Effects Of Functional Electrical Stimulation Research Articles

Long-term stimulation by implanted pacemaker enables non-atrophic treatment of bilateral vocal fold paresis in a human-like animal model

A wide variety of treatments have been developed to improve respiratory function and quality of life in patients with bilateral vocal fold paresis (BVFP). One experimental method is the electrical activation of the posterior cricoarytenoid (PCA) muscle with a laryngeal pacemaker (LP) to open the vocal folds. We used an ovine (sheep) model of unilateral VFP to study the long-term effects of functional electrical stimulation on the PCA muscles. The left recurrent laryngeal nerve was cryo-damaged in all animals and an LP was implanted except for the controls. After a reinnervation phase of six months, animals were pooled into groups that received either no treatment, implantation of an LP only, or implantation of an LP and six months of stimulation with different duty cycles. Automated image analysis of fluorescently stained PCA cross-sections was performed to assess relevant muscle characteristics. We observed a fast-to-slow fibre type shift in response to nerve damage and stimulation, but no complete conversion to a slow-twitch-muscle. Fibre size, proportion of hybrid fibres, and intramuscular collagen content were not substantially altered by the stimulation. These results demonstrate that 30 Hz burst stimulation with duty cycles of 40% and 70% did not induce PCA atrophy or fibrosis. Thus, long-term stimulation with an LP is a promising approach for treating BVFP in humans without compromising muscle conditions.

Effects of Functional Electrical Stimulation on Attention and Brain Activity in Healthy Participants Using Near-Infrared Spectroscopy: An Interventional Study.

Background Involuntary limb activation using functional electrical stimulation (FES) can improve unilateral spatial neglect. However, the impact of FES on brain activity related to spatial attention remains unclear. Thus, in this study, we aimed to examine the effects of FES on spatial attention. Methodology In this interventional study, 13 healthy right-handed participants were asked to perform the Posner task for six minutes both before and after either FES or sham stimulation during each set, resulting in a total of two sets. FES was applied to the left forearm extensor muscles, with a frequency of 25 Hz, a pulse width of 100 μs, and the intensity adjusted to reach the motor threshold. Both the energization and pause times were set to five seconds. The Posner task was used to measure reaction time to a target appearing on a computer screen. Brain activity, indicated by oxygenated hemoglobin values, was measured using near-infrared spectroscopy with 24 probes according to the International 10-20 system method. Results In the left hemisphere, oxygenated hemoglobin values in the premotor and supplementary motor areas, primary somatosensory cortex, and somatosensory association areas were significantly higher after FES than after sham stimulation. In the right hemisphere, oxygenated hemoglobin values were significantly increased in the premotor, primary, and supplementary motor areas; in the supramarginal gyrus; and in the somatosensory association areas after FES. Reaction times in the Posner task did not differ significantly between the FES and sham conditions. Conclusions Collectively, these results suggest that FES of the upper limbs can activate the ventral pathway of the visual attention network and improve stimulus-driven attention. Activation of stimulus-driven attentional function could potentially contribute to symptom improvement in patients with unilateral spatial neglect.

Usage Frequency, Barriers, And Effectiveness of Functional Electrical Stimulation as An Intervention for Stroke Patients

Objective: To determine the frequency of Functional Electrical Stimulation (FES) use in stroke rehabilitation and to identify the barriers and effectiveness of its usage as an intervention for stroke patients. Materials & Methods: This prospective observational study was performed in different clinics and hospitals in Hyderabad. Physical therapists actively practicing in healthcare facilities within Hyderabad, with a minimum of one year of clinical experience in stroke rehabilitation of either gender were included. A questionnaire was structured to collect data on the usage frequency, perceived barriers, and effectiveness related to the utilization of FES in stroke rehabilitation. Results: Most of the participants were using FES frequently and sometimes for shoulder subluxation, improving arm function, enhancing walking function, improving muscle strength and endurance, addressing hypertonia and spasticity, and improving sensation. Respondents when asked about having sufficient time to apply FES, lack of evidence justifying FES use, and regards to workplace support most of the cases >50% agreed strongly agreed, while <50% of study subjects’ believed that does not provide advantages for individuals having a chronic stroke. FES utilization among healthcare professionals in stroke patient rehabilitation, highlighting its potential benefits in improving arm function, shoulder subluxation, walking performance, and hemiplegic shoulder pain. However, there were no significant barriers identified. Conclusion: There was a significant use of FES by physical therapists in Hyderabad to address various aspects of stroke rehabilitation. The study overall highlights its potential for improving arm function, preventing shoulder subluxation, enhancing walking, and reducing hemiplegic shoulder pain, without significant identified barriers.

Effect of functional electrical stimulation of interscapular muscles on trunk performance and balance in post-stroke elderly patients

BackgroundDisability in the upper limb in post-stroke survivors may have a variety of effects, particularly in the elderly, that require planning therapeutic actions to restore function. Thirty-four patients were randomly assigned to the control group (CON) and the Functional Electrical Stimulation (FES) group. For 12 weeks, the CON group received core stabilization exercises (CSEs). The FES group received (FES) for the interscapular muscles with CSEs for the first six weeks and completed the following six weeks with only CSEs. Patients were assessed at baseline, 6 and 12 weeks post-intervention. The trunk impairment scale (TIS) and the Postural Assessment Scale for Stroke (PASS) were used to assess trunk performance. A palpation meter was used to measure the scapular horizontal position (SP). Balance was assessed by the Berg Balance Scale (BBS), and the Timed Up-and-Go test (TUG). Function was assessed with Barthel Index (BI).ResultsBoth groups improved significantly (P < 0.001 for both groups, d = 1.1–3.7 for control group and d = 1.9–6.1 for FES group) post-treatment (at 6 and 12 weeks) in all outcomes except SP in the control group (P < 0.05 at both times, d = 0.6 at 6 weeks and 0.8 at 12 weeks).ConclusionFES for interscapular muscles may have positive effects on trunk performance, scapular position, balance, and function in stroke patients. Also, additional improvements were observed post-intervention compared to baseline. FES is recommended to be part of the rehabilitation program of elderly post-stroke patients.

Functional electrical stimulation to enhance reactive balance among people with hemiparetic stroke.

Individuals with stroke demonstrate a twofold higher fall incidence compared to healthy counterparts, potentially associated with deficits in reactive balance control, which is crucial for regaining balance from unpredictable perturbations to the body. Moreover, people with higher stroke-related motor impairment exhibit greater falls and cannot recover balance during higher perturbation intensities. Thus, they might need supplemental agents for fall prevention or even to be included in a perturbation-based protocol. Functional electrical stimulation is a widely used clinical modality for improving gait performance;however, it remains unknown whether it can enhance or interfere with reactive balance control. We recruited twelve ambulatory participants with hemiparetic stroke (61.48 ± 6.77years) and moderate-to-high motor impairment (Chedoke-McMaster Stroke Leg Assessment ≤ 4/7). Each participant experienced 4 unpredicted paretic gait-slips, with and without functional electrical stimulation (provided 50-500ms after perturbation) in random order. The paretic quadriceps muscle group was chosen to receive electrical stimulation, considering the role of support limb knee extensors for preventing limb-collapse. Outcomes includingprimary (laboratory falls), secondary (reactive stability, vertical limb support) and tertiary (compensatory step length, step initiation, execution time) measureswere compared between the two conditions. Participants demonstrated fewer falls, higher reactive stability, and higher vertical limb support (p < 0.05) following gait-slips with functional electrical stimulation compared to those without. This was accompanied by reduced step initiation time and a longer compensatory step (p < 0.05). The application of functional electrical stimulation to paretic quadriceps following gait-slips reduced laboratory fall incidence with enhanced reactive balance outcomes among people with higher stroke-related motor impairment. Our results lay the preliminary groundwork for understanding the instantaneous neuromodulatory effect of functional electrical stimulation in preventing gait-slip falls, future studies could test its therapeutic effect on reactive balance. Clinical registry number: NCT04957355.

Effect of functional electrical stimulation-based mirror therapy using gesture recognition biofeedback on upper extremity function in patients with chronic stroke: A randomized controlled trial

Background: Mirror therapy (MT) is an intervention used for upper extremity rehabilitation in stroke patients and has been studied in various fields. Recently, effective MT methods have been introduced in combination with neuromuscular electrical stimulation or with electromyography (EMG)-triggered biofeedback. The purpose of this study was to investigate the effects of functional electrical stimulation (FES)-based MT incorporating a motion recognition biofeedback device on upper extremity motor recovery to chronic stroke patients. Methods: Twenty-six chronic stroke patients with onset of more than 6 months were randomly assigned into experimental group (n = 13) and control group (n = 13). Both groups participated in conventional rehabilitation program, while the control group received conventional MT intervention and the experimental group received FES-based MT with motion recognition biofeedback device. All interventions were conducted for 30 min/d, 5 d/wk, for 4 weeks. Upper limb motor recovery, upper limb function, active-range of motion (ROM), and activities of daily living independence were measured before and after the intervention and compared between the 2 groups. Results: The Fugl-Meyer assessment (FMA), manual function test (MFT), K-MBI, and active-ROM (excluding deviation) were significantly improved in both groups (P &lt; .05). Only the experimental group showed significant improvement in upper extremity recovery, ulnar and radial deviation (P &lt; .05). There was a significant difference of change in Brunstrom’s recovery level, FMA, MFT, and active-ROM in the experimental group compared to the control group (P &lt; .05). Conclusion: FES-based MT using gesture recognition biofeedback is an effective intervention method for improving upper extremity motor recovery and function, active-ROM in patients with chronic stroke. This study suggests that incorporating gesture-recognition biofeedback into FES-based MT can provide additional benefits to patients with chronic stroke.

Effectiveness of functional electrical stimulation machine in managing neurological diseases - A retrospective study.

Cerebrovascular Accident (CVA) or stroke, Spinal Cord injury can lead to neurological diseases resulting in major loss in motor function causing hemiplegia or tetraplegia. In 2019, according to The Global Burden of Diseases (GBD) CVA/Stroke is the second leading cause of death and the third leading cause of death and disability combined, globally. Its prevalence vary drastically among South Asian countries. The objective of this study was to determine the effectiveness of Functional Electrical Stimulation (FES) machine on neurologically impaired patients at the Physical Therapy department at IHHN, Karachi, Pakistan. In this retrospective study data was extracted from August 2016 to February 2022 on patients with neurological symptoms i.e. hemiplegia or paraplegia with muscle power of two or less on Manual Muscle Testing (MMT). The parameters for evaluating patients progress pre and post treatment were MMT results and their mobility status. The number of sessions ranged between 40 to 100 sessions of Functional Electrical Stimulation (FES) provided on alternate days according to the patient's need. Data of 51 patients who had completed their treatment were extracted and analyzed. The mean age of patients who completed treatment was 49.62 ± 17.26 years. Out of 51(100%), 30 (58.8%) were male and 21 (41.2%) were female. Pre- and post-treatment median (IQR) showed remarkable improvement in MMT of upper limb muscle (from 1.0 to 4.0) and lower limb muscle (from 2.0 to 4.0). FES cycling is an effective treatment for patients with neurological impairments, as it resulted in improvement in both upper and lower limb muscle strength, along with mobility status.

Orthotic effects of functional electrical stimulation (FES) on gait and dual-task ability in adult patients with upper motor neuron disease

Orthotic effects of functional electrical stimulation (FES) on gait and dual-task ability in adult patients with upper motor neuron disease

Effect of functional electric stimulation on phonation in an ex vivo aged ovine model.

With age, the atrophy of the thyroarytenoid muscle (TAM), and thus atrophy of the vocal folds, leads to decreased glottal closure, increased breathiness, and a loss in voice quality, which results in a reduced quality of life. A method to counteract the atrophy of the TAM is to induce hypertrophy in the muscle by functional electric stimulation (FES). In this study, phonation experiments were performed with ex vivo larynges of six stimulated and six unstimulated ten-year-old sheep to investigate the impact of FES on phonation. Electrodes were implanted bilaterally near the cricothyroid joint. FES treatment was provided for nine weeks before harvesting. The multimodal measurement setup simultaneously recorded high-speed video of the vocal fold oscillation, the supraglottal acoustic signal, and the subglottal pressure signal. Results of 683 measurements show a 65.6% lower glottal gap index, a 22.7% higher tissue flexibility (measured by the amplitude to length ratio), and a 473.7% higher coefficient of determination (R2) of the regression of subglottal and supraglottal cepstral peak prominence during phonation for the stimulated group. These results suggest that FES improves the phonatory process for aged larynges or presbyphonia.

Student Researcher Spotlight

Matthew is an undergraduate student in the Faculty of Science who is researching the effects of functional electrical stimulation on glial cells of the nervous system. His image titled Galaxies of Glia Interface with Technology is featured on the back cover of this issue.

Effect of Functional Electrical Stimulation in Convalescent Stroke Patients: A Multicenter, Randomized Controlled Trial

We evaluated whether the Walkaide® device could effectively improve walking ability and lower extremity function in post-stroke patients with foot drop. Patients aged 20-85 years with an initial stroke within ≤6 months and a functional ambulation classification score of 3 or 4 were eligible. Patients were randomly allocated to the functional electrical stimulation (FES) or control group at a 1:1 ratio. A 40 min training program using Walkaide was additionally performed by the FES group five times per week for 8 weeks. The control group received the 40 min training program without FES. A total of 203 patients were allocated to the FES (n = 102) or control (n = 101) groups. Patients who did not receive the intervention or whose data were unavailable were excluded. Finally, the primary outcome data of 184 patients (n = 92 in each group) were analyzed. The mean change in the maximum distance during the 6-MWT (primary outcome) was 68.37 ± 62.42 m and 57.50 ± 68.17 m in the FES and control groups (difference: 10.86 m; 95% confidence interval: -8.26 to 29.98, p = 0.26), respectively. In Japanese post-stroke patients with foot drop, FES did not significantly improve the 6 min walk distance during the convalescent phase. The trial was registered at UMIN000020604.

Effects of Functional Electrical Stimulation with and without Kinesiotherapy on Pain, Range of Motion and Quality of Life in Patients with Cervical Dystonia; A Randomized Clinical Trial

Methods: This study was a Randomized Controlled Trial conducted at The University of Lahore Teaching Hospital, University Institute of Physical Therapy, Lahore. n= 84 patients with Cervical Dystonia were recruited in this study using non- probability convenient sampling technique. Patients suffering with Cervical Dystonia who aged between 30 till 50 years were randomly assigned into two groups, 42 patients in each group. First Group A which was the control group which was treated with Functional Electrical Stimulation and routine physical therapy only while Group B was the Experimental group which was treated with Functional Electrical Stimulation also with kinesiotherapy and routine physical therapy. Both the groups were evaluated and assessed using the Toronto Western Spasmodic Torticollis Rating Scale, the Pain Numerating Scale, the 36- item short form health survey( SF-36), Neck Disability index and range of motion of neck flexion, neck extension and neck rotation was measured using universal goniometer. Results: Functional Electrical Stimulation combined with kinesiotherapy given to the experimental group showed more improvement in range of motion, quality of life , functional disability and the symptom of the pain also was reduced in the experimental group as compared to the control group. The mean values showed that there was a statistically significant difference in different variables between both the groups. When the scores( scores at baseline and at 16th week) for Toronto Western Spasmodic Torticollis Rating Scale for both the groups were compared it showed statistical difference between both the groups(p&lt;0.05). Conclusion: Despite the fact that cervical dystonia has central neurological etiology, this study concludes that multimodal kinesiotherapy program which included stretching and relaxation, active exercises in addition to Functional Electrical Stimulation and Routine Physical Therapy tempts to have beneficial effects on a patient suffering from Cervical Dystonia. It showed beneficial effects on pain, quality of life, functional disability and range of motion of patients with cervical dystonia. Key Words: Functional Electrical Stimulation, Kinesiotherapy, Cervical Dystonia, Pain, Rang of Motion, Quality of life

Effect of Functional Electrical Stimulation on Muscle Mass, Fatigue, and Quality of Life in Older Patients With COVID-19: A Randomized Clinical Trial Study

ObjectiveThis study aimed to evaluate the effects of functional electrical stimulation (FES) on muscle strength, fatigue, muscle mass, and quality of life (QoL) in older patients with COVID-19. MethodsOlder patients with COVID-19 were randomly divided into the following 2 groups: real FES (intervention group, n = 20) and sham FES (control group, n = 20). These patients received FES concurrent with the voluntary contraction of muscles for 10 consecutive sessions. Ultrasound imaging, pressure biofeedback, Chalder fatigue scale, and QoL were utilized to measure muscle mass, muscle strength, chronic fatigue, and QoL, respectively. Evaluations were performed at the beginning, immediately, and 1 month after the end of intervention. ResultsAll variables showed statistically significant improvement immediately and 1 month after the intervention in the real FES group (P < .05). However, the tibialis anterior muscle mass and fatigue significantly improved immediately after the intervention in the sham FES group. However, the tibialis anterior and rectus femoris muscles strength and rectus femoris muscle mass were not significantly changed immediately and 1 month after the intervention (P > .05). There were significant differences in muscle mass, physical fatigue, muscle strength, and QoL between groups with more efficacy of real FES (P < .05). ConclusionFor this sample of patients, FES improved fatigue, muscle strength, muscle mass, and QoL in older adults with COVID-19.

Effectiveness of Functional Electrical Stimulation (FES) on Gluteus Muscle to Improve Gait in Patient with Spastic Diplegic Cerebral Palsy - A Single Case Study

Effectiveness of Functional Electrical Stimulation (FES) on Gluteus Muscle to Improve Gait in Patient with Spastic Diplegic Cerebral Palsy - A Single Case Study

Recent trends in applying functional electrical stimulation in the management of spastic paraplegia induced by spinal cord injury: a systematic review

IntroductionFunctional electrical stimulation is one of the latest emerging trends in the field of electrotherapy in physiotherapy practice. It is nowadays used as an orthotic device for functional activity. The study aimed to determine the effectiveness of functional electrical stimulation in spasticity of lower extremity in spinal cord injury patients.MethodsWe conducted a qualitative systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic literature search covered articles published in years 2000–2020. The databases considered for the literature search were PubMed, Cochrane, ScienceDirect, and Google Scholar. The Medical Subject Headings (MeSH) applied for the search included "functional electrical stimulation", "lower limb", "rehabilitation", "spasticity", "spinal cord injury". The records were assessed for the risk of bias with the RoB 2 Cochrane tool.ResultsThe statistical evidence suggests functional electrical stimulation to be equivalent to other modes of treatment. The overall observation of the within-group results and the feedback from the patients indicate that functional electrical stimulation is superior to all other interventions in improving the functional activities of daily life.ConclusionsFrom the evidence collected within the limitations of the present systematic review, it can be concluded that the effectiveness of functional electrical stimulation allows to apply it as an adjunct to the standard treatments available with more priority.

Effects of Functional Electrical Stimulation on Attentional Function: A Study on Healthy Young Participants

Effects of Functional Electrical Stimulation on Attentional Function: A Study on Healthy Young Participants

Non-retentive faecal incontinence in children: Conventional therapy alone or combined electrical stimulation.

To compare the effects of functional electrical stimulation (FES) with conventional therapy and conventional therapy alone on improvement of faecal incontinence (FI) symptoms in a number of children with functional non-retentive FI. Data of 28 children with FI were accepted for this retrospective study. The case group (n= 14) underwent FES + conventional therapy and the control group (n= 14) received conventional therapy only. Data of children with faecal retention, inflammatory, anatomic, metabolic and neurological disorders were excluded. Children were assessed with a paediatric FI score questionnaire, and a bowel habit diary both before treatment sessions, after they ended, and after 6 months. A FI quality of life questionnaire was completed before and after treatment for all children. Full response to the treatment (100% reduction in FI episodes) was significantly observed in 8/14 (57.1%) of children in the case group compared to 2/14 (14.2%) of children in the control group after the ending of treatment sessions (P= 0.005). The baseline mean ± SD of FI episodes per week was 3.7± 2.1 among both groups which significantly decreased after the ending of treatment sessions in the case group compared to the control group (1.4± 2.1 vs 3± 2.7; P= 0.05). Mean ± SD of FI score was significantly reduced in the case group compared to the controls after the ending of treatment sessions (3.9± 4.5 vs 8± 4.7; P= 0.02) and maintained after 6 months (P= 0.05). Functional electrical stimulation is a safe, effective, non-invasive, inexpensive, reproducible and easy-to-use modality for treatment of functional non-retentivefaecal incintinence in children.

Effect of Functional Electrical Stimulation on Capillary Blood Flow to Muscle.

Functional electrical stimulation (FES) modifies red blood cells (RBCs) flux in blood capillaries of muscle. In this work, we aim to investigate changes in the RBC flux in small and large capillaries due to FES using zinc oxide nanowires (ZnO NWs) based electrode at different stimulation parameters. The RBC flux was significantly increased immediately after stimulation, which was evident from decreasing light intensity measured in the region of interest. Clinical Relevance- FES has numerous forms and functions. The benefit of FES is the increased blood flow to a muscle which is contracted abnormally. This work explores the use of FES to increase the blood flow and RBC flux in blood capillaries of stimulated muscle as FES generate muscle contraction and absorption.

Effects of transcutaneous spinal stimulation on spatiotemporal cortical activation patterns: a proof-of-concept EEG study

Objective. Transcutaneous spinal cord stimulation (TSS) has been shown to be a promising non-invasive alternative to epidural spinal cord stimulation for improving outcomes of people with spinal cord injury (SCI). However, studies on the effects of TSS on cortical activation are limited. Our objectives were to evaluate the spatiotemporal effects of TSS on brain activity, and determine changes in functional connectivity under several different stimulation conditions. As a control, we also assessed the effects of functional electrical stimulation (FES) on cortical activity. Approach. Non-invasive scalp electroencephalography (EEG) was recorded during TSS or FES while five neurologically intact participants performed one of three lower-limb tasks while in the supine position: (1) A no contraction control task, (2) a rhythmic contraction task, or (3) a tonic contraction task. After EEG denoising and segmentation, independent components (ICs) were clustered across subjects to characterize sensorimotor networks in the time and frequency domains. ICs of the event related potentials (ERPs) were calculated for each cluster and condition. Next, a Generalized Partial Directed Coherence (gPDC) analysis was performed on each cluster to compare the functional connectivity between conditions and tasks. Main results. IC analysis of EEG during TSS resulted in three clusters identified at Brodmann areas (BA) 9, BA 6, and BA 4, which are areas associated with working memory, planning, and movement control. Lastly, we found significant (p < 0.05, adjusted for multiple comparisons) increases and decreases in functional connectivity of clusters during TSS, but not during FES when compared to the no stimulation conditions. Significance. The findings from this study provide evidence of how TSS recruits cortical networks during tonic and rhythmic lower limb movements. These results have implications for the development of spinal cord-based computer interfaces, and the design of neural stimulation devices for the treatment of pain and sensorimotor deficit.

P 52 Short-term therapeutic effects of functional electrical stimulation on the somatosensory evoked potentials in the rehabilitation of the patients after the stroke: an interventional study

Objective: The aim was to investigate whether the short-term therapeutic effects of functional electrostimulation (FES) have a role in improving pathological latencies and/or amplitudes of somatosensory evoked potentials (SSEPs) caused by a cortical post-stroke lesion in acute patients with a foot drop. Methods: A randomized clinical sequential two-period crossover-design protocol was constructed and the study followed the PICO Consort criteria. 32 patients were divided in a two separate consecutive treatment periods as part of a four-week inpatient neurological rehabilitation. All patients received conventional rehabilitation therapy. Additionally, group A was treated with FES for two weeks and after this period Group A and Group B were switched. Results: The initial results indicated interaction between functional electrostimulation and the primary somatosensory cortical complex because we observed at this stage of the study that the cortical latency P40 of the intervention group remained invariable. Nevertheless, the control group indicated increase in P40 latency delay. Further data evaluation is necessary to answer the main objective of the study.