[ARTICLE] Multi-contact functional electrical stimulation for hand opening: electrophysiologically driven identification of the optimal stimulation site | Journal of NeuroEngineering and Rehabilitation – Full Text
Functional Electrical Stimulation (FES) is increasingly applied in neurorehabilitation. Particularly, the use of electrode arrays may allow for selective muscle recruitment. However, detecting the best electrode configuration constitutes still a challenge.
A multi-contact set-up with thirty electrodes was applied for combined FES and electromyography (EMG) recording of the forearm. A search procedure scanned all electrode configurations by applying single, sub-threshold stimulation pulses while recording M-waves of the extensor digitorum communis (EDC), extensor carpi radialis (ECR) and extensor carpi ulnaris (ECU) muscles. The electrode contacts with the best electrophysiological response were then selected for stimulation with FES bursts while capturing finger/wrist extension and radial/ulnar deviation with a kinematic glove.
The stimulation electrodes chosen on the basis of M-waves of the EDC/ECR/ECU muscles were able to effectively elicit the respective finger/wrist movements for the targeted extension and/or deviation with high specificity in two different hand postures.
A subset of functionally relevant stimulation electrodes could be selected fast, automatic and non-painful from a multi-contact array on the basis of muscle responses to subthreshold stimulation pulses. The selectivity of muscle recruitment predicted the kinematic pattern. This electrophysiologically driven approach would thus allow for an operator-independent positioning of the electrode array in neurorehabilitation.
Continue – Multi-contact functional electrical stimulation for hand opening: electrophysiologically driven identification of the optimal stimulation site | Journal of NeuroEngineering and Rehabilitation | Full Text
[ARTICLE] Combination of Transcranial Direct Current Stimulation and Neuromuscular Electrical Stimulation Improves Gait Ability in a Patient in Chronic Stage of Stroke – Full Text HTML/PDF
Continue —> Combination of Transcranial Direct Current Stimulation and Neuromuscular Electrical Stimulation Improves Gait Ability in a Patient in Chronic Stage of Stroke – FullText – Case Reports in Neurology 2016, Vol. 8, No. 1 – Karger Publishers
[ARTICLE] Effects of repetitive facilitative exercise with neuromuscular electrical stimulation, vibratory stimulation and repetitive transcranial magnetic stimulation of the hemiplegic hand in chronic stroke patients
Aim: Repetitive facilitative exercise (RFE) is a developed approach to the rehabilitation of hemiplegia. RFE can be integrated with neuromuscular electrical stimulation (NMES), direct application of vibratory stimulation (DAVS) and repetitive transcranial magnetic stimulation (rTMS). The aims of the present study were to retrospectively compare the effects of RFE and NMES, DAVS with those of RFE and rTMS, and to determine the maximal effect of the combination of RFE with NMES, DAVS, rTMS and pharmacological treatments in stroke patients.
Subjects and methods: Thirty-three stroke patients were enrolled and divided into three groups: 15 who received RFE with rTMS (4 min) (TMS4 alone), 9 who received RFE with NMES, DAVS (NMES, DAVS alone) and 9 who received RFE with NMES, DAVS and rTMS (10 min) (rTMS10 + NMES, DAVS). The subjects performed the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) before and after the 2-week session. The 18 patients in the NMES, DAVS alone and rTMS10 + NMES, DAVS group underwent the intervention for 4 weeks.
Result: There were no significant differences in the increases in the FMA, ARAT scores in the three groups. The FMA or ARAT scores in the NMES, DAVS alone and the rTMS10 + NMES, DAVS group were increased significantly. The FMA and ARAT scores were significantly improved after 4 weeks in the NMES, DAVS alone group.
Discussion: RFE with NMES, DAVS may be more effective than RFE with rTMS for the recovery of upper-limb function. Patients who received RFE with NMES, DAVS and pharmacological treatments showed significant functional recovery.
Source: Taylor & Francis Online
[ARTICLE] Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke
Background: Augmented physical training with assistance from robot and neuromuscular electrical stimulation (NMES) may introduce intensive motor improvement in chronic stroke.
Objective: To compare the rehabilitation effectiveness achieved by NMES robot–assisted wrist training and that by robot-assisted training.
Methods: This study was a single-blinded randomized controlled trial with a 3-month follow-up. Twenty-six hemiplegic subjects with chronic stroke were randomly assigned to receive 20-session wrist training with an electromyography (EMG)-driven NMES robot (NMES robot group, n = 11) and with an EMG-driven robot (robot group, n = 15), completed within 7 consecutive weeks. Clinical scores, Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), and Action Research Arm Test (ARAT) were used to evaluate the training effects before and after the training, as well as 3 months later. An EMG parameter, muscle co-contraction index, was also applied to investigate the session-by-session variation in muscular coordination patterns during the training.
Results: The improvement in FMA (shoulder/elbow, wrist/hand) obtained in the NMES robot group was more significant than the robot group (P < .05). Significant improvement in ARAT was achieved in the NMES robot group (P < .05) but absent in the robot group. NMES robot–assisted training showed better performance in releasing muscle co-contraction than the robot-assisted across the training sessions (P < .05).
Conclusions: The NMES robot–assisted wrist training was more effective than the pure robot. The additional NMES application in the treatment could bring more improvements in the distal motor functions and faster rehabilitation progress.
[ARTICLE] Comparing the Effects of Functional Electrical Stimulation Versus Somatosensory Stimulation on Increasing Corticospinal Excitability for a Muscle of the Hand – Full Text PDF
The electrically-evoked afferent volley generated during NeuroMuscular Electrical Stimulation (NMES) can increase the excitability of CorticoSpinal (CS) pathways. Over time, NMES can strengthen damaged CS pathways and result in enduring improvements in function for persons with central nervous system injury or disease. NMES-induced increases in CS excitability have been studied using a variety of NMES parameters, yet the influence of these stimulation parameters on increasing CS excitability is not well understood.
NMES is commonly delivered at intensities sufficient to generate repeated functional contractions for relatively short durations (30-40 min) or at low intensities, near motor threshold, for long durations (2 h).
For the purpose of this study, these different stimulation protocols are termed Functional Electrical Stimulation (FES) and Somatosensory Stimulation (SS), respectively. A direct comparison of increases in CS excitability induced by such protocols has not been conducted. Thus, the present experiments were designed to compare changes in CS excitability for Abductor Pollicis Brevis (APB) in the hand following FES and SS of the median nerve.
We hypothesized that due to the generation of a larger afferent volley, the FES would increase CS excitability more than the SS. Ten Motor Evoked Potentials (MEPs) were evoked in APB using transcranial magnetic stimulation before and after each type of NMES. MEP amplitude increased significantly following both the FES (by 66 ± 7%, mean ± standard error) and SS (49 ± 6%), but the amplitude of these increases was not significantly different.
These results suggest that just 40 min of FES can increase CS excitability, and potentially provide rehabilitative benefits, to the same extent as 2 h of SS.
[ARTICLE] Research of rehabilitation aid system by DOF constraintable mechanism and NMES for hemiplegic upper limbs
In this paper, rehabilitation aid system by selectable DOF constraintable mechanism and NMES (Neuromuscular Electrical Stimulation) for hemiplegic upper limbs was developed. By using this mechanism, it became possible to separate synergic movement while flexion-extension training of shoulder and elbow by constraining each individual joints. As the clinical trial result by using this mechanism and NMES, the shoulder-elbow UE-FMA sub-scores improved significantly.
In this research, NMES timing control system and quantitative evaluation method for sensing the flexion-extension movement of the elbow and shoulder joints are proposed.
[ARTICLE] Effects of a 12-hour neuromuscular electrical stimulation treatment program on the recovery of upper extremity function in sub-acute stroke patients: a randomized controlled pilot trial – Full Text PDF
[Purpose] This study investigated the effects of a 12-hour neuromuscular electrical stimulation program in the evening hours on upper extremity function in sub-acute stroke patients.
[Subjects and Methods] Forty-five subjects were randomized to one of three groups: 12-hour neuromuscular electrical stimulation group (n=15), which received 12 hours of neuromuscular electrical stimulation and conventional rehabilitation for the affected upper extremity; neuromuscular electrical stimulation group (n=15), which received 30 min of neuromuscular electrical stimulation and conventional rehabilitation; and control group (n=15), which received conventional rehabilitation only. The Fugl-Meyer assessment, Action Research Arm Test, and modified Ashworth scale were used to evaluate the effects before and after intervention, and 4 weeks later.
[Results] The improvement in the distal (wrist-hand) components of the Fugl-Meyer assessment and Action Research Arm Test in the 12-hour neuromuscular electrical stimulation group was more significant than that in the neuromuscular electrical stimulation group. No significant difference was found between the two groups in the proximal component (shoulder-elbow) of the Fugl-Meyer assessment.
[Conclusion] The 12-hour neuromuscular electrical stimulation group achieved better improvement in upper extremity motor function, especially in the wrist-hand function. This alternative therapeutic approach is easily applicable and can be used in stroke patients during rest or sleep.
Full Text PDF [485K]
[ARTICLE] Wrist Rehabilitation Assisted by an Electromyography (EMG)-driven Neuromuscular Electrical Stimulation (NMES)-robot after Stroke – Full Text PDF
Background. Augmented physical training with assistance from robot and neuromuscular electrical stimulation (NMES) may introduce intensive motor improvement in chronic stroke.
Objective. To compare the rehabilitation effectiveness achieved by NMES-robot assisted wrist training and that by robot assisted training.
Methods. This study was a single-blinded randomized controlled trial with a 3-month follow-up. Twenty-six hemiplegic subjects with chronic stroke were randomly assigned to receive 20-session wrist training with an electromyography (EMG)-driven NMESrobot (NMES-robot group, n=11) and with an EMG-driven robot (robot group, n=15), completed within 7 consecutive weeks. Clinical scores, Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS) and Action Research Arm Test (ARAT), were used to evaluate the training effects before and after the training, as well as 3 months later. An EMG parameter, muscle co-contraction index, was also applied to investigate the sessionby-session variation in muscular coordination patterns during the training.
Results. The improvement in FMA (shoulder/elbow, wrist/hand) obtained in the NMES-robot group was more significant than the robot-group (P<0.05). Significant improvement in ARAT was achieved in the NMES-robot group (P<0.05), but absent in the robot-group. NMESrobot-assisted training showed better performance in releasing muscle co-contraction than the robot-assisted across the training sessions (P<0.05).
Conclusions. The NMESrobot assisted wrist training was more effective than the pure robot. The additional NMES application in the treatment could bring more improvements in the distal motor functions and faster rehabilitation progress.