Functional Electrical Stimulation Therapy for Retraining Reaching and Grasping After Spinal Cord Injury and Stroke.

Naaz Kapadia,Bastien Moineau,Milos R Popovic

doi:10.3389/fnins.2020.00718

Abstract

Neurological conditions like hemiplegia following stroke or tetraplegia following spinal cord injury, result in a massive compromise in motor function. Each of the two conditions can leave individuals dependent on caregivers for the rest of their lives. Once medically stable, rehabilitation is the main stay of treatment. This article will address rehabilitation of upper extremity function. It is long known that moving the affected limb is crucial to recovery following any kind of injury. Overtime, it has also been established that just moving the affected extremities does not suffice, and that the movements have to involve patient’s participation, be as close to physiologic movements as possible, and should ideally stimulate the entire neuromuscular circuitry involved in producing the desired movement. For over four decades now, functional electrical stimulation (FES) is being used to either replace or retrain function. The FES therapy discussed in this article has been used to retrain upper extremity function for over 15 years. Published data of pilot studies and randomized control trials show that FES therapy produces significant changes in arm and hand function. There are specific principles of the FES therapy as applied in our studies: (i) stimulation is applied using surface stimulation electrodes, (ii) there is minimum to virtually no pain during application, (iii) each session lasts no more than 45–60 min, (iv) the technology is quite robust and can make up for specificity to a certain extent, and (v) fine motor function like two finger precision grip can be trained (i.e., thumb and index finger tip to tip pinch). The FES therapy protocols can be successfully applied to individuals with paralysis resulting from stroke or spinal cord injury.

Highlights

Application of functional electrical stimulation (FES) for therapeutic purposes in rehabilitation settings dates back to the 1960’s when Liberson et al (1961) used an FES system to stimulate the peroneal nerve to correct foot drop by triggering a foot switch, a single-channel electrical stimulation device stimulated the common peroneal nerve via a surface electrode, producing ankle dorsiflexion during the swing phase of gait (Liberson et al, 1961)
A few high-quality randomized controlled trials have been performed, proving the efficacy of FES therapy over other rehabilitation techniques (Sharififar et al, 2018; Yen et al, 2019). This paucity in multicenter randomized controlled trials and the limited access to systems that can properly deliver FES therapy might have affected its uptake in clinical settings (Ho et al, 2014; Auchstaetter et al, 2016). Both these issues are being addressed as new FES systems that are developed for FES therapy are being introduced, as well as large scale multicenter randomized controlled trials are being planned to further confirm the efficacy of this rehabilitation modality
This article will provide readers with the details on how transcutaneous multichannel FES therapy for the upper extremity can be applied in clinical trials and as such the same methodology can be used in clinical practice by physiotherapists and occupational therapists

Summary

Introduction

Application of functional electrical stimulation (FES) for therapeutic purposes in rehabilitation settings dates back to the 1960’s when Liberson et al (1961) used an FES system to stimulate the peroneal nerve to correct foot drop by triggering a foot switch, a single-channel electrical stimulation device stimulated the common peroneal nerve via a surface electrode, producing ankle dorsiflexion during the swing phase of gait (Liberson et al, 1961). A few high-quality randomized controlled trials have been performed, proving the efficacy of FES therapy over other rehabilitation techniques (Sharififar et al, 2018; Yen et al, 2019) This paucity in multicenter randomized controlled trials and the limited access to systems that can properly deliver FES therapy might have affected its uptake in clinical settings (Ho et al, 2014; Auchstaetter et al, 2016). This article will provide readers with the details on how transcutaneous multichannel FES therapy for the upper extremity can be applied in clinical trials and as such the same methodology can be used in clinical practice by physiotherapists and occupational therapists

Methods

Results

Conclusion