Posts Tagged NMES
[ARTICLE] Effects of Electrical Stimulation in Spastic Muscles After Stroke Systematic Review and Meta-Analysis of Randomized Controlled Trials – Full Text PDF
Posted by Kostas Pantremenos in Functional Electrical Stimulation (FES), Spasticity on October 9, 2015
Background and Purpose—Neuromuscular electric stimulation (NMES) has been used to reduce spasticity and improve range of motion in patients with stroke. However, contradictory results have been reported by clinical trials. A systematic review of randomized clinical trials was conducted to assess the effect of treatment with NMES with or without association to another therapy on spastic muscles after stroke compared with placebo or another intervention.
Methods—We searched the following electronic databases (from inception to February 2015): Medline (PubMed), EMBASE, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro). Two independent reviewers assessed the eligibility of studies based on predefined inclusion criteria (application of electric stimulation on the lower or upper extremities, regardless of NMES dosage, and comparison with a control group which was not exposed to electric stimulation), excluding studies with ❤ days of intervention. The primary outcome extracted was spasticity, assessed by the Modified Ashworth Scale, and the secondary outcome extracted was range of motion, assessed by Goniometer.
Results—Of the total of 5066 titles, 29 randomized clinical trials were included with 940 subjects. NMES provided reductions in spasticity (−0.30 [95% confidence interval, −0.58 to −0.03], n=14 randomized clinical trials) and increase in range of motion when compared with control group (2.87 [95% confidence interval, 1.18–4.56], n=13 randomized clinical trials) after stroke.
Conclusions—NMES combined with other intervention modalities can be considered as a treatment option that provides improvements in spasticity and range of motion in patients after stroke.
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[ARTICLE] Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke
Posted by Kostas Pantremenos in Rehabilitation robotics on September 27, 2015
Abstract
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.
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[ARTICLE] Comparing the Effects of Functional Electrical Stimulation Versus Somatosensory Stimulation on Increasing Corticospinal Excitability for a Muscle of the Hand – Full Text PDF
Posted by Kostas Pantremenos in Functional Electrical Stimulation (FES), Paretic Hand, tDCS/rTMS on September 26, 2015
Abstract
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.
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[ARTICLE] Research of rehabilitation aid system by DOF constraintable mechanism and NMES for hemiplegic upper limbs
Posted by Kostas Pantremenos in Paretic Hand, Rehabilitation robotics on September 21, 2015
Abstract
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.
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[ARTICLE] Effects of Electrical Stimulation in Spastic Muscles After Stroke
Posted by Kostas Pantremenos in Functional Electrical Stimulation (FES) on July 21, 2015
Abstract
Background and Purpose—Neuromuscular electric stimulation (NMES) has been used to reduce spasticity and improve range of motion in patients with stroke. However, contradictory results have been reported by clinical trials. A systematic review of randomized clinical trials was conducted to assess the effect of treatment with NMES with or without association to another therapy on spastic muscles after stroke compared with placebo or another intervention.
Methods—We searched the following electronic databases (from inception to February 2015): Medline (PubMed), EMBASE, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro). Two independent reviewers assessed the eligibility of studies based on predefined inclusion criteria (application of electric stimulation on the lower or upper extremities, regardless of NMES dosage, and comparison with a control group which was not exposed to electric stimulation), excluding studies with ❤ days of intervention. The primary outcome extracted was spasticity, assessed by the Modified Ashworth Scale, and the secondary outcome extracted was range of motion, assessed by Goniometer.
Results—Of the total of 5066 titles, 29 randomized clinical trials were included with 940 subjects. NMES provided reductions in spasticity (−0.30 [95% confidence interval, −0.58 to −0.03], n=14 randomized clinical trials) and increase in range of motion when compared with control group (2.87 [95% confidence interval, 1.18–4.56], n=13 randomized clinical trials) after stroke.
Conclusions—NMES combined with other intervention modalities can be considered as a treatment option that provides improvements in spasticity and range of motion in patients after stroke.
via Effects of Electrical Stimulation in Spastic Muscles After Stroke.
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[ARTICLE] Wrist Rehabilitation Assisted by an Electromyography (EMG)-driven Neuromuscular Electrical Stimulation (NMES)-robot after Stroke – Full Text PDF
Posted by Kostas Pantremenos in Functional Electrical Stimulation (FES), Rehabilitation robotics on July 4, 2015
Abstract
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.
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[ARTICLE] Effects of Neuromuscular Electrical Stimulation (NMES) on Hand Function in Stroke Patients
Posted by Kostas Pantremenos in Functional Electrical Stimulation (FES), Paretic Hand on June 24, 2015
Abstract
Background
Motor dysfunction after stroke is a major reason which disables a person in performing activities of daily living (ADL). During the process of natural recovery affected upper limb and lower limb recovers but recovery of the hand function often remains incomplete and can lead to a major disability for a person. A lot of treatment options are available to solve this problem and NMES appears to be a promising and easily available among them.
Objective
To assess the effectiveness of NMES along with Conventional Physiotherapy on Hand Function rehabilitation in Stroke Patients.
Methodology
30 (thirty) patients were divided in a consecutive manner into two groups for the study; one group received conventional treatment (Control Group) and other for conventional treatment as well as NMES to wrist and finger extensors (Experimental group). An assessment was done prior to starting of treatment and after 4 weeks of treatment.
Results
At the end of 4 weeks experimental group showed significant improvement in Block to Box Test (p<0.05), Fugl Meyer Assessment Tool for Wrist and Hand (p<0.05) and Grip Strength (p0.05).
Conclusion
Conventional exercise therapy and NMES to wrist and finger extensors is more effective than Conventional exercise therapy alone in improving hand function in stroke patients.
via Indian Journals.
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[ARTICLE] Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke
Posted by Kostas Pantremenos in Functional Electrical Stimulation (FES), Rehabilitation robotics on January 6, 2015
Abstract
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.
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[WEB SITE] Stroke Treatment and Technology
Posted by Kostas Pantremenos in REHABILITATION on January 5, 2015
PUBLISHED ON JANUARY 1, 2015
At the JFK-Johnson Rehabilitation Institute (JFK-JRI), physical therapists have a diverse mix of technologies available to assist with recovery of patients who have been affected by stroke. These devices support rehabilitation that can meet patients almost anywhere on the functional continuum, and support therapeutic activities that will help them meet their goals. Among the technologies available to PTs in both inpatient and outpatient settings are a body weight support treadmill, electrically powered mobile lift device, motorized elliptical trainers, computerized balance assessment system, neuromuscular electrical stimulation, functional electrical stimulation devices, and conventional lower extremity and upper extremity braces. This article explores the advantages these technologies provide especially when tailored to the needs of poststroke patients, and their varying levels of function…
more –> Stroke Treatment and Technology | Rehab Managment.
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[REVIEW] Effectiveness of functional electrical stimulation in improving clinical outcomes in the upper arm following stroke: a systematic review and meta-analysis – Full Text PDF
Posted by Kostas Pantremenos in Functional Electrical Stimulation (FES) on November 2, 2014
ABSTRACT
Background: persistent impairment in the upper arm is one of the main challenges in the treatment of stroke patients. Different therapeutic methods are being used to prevent or decrease such long-term impairments. Functional electrical stimulation (FES) is one of these methods, which aims to stimulate the nerves of weakened muscles so that the resulting muscle contractions resemble that of a functional task.
Objectives: The objective of this study was to review the evidence for the effect of FES on 1) shoulder subluxation, 2) pain, and 3) upper arm motor function in stroke patients, when added to conventional therapy.
Methods: From 727 articles retrieved during database searches, 10 articles (9 RCTs, 1 quasi-RCT) were selected for final analysis. For all three considered outcomes, the articles were rated based on the PEDro (Physiotherapy Evidence Database) scores and the Sackett’s levels of evidence. A meta-analysis was also performed for each outcome.
Results: The result of meta-analyses showed a significant reduction in shoulder subluxation in the experimental group compared to the control group, if FES was applied early after stroke. No difference was found for pain and motor function outcomes.
TBI Rehabilitation 