The application of precisely controlled functional electrical stimulation to the shoulder, elbow and wrist for upper limb stroke rehabilitation: a feasibility study.

Katie L Meadmore,Valerie Benson,Mustafa Kutlu,Jane H Burridge,Timothy A Exell,Chris T Freeman,Eric Rogers,Emma Hallewell,Ann-Marie Hughes

doi:10.1186/1743-0003-11-105

Katie L Meadmore, Valerie Benson + Show 7 more

Open Access

https://doi.org/10.1186/1743-0003-11-105

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Abstract

BackgroundFunctional electrical stimulation (FES) during repetitive practice of everyday tasks can facilitate recovery of upper limb function following stroke. Reduction in impairment is strongly associated with how closely FES assists performance, with advanced iterative learning control (ILC) technology providing precise upper-limb assistance. The aim of this study is to investigate the feasibility of extending ILC technology to control FES of three muscle groups in the upper limb to facilitate functional motor recovery post-stroke.MethodsFive stroke participants with established hemiplegia undertook eighteen intervention sessions, each of one hour duration. During each session FES was applied to the anterior deltoid, triceps, and wrist/finger extensors to assist performance of functional tasks with real-objects, including closing a drawer and pressing a light switch. Advanced model-based ILC controllers used kinematic data from previous attempts at each task to update the FES applied to each muscle on the subsequent trial. This produced stimulation profiles that facilitated accurate completion of each task while encouraging voluntary effort by the participant. Kinematic data were collected using a Microsoft Kinect, and mechanical arm support was provided by a SaeboMAS. Participants completed Fugl-Meyer and Action Research Arm Test clinical assessments pre- and post-intervention, as well as FES-unassisted tasks during each intervention session.ResultsFugl-Meyer and Action Research Arm Test scores both significantly improved from pre- to post-intervention by 4.4 points. Improvements were also found in FES-unassisted performance, and the amount of arm support required to successfully perform the tasks was reduced.ConclusionsThis feasibility study indicates that technology comprising low-cost hardware fused with advanced FES controllers accurately assists upper limb movement and may reduce upper limb impairments following stroke.

Highlights

Motor impairments of the upper limb are one of the most common consequences of stroke, leading to lack of coordination, lack of motor control and importantly, loss of functional movement [1]
It is estimated that about 70% of stroke patients are left with a dysfunctional upper limb [1], resulting in many stroke survivors being dependent on others for activities of daily living [2,3]
We investigate a new way of improving upper limb functional motor recovery following stroke

Summary

Introduction

Motor impairments of the upper limb are one of the most common consequences of stroke, leading to lack of coordination, lack of motor control and importantly, loss of functional movement [1]. Most research has used one or two channel systems in which one or two muscle groups of the upper limb are stimulated (usually a combination of the wrist extensors, triceps or deltoids). These studies have shown that FES treatments can be effective in improving upper limb motor function (e.g., [6,7,8,9,10,11]). The aim of this study is to investigate the feasibility of extending ILC technology to control FES of three muscle groups in the upper limb to facilitate functional motor recovery post-stroke

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