Effects Of Functional Electrical Stimulation Research Articles

Validation and Use of a Musculoskeletal Gait Model to Study the Role of Functional Electrical Stimulation.

Musculoskeletal modeling has been used to predict the effect of functional electrical stimulation (FES) on the mechanics of the musculoskeletal system. However, validation of the resulting muscle activations due to FES is challenging as conventional electromyography (EMG) recording of signals from the stimulated muscle is affected by stimulation artefacts. A validation approach using a combination of musculoskeletal modeling and EMG was proposed, whereby the effect on nonstimulated muscles is assessed using both techniques. The aim is to quantify the effect of FES on biceps femoris long head (BFLH) and validate this directly against EMG of gluteus maximus (GMAX). The hypotheses are that GMAX activation correlates with BFLH activation; and the muscle activation during FES gait can be predicted using musculoskeletal modeling. Kinematics, kinetics, and EMG of healthy subjects were measured under four walking conditions (normal walking followed by FES walking with three levels of BFLH stimulation). Measured kinematics and kinetics served as inputs to the musculoskeletal model. Strong positive correlations were found between GMAX activation and BFLH activation in early stance peak (R = 0.78, p = 0.002) and impulse (R = 0.63, p = 0.021). The modeled peak and impulse of GMAX activation increased with EMG peak (p < 0.001) and impulse (p = 0.021). Musculoskeletal modeling can be used reliably to quantify the effect of FES in a healthy gait. The validation approach using EMG and musculoskeletal modeling developed and tested can potentially be applied to the use of FES for other muscles and activities.

Effectiveness of functional electrical stimulation of gait. Evaluating of modifications to the center of pressure for a hemiparetic patient

Drop foot is the principal ambulatory anomaly impacting hemiplegic patients. The effectiveness of Functional Electric Stimulation (FES) on gait parameters in hemiplegics has been demonstrated over the medium and long term. Clinical evaluation of this setup and its’ effectiveness is not always easy; changes in gait parameters being difficult to measure solely by observation. Ideally, the application of FES should be done along with a 3-D analysis of the patient's gait, which can be a time-consuming procedure. The goal of this study is to evaluate dynamic changes in the center of pressure (COP), measured using an instrumented walkway, when applying FES. A mono-paretic patient, stable after frontal tumor surgery, was treated with FES of the fibularis communis nerve. The evaluation of gait, at a comfortable walking pace, was realized using an analysis of both spatio-temporal parameters and COP, obtained using the GAITRite walkway. The evaluation was conducted, immediately before and after application of FES. Spatio-temporal gait parameters (walking speed, stride length, cadence) were not modified by FES. Our analysis confirms an immediate ‘posteriorization’ of the COP upon initial application of FES. Net postero-anterior displacement of the COP was increased by FES. This study confirms the findings in the referenced literature, where during same-day evaluation, FES is shown to not modify spatio-temporal parameters. These modifications only being manifest during prolonged use. We observed changes in the net displacement of the COP on initial application of FES. This corroborates a recent study, which suggests that FES could have an immediate effect on weight transfer and thus increase gait stability. The evaluation of the displacement in the COP could represent a readily observable parameter in gauging the effectiveness of FES when applied to patients with drop-foot. This parameter could be easily and objectively measured with available tools such as an instrumented walkway.

Effect of functional electrical stimulation of the peroneal nerve on antagonist resistances measured during swing phase of gait in spastic paresis. A randomized, controlled study

In hemiparesis, functional electrical stimulation (FES) of the peroneal nerve aims to compensate for ankle dorsiflexor paresis in swing phase. The present prospective study compared the effects of gait training with FES vs. conventional therapy on plantar flexor overactivity. Twenty subjects with chronic hemiparesis (6 ± 4years post-lesion; mean ± SD) were randomized into two groups: FES (45 min/day of gait self-training using FES) and Control (CON, 3 × 45 min/week of conventional physiotherapy) for 10 weeks. Outcomes at Day 1 and Week 10 included comfortable speed barefoot gait analysis with gastrocnemius medialis (GM) and soleus (SO) electromyography, yielding:, walking speed; and, at the paretic ankle: maximal passive dorsiflexion during stance, maximal active dorsiflexion during swing, velocity of active dorsiflexion over early swing, coefficient of spastic cocontraction in GM and SO over the three thirds of swing (CSC, calculated by the ratio of the RMS of the electromyogram in the period of interest over the RMS of the electromyogram of the same muscle over 100 ms around its maximal voluntary contraction). Intra- and inter-group comparison used rank-ANOVAs. No difference was observed in walking speed changes (both groups pooled; D1, 0.73 ± 0.25 m/s, W10, 0.80 ± 0.30 m/s, ns) and in passive and active dorsiflexion amplitudes (ns). However, the velocity of active dorsiflexion increased in FES while it decreased in Controls (D1 vs. W10, FES, +5 ± 2°/s, P = 0.02; CON, −4 ± 1°/s, P = 0.04). In parallel, CSC GM in early swing tended to improve in FES only (FES, −41 ± 23%, P = 0.09; CON, −24 ± 89%, ns; between group difference ns). In chronic hemiparesis, FES, which focuses on agonist dorsiflexor stimulation during gait improves active dorsiflexion velocity in swing and may also be associated with reduction of plantar flexor spastic cocontraction. Further studies are required to confirm these findings and evaluate whether reciprocal inhibition toward plantar flexors may be restored by FES.

An initial study on the effect of functional electrical stimulation in erectile dysfunction: a randomized controlled trial.

Erectile dysfunction (ED) affects approximately 150 million men worldwide. Functional electrical stimulation (FES) therapy has shown a high regenerative capacity for smooth muscle cells and, therefore, is being increasingly adopted. FES can be a beneficial treatment option when the cause of ED is related to degeneration of cavernous smooth muscle. To evaluate the impact of FES on erectile function in men with erectile dysfunction. Twenty-two patients with ED participated in this randomized clinical trial. Participants were randomly assigned to two groups: intervention (IG) or control (CG). IG participants underwent FES therapy (50 Hz/500 µs) for a total of 4 weeks, divided into two weekly sessions lasting 15 min each, with intensity lower than the motor threshold. CG participants were treated with placebo FES and followed the same routine as the IG. Erectile function was assessed by the validated International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS), applied before and after treatment, and quality of life, by the WHOQOL questionnaire. Statistically significant differences in IIEF-5 and EHS were found between the IG and CG after treatment (p < 0.05), as well as a within-group difference in the IG when comparing the post-treatment periods (p < 0.0001) The WHOQOL revealed a significant difference between CG and IG after treatment (p < 0.05), as well as a within-group difference in the IG after treatment (p < 0.0001), except in the Environment domain, in which there was no difference between the pre- and post-treatment periods (50.9 ± 2.8 pre vs. 52.3 ± 3.1 post). This trial showed that FES therapy may improve erectile function and quality of life in men with ED.

Effects of biofeedback versus switch-triggered functional electrical stimulation on sciatica-related foot drop.

Sciatica-related Foot Drop is a peripheral nervous condition that produces a loss of power in the ankle dorsiflexion muscles. Functional electrical stimulation is a modality of electrical stimulation that produces muscle contraction in a functional movement of the limb. This technique was utilized with positive effects in central nervous afflictions but it is not known whether or not it has any influence in motor recovery following peripheral nervous system problems. This study aims to clarify the effects of functional electrical stimulation on foot drop caused by peripheral nerve compression resulting from lumbar disc herniation. Fifty patients were enrolled in our study; of whom 25 were treated with EMG triggered electrical stimulation (EMG-FES) and 25 with heel-floor sensor triggered electrical stimulation (SWITCH-FES) during normal gait cycle. Patients received functional electrical stimulation (with a pulse of 60 Hz and phase duration of 200 ms) once a day, for 30 minutes during 5 consecutive days, over a period of 4 weeks. Electrical diagnostic tests (nerve conduction velocity/NCV and the amplitude of compound muscle action potential/CMAP), dynamometry and Osvestry Disability Index scores were measured at baseline and after treatment. We found that axonal loss was lower in the EMG-FES group than in the SWITCH-FES group (p< 0.004). The motor functional recovery was higher in terms of muscle force and overall functional status for the EMG-FES group compared to the SWITCH-FES group. This was underlined by Dynamometry test with a p value of < 0.0001 and ODI score with a statistical significant p value of < 0.0001. The overall results showed that there was a significant increase in all the parameters studied for both types of FES applications. However we found that the EMG triggered electrical stimulation technique had a higher influence on the quality of the muscle action control. For patients who cannot yet produce minimal muscle active contraction we recommend switch triggered stimulation first and then, immediately after the recovery of the motor control, to change to EMG triggered functional electrical stimulation.

Influence of functional electrical stimulation of the hamstrings on knee kinematics in stroke survivors walking with stiff knee gait.

To explore whether functional electrical stimulation of the hamstrings results in improved knee kinematics in chronic stroke survivors walking with a stiff knee gait. Quasi-experimental. Sixteen adult chronic stroke survivors. Survivors received functional electrical stimulation of the hamstrings, 3 times a week for 1 h during a period of 5 weeks. 3D kinematics was calculated before the training period and after 5 weeks of training. Knee kinematics of walking without stimulation before the training period was compared with walking with stimulation after 5 weeks of training. (intervention effect). In addition, knee kinematics of walking without stimulation before the training period was compared with walking without stimulation after the training period (therapeutic effect). The intervention effect showed a significant increase, of mean 8.7° (standard deviation (SD) 8.3, p = 0.001), in peak knee flexion. The therapeutic effect showed a significant increase in peak knee flexion, of mean 3.1° (SD 4.7, p = 0.021) Conclusion: The results of this exploratory study suggest an increase in knee kinematics in swing after functional electrical stimulation of the hamstrings in stroke survivors walking with a stiff knee gait. The largest improvement in peak knee flexion in swing was seen when participants walked with hamstring stimulation. Participants with low neurological impairment responded better to hamstring stimulation, and there are indications that the effect of hamstring stimulation can be predicted during a single session. The effect of functional electrical stimulation is comparable to that of more invasive treatment options, such as botulinum toxin or soft-tissue surgery. This makes functional electrical stimulation a feasible treatment option for daily clinical practice.

The Effect of Functional Electrical Stimulation on Stroke Recovery: A Randomized Controlled Trial

The Effect of Functional Electrical Stimulation on Stroke Recovery: A Randomized Controlled Trial

A comparison of the initial orthotic effects of functional electrical stimulation and ankle-foot orthoses on the speed and oxygen cost of gait in multiple sclerosis.

BackgroundFoot drop affects walking in people with multiple sclerosis (pwMS). This study compares the initial orthotic effects of two treatments for foot drop: ankle-foot orthoses (AFO) and functional electrical stimulation (FES), on the speed and oxygen cost of walking in MS.Method and materialsSeventy-eight pwMS were randomised to receive AFO or FES (ODFS PACE (OML, Salisbury, UK)). Participants completed the 25-ft walk test (25ftWT) and 5-min self-selected walk test (5minSSWT), from which oxygen cost was determined, with and without their device. Between-, within- and sub-group analyses (based on baseline walking speed of <0.8 m/s (slow) or ≥0.8 m/s (fast)) were undertaken.ResultsNo significant differences between baseline measures were observed. The AFO group walked significantly slower than the FES group (5minSSWT, p = 0.037, 0.11 m/s). The AFO group walked significantly slower with than without AFO (25ftWT, p = 0.037), particularly in the fast-walking group ( p = 0.011). The slow-walking FES group walked significantly faster with FES than without (25ftWT; p = 0.029, 5minSSWT; p = 0.037). There were no differences in the fast-walking FES group or in the oxygen cost for either device.ConclusionAFO reduced walking speed, particularly in fast walkers. FES increased walking speed in slow, but not fast walkers.

The Effectiveness of Functional Electrical Stimulation (FES) in On-Off Mode for Enhancing the Cycling Performance of Team Phoenix at 2016 Cybathlon.

In this study we designed a Functional Electrical Stimulation (FES) trike for a female subject with spinal cord injury to exercise her lower limbs and improve her lower limb muscle condition for attending the 2016 Cybathlon FES bike competition. Our FES pilot was the only female participant, in the FES cycling competition and she rode for Team Phoenix from the Chinese University of Hong Kong. Due to the weakness of muscles in the lower limb of the subject, and due to scoliosis over her thoracolumbar aéra, the mechanical structure of the trike had to be tailor-made to ensure she sat on the bike in a safe and secure position. A six-phase angle-driven stimulation pattern was developed to stimulate quadriceps and hamstrings without gluteus muscles for contraction through four surface electrodes, thereby creating a cycling movement. To improve the cycling endurance and reduce the muscle fatigue, an on-off mode was developed for controlling the stimulation time that allowed the subject to cycle for 20s, then pause while the trike advanced without stimulation for 5s, followed by a subsequent 20 sec stimulation, to continue cycling. The pilot participated in the training procedure including training exercise at home, trike fitting in the trike by modifying the mechanical structure, and conducting the cycling exercise for six months. We observed significant improvements in the pilot’s lower limb condition. The on-off mode enabled our pilot to extend her cycling endurance effectively, from 1 min to 2.5 mins and the distance from 62m to 100m. Over the eight minutes time limit, our team successfully finished 100 m in the Cybathlon FES.

Five-Year Follow-up of a Longitudinal Cohort Study of the Effectiveness of Functional Electrical Stimulation for People with Multiple Sclerosis.

Few studies have examined the long-term consequences of using peroneal nerve functional electrical stimulation (FES) for people with multiple sclerosis (MS). This study examines orthotic effects on a longitudinal cohort and explores additional benefits of FES on self-reported measures such as joint pain. One hundred forty-five people with foot drop and MS were included (mean age, 52 [range, 28-74] years). Orthotic effects, unassisted walking speed, and clinically important differences (ie, ≥0.05 and ≥0.10 m/s) were derived from walking speed over 10 m. Visual analogue scales examined joint pain, walking effort, trips, confidence, and quality of life. Measures were taken on day 1, after 6 months, and at 2, 3, 4, and 5 years. A significant difference was found overall for walking with FES compared with walking without FES for the 5-year period (P < .001). Despite a significant decline in overall unassisted walking speed at baseline (0.58 m/s) compared with 5 years later (0.46 m/s) (P < .001), participants achieved an orthotic effect with (0.52 m/s) versus without (0.46 m/s) FES after 5 years (P < .001). A significant decrease in joint pain was found after 6 months compared with day 1 (P = .004), which was maintained after 5 years (P < .001). Despite progression of MS, long-term users of FES still benefit from an orthotic effect after using FES for 5 years. The study highlights the need for further work to assess the perceived benefits of FES regarding the experience of joint pain.

Study on the effect of intelligent assistance model functional electrical stimulation on children with spastic diplegic cerebral palsy

Objective To study the effect of functional electrical stimulation(FES) with innovative static state combined assistance pattern on lower extremity muscle status, motor function and walking function in children with spastic diplegic cerebral palsy. Methods A total of 40 children with spastic diplegic cerebral palsy were randomly divided into a observation group (20 cases) and a control group (20 cases), which were selected from the Third Affiliated Hospital of Jiamusi University from March 2016 to July 2016.The observation group included 11 males and 9 females, aged 3 to 6 years old, on the average of (4.80±1.06)years; the control group including 7 males and 13 females, aged 3 to 6 years old, with mean age (4.75±0.96)years.The control group was only treated with conventional rehabilitation therapy such as kinesitherapy and occupational therapy.On the basis of routine rehabilitation therapy, the observation group was treated with functional electrical stimulation with innovative static state combined with intelligent assistance patterns.All the therapies including conventional and FES treatment were conducted once per day, 5 times per week, total for 8 weeks totally.The outcomes before treatment, 4 weeks after treatment and 8 weeks after treatment for all the subserved objects were evaluated by modified Ashworth scale(MAS), including joint range of motion(ROM), manual muscle assessment (MMT), gross motor function scale (GMFM-88 D and E regions), gait analysis and musculoskeletal ultrasound (measured muscle thickness). All the data were collected and analyzed by SPSS 17.0 statistical software. Results After 4 weeks to 8 weeks of treatment, 2 groups of children with joint range of motion of lower limbs, muscle strength, muscle tension, GMFM-88 score of D and E regions, muscle thickness and gait in 2 groups of children were improved than those before treatment (P<0.05), after 4 to 8 weeks of treatment, 2 groups of children with lower limb joint activity, muscle strength, muscle tension, GMFM-88 score, D and E regions of the muscle thickness and gait in 2 groups of children were improved than those before treatment, and the differences were significant (P<0.05). The evaluation index of the observation group, Ashworth[left (1.80±0.52) scores, right (3.40±0.88) scores], ROM[left (19.5±2.8)°, right (19.4±1.5)°], muscle strength[left (1.80±0.52) grade, right (2.00±0.56) grade] and muscle thickness[left gastrocnemius (32.35±1.79) mm, right gastrocnemius(32.95±2.63) mm, left anterior tibial muscle(30.60±1.00) mm, right anterior tibial muscle(30.05±1.8) mm], were all significantly better than those of the control group (all P<0.05). Step length (23.75±3.19) cm and step speed (0.45±0.01) m/s compared with the control group improved significantly compared with the control group (P<0.05), the GMFM scores [D regions (31.30±1.46) scores, E regions (48.95±1.40) scores]was significantly higher than those of the control group (P<0.05). Conclusions The FES with innovative static state combined with intelligent assistance pattern can effectively improve the lower limb muscle state and motor function in children with spastic diplegic cerebral palsy. Key words: Functional electrical stimulation; Spastic diplegic; Cerebral palsy

The Effects of Functional Electrical Stimulation Combined with Action Observation on Sensorimotor Cortex

Purpose: Functional electrical stimulation (FES) is a device that activates the sensorimotor cortex through electrodes attached to the surface of the skin. However, it is difficult to expect positive changes if the recipient is not attentive to the motion. To complement the perceived cognitive limitations of FES, we attempted to investigate the changes of sensorimotor cortex activity by simultaneously providing action observation with FES. Methods: Electroencephalogram was measured in 28 healthy volunteers. Relative band power over the sensorimotor cortex was analyzed and compared in three conditions: during rest, during FES alone, during action observation with FES. Results: The results showed significant differences in each relative band power. Relative alpha power and relative beta power were the lowest by application of FES combined with action observation, while the relative gamma power was the highest. Conclusion: These results suggest that combining FES with observation could be more effective than FES alone in neurorehabilitation.

P295 Effects of functional electric stimulation and task specific training on gait recovery in patients with stroke: Randomized controlled trial

Objectives This work was designed to assess the effects of functional electrical stimulation (FES) combined with task specific training on gait recovery in stroke patients. Methods Thirty hemiparetic stroke patients aged 40–58 years old were randomly assigned into two equal groups; the control group had received conventional physiotherapy program while the study group had received the same program in addition to FES therapy during treadmill training. Two dimensional (2D) gait analysis was used to assess gait parameters before and after completion of the treatment sessions. Results A statistically significant improvement had been reported in all gait parameters in the post-treatment assessment of the study group as compared to the control group including the gait velocity (P = 0.048), cadence (P = 0.030), ten meters walking time (P = 0.043), step length (P = 0.033), stride length (P = 0.015) and the instantaneous angles of knee and ankle of the affected lower limb during gait cycle sub-phases. Discussion These results may be attributed to physiological effect of FES during treadmill training. It induces afferent-efferent stimulation which results in limb movement. It provides task-oriented practice of walking and active repetitive movement training. It activates sensory inputs and central neuronal circuits that allow optimal motor learning. It stimulates neuronal recovery and neuroplasticity. Conclusion FES therapy combined with conventional stroke rehabilitation program improves gait parameters when compared to conventional therapy alone in hemiparetic stroke patients. Significance The beneficial effects of FES on gait encourage the corporation of its use in the rehabilitation programs for patients with hemiparetic stroke.

Functional electrical stimulation of the ankle dorsiflexors during walking in spastic cerebral palsy: a systematic review

To assess the effect of functional electrical stimulation (FES) of ankle dorsiflexors in children and adolescents with spastic cerebral palsy (CP) during walking. A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched for studies applying interventions to patients aged younger than 20years. Outcomes were classified according to the International Classification of Functioning, Disability and Health (ICF). Seven hundred and eighty abstracts were found, 35 articles were fully screened, and 14 articles were used for analysis. Only five articles (three studies) were of level I to III evidence. At ICF participation and activity level, there is limited evidence for a decrease in self-reported frequency of toe-drag and falls. At ICF body structure and function level, there is clear evidence (I-III) that FES increased (active) ankle dorsiflexion angle, strength, and improved selective motor control, balance, and gait kinematics, but decreased walking speed. Adverse events include skin irritation, toleration, and acceptation issues. There are insufficient data supporting functional gain by FES on activity and participation level. However, evidence points towards a role for FES as an alternative to orthoses in children with spastic CP. Effects of functional electrical stimulation (FES) point towards a potential role as an alternative to orthoses for patients with spastic cerebral palsy (CP). Some evidence for a decrease in self-reported frequency of toe-drag and falls with the use of FES in spastic CP. Limited evidence for improvements in activity and participation in patients with spastic CP using FES.

A Randomized Controlled Study: Effectiveness of Functional Electrical Stimulation on Wrist and Finger Flexor Spasticity in Hemiplegia

The objective of this study was to investigate the effectiveness of functional electrical stimulation (FES) applied to the wrist and finger extensors for wrist flexor spasticity in hemiplegic patients. Thirty stroke patients treated as inpatients were included in the study. Patients were randomly divided into study and control groups. FES was applied to the study group. Wrist range of movement, the Modified Ashworth Scale (MAS), Rivermead Motor Assessment (RMA), Brunnstrom (BS) hand neurophysiological staging, Barthel Index (BI), and Upper Extremity Function Test (UEFT) are outcome measures. There was no significant difference regarding range of motion (ROM) and BI values on admission between the groups. A significant difference was found in favor of the study group for these values at discharge. In the assessment within groups, there was no significant difference between admission and discharge RMA, BS hand, and UEFT scores in the control group, but there was a significant difference between the admission and discharge values for these parameters in the study group. Both groups showed improvement in MAS values on internal assessment. It was determined that FES application is an effective method to reduce spasticity and to improve ROM, motor, and functional outcomes in hemiplegic wrist flexor spasticity.

Clinical curative effect observation on functional electrical stimulation combined with biofeedback pelvic floor exercise of pelvic congestion syndrome

Objective : Analyze the curative effect of functional electrical stimulation combined with biofeedback pelvic floor muscle training in the treatment of pelvic congestion comprehensive syndrome. Methods : A retrospective analysis of our hospital during June 2013 to June 2015 45 cases by analgesic drugs and traditional Chinese medicine enema poor treatment of pelvic congestion syndrome in patients with functional electrical stimulation combined with biofeedback pelvic floor muscle training in the treatment, current frequency 10-20Hz period of 200 microseconds pulse, current intensity for 10 ~ 50mA, for 30 min each time, 2 times a week, continuous treatment for 5 weeks. Before and after the treatment of pelvic vein diameter and blood flow rate, as well as the pain score [using the pain score table (VAS)]. Results : Patients in the treatment without adverse reaction and after treatment of pelvic vein diameter (2.9 + 1.6 mm was significantly lower than the treatment of 7.5 + 2.6) mm, P < 0.05, venous blood flow velocity (84.9 + 3.8) mm / s significantly faster than before treatment (53.6 + 2.9) mm / s, P < 0.05. The total effective rate was 91.1%, pain score (2.52 + 1.29) were significantly lower than those before treatment (4.82 + 1.29) (P < 0.05). Conclusion : functional electrical stimulation combined with biological feedback and pelvic muscle exercise can significantly alleviate the pelvic congestion syndrome pain symptoms. The curative effect is distinct and worth popularization in clinical.

Effect of functional electrical stimulation on cardiovascular outcomes in patients with chronic heart failure.

Background/design Functional electrical stimulation of lower limb muscles is an alternative method of training in patients with chronic heart failure (CHF). Although it improves exercise capacity in CHF, we performed a randomised, placebo-controlled study to investigate its effects on long-term clinical outcomes. Methods We randomly assigned 120 patients, aged 71 ± 8 years, with stable CHF (New York Heart Association (NYHA) class II/III (63%/37%), mean left ventricular ejection fraction 28 ± 5%), to either a 6-week functional electrical stimulation training programme or placebo. Patients were followed for up to 19 months for death and/or hospitalisation due to CHF decompensation. Results At baseline, there were no significant differences in demographic parameters, CHF severity and medications between groups. During a median follow-up of 383 days, 14 patients died (11 cardiac, three non-cardiac deaths), while 40 patients were hospitalised for CHF decompensation. Mortality did not differ between groups (log rank test P = 0.680), while the heart failure-related hospitalisation rate was significantly lower in the functional electrical stimulation group (hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.21-0.78, P = 0.007). The latter difference remained significant after adjustment for prognostic factors: age, gender, baseline NYHA class and left ventricular ejection fraction (HR 0.22, 95% CI 0.10-0.46, P < 0.001). Compared to placebo, functional electrical stimulation training was associated with a lower occurrence of the composite endpoint (death or heart failure-related hospitalisation) after adjustment for the above-mentioned prognostic factors (HR 0.21, 95% CI 0.103-0.435, P < 0.001). However, that effect was mostly driven by the favourable change in hospitalisation rates. Conclusions In CHF patients, 6 weeks functional electrical stimulation training reduced the risk of heart failure-related hospitalisations, without affecting the mortality rate. The beneficial long-term effects of this alternative method of training require further investigation.

The effects of functional electrical stimulation on muscle tone and stiffness of stroke patients.

[Purpose] The purpose of this study was to determine the effects of functional electrical stimulation on muscle tone and stiffness in stroke patients. [Subjects and Methods] Ten patients who had suffered from stroke were recruited. The intervention was functional electrical stimulation on ankle dorsiflexor muscle (tibialis anterior). The duration of functional electrical stimulation was 30 minutes, 5 times a week for 6 weeks. The Myoton was used a measure the muscle tone and stiffness of the gastrocnemius muscle (medial and lateral part) on paretic side. [Results] In the assessment of muscle tone, medial and lateral part of gastrocnemius muscle showed differences before and after the experiment. Muscle stiffness of medial gastrocnemius muscle showed differences, and lateral gastrocnemius muscle showed differences before and after the experiment. The changes were greater in stiffness scores than muscle tone. [Conclusion] These results suggest that FES on ankle dorsiflexor muscle had a positive effect on muscle tone and stiffness of stroke patients.

機能的電気刺激の慢性期脳卒中片麻痺下肢に対する効果

機能的電気刺激の慢性期脳卒中片麻痺下肢に対する効果

Training and orthotic effects related to functional electrical stimulation of the peroneal nerve in stroke.

To examine the evidence for a training effect on the lower limb of functional electrical stimulation. Cohort study. A total of 133 patients >6 months post-stroke. Training and orthotic effects were determined from walking speed over 10 m, associated minimal and substantial clinically important differences (i.e. >0.05 and >0.10 m/s), and Functional Ambulation Category (FAC), ranging from household walking to independent walking in the community. An overall significant (p < 0.01) training effect was found that was not a clinically important difference (0.02 m/s); however, "community" FAC (≥ 0.8 m/s) and "most limited community walkers" FAC (0.4-0.58 m/s), but not "household walkers" (< 0.4 m/s), benefitted from a clinically important difference. A highly significant (p< 0.001), substantial clinically important orthotic effect (0.10 m/s) was found. In terms of overall improvement of one or more FACs, 23% achieved this due to a training effect, compared with 43% due to an orthotic effect. The findings suggest that functional electrical stimulation provides a training effect in those who are less impaired. Further work, which optimizes the use of the device for restoration of function, rather than as an orthotic device, will provide greater clarity on the effectiveness of functional electrical stimulation for eliciting a training effect.