Effects Of Functional Electrical Stimulation Research Articles

The Effects of Functional Electrical Stimulation Cycling on Muscle Spasticity in Individuals with Spinal Cord Injury: A Systematic Review

Objectives: To evaluate the effects of functional electrical stimulation (FES) cycling on muscle spasticity in individuals with spinal cord injury (SCI) and provide recommendations for optimal FES cycling parameters to treat muscle spasticity. Method: In this systematic review, database searches of CINAHL, MEDLINE (Ovid), PEDro, PubMed, and Scopus were conducted to identify relevant studies published up to June 2023. Studies were screened for eligibility. Those that included an FES cycling intervention, an outcome measure of spasticity, and were available in full-text English were included. Two independent reviewers extracted the data and appraised the literature via the Crowe Critical Appraisal Tool (CCAT). Results: Of the 1782 studies identified, 16 satisfied the criteria for this review. Two-hundred and three participants were included, aged 7 to 80 years old. Ten studies identified a reduction in spasticity following FES cycling via objective or subjective outcome measures. Methodological quality was variable, with CCAT scores ranging from 19/40 (48%) to 35/40 (88%). National Health and Medical Research Council hierarchy levels ranged from II to IV. Conclusion: Evidence for the effectiveness of FES cycling to reduce muscle spasticity remains inconclusive. Long-term effects on spasticity were evident in moderate- to high-quality studies where FES cycling was conducted for 60 minutes, three times per week for 16 weeks. Additional research with larger sample sizes is warranted to confirm these findings. Further clarification of the optimal parameters of FES frequency, amplitude, and pulse width to reduce spasticity is required.

The effect of functional electrical stimulation on freezing of gait in people with parkinsons’ disease: a pilot study

The effect of functional electrical stimulation on freezing of gait in people with parkinsons’ disease: a pilot study

Comparing the effects of functional electrical stimulation with different frequencies and time duration to improve lower extremity muscle strength, gait, balance, posture control and quality of life among stroke patients

Comparing the effects of functional electrical stimulation with different frequencies and time duration to improve lower extremity muscle strength, gait, balance, posture control and quality of life among stroke patients

Effect of Functional Electrical Stimulation on Balance and Gait Speed of Stroke Patients: A Systematic Review and Meta-Analysis

Effect of Functional Electrical Stimulation on Balance and Gait Speed of Stroke Patients: A Systematic Review and Meta-Analysis

Comparison of the Conjunct Effects of Electrical Stimulation and Whole-Body Vibration Therapy with Transcranial Direct Current Stimulation and Whole-body Vibration Therapy on Balance and Function in Children With Spastic Cerebral Palsy.

Cerebral palsy is a neurodevelopmental condition that results in impaired movement and posture, often accompanied by disturbances in balance and functional abilities. Recent advances in neurorehabilitation, including whole-body vibration therapy (WBVT), functional electrical stimulation, and transcranial direct current stimulation, show promise in enhancing traditional interventions and fostering neuroplasticity. However, the efficacy of their conjunct effects remains largely uncharted territory and warrants further exploration. The objective of the study was to compare the conjunct effects of functional electrical stimulation (FES) and WBVT with transcranial direct current stimulation (tDCS) and WBVT on lower extremity range of motion (ROM), dynamic balance, functional mobility, isometric muscle strength and hand grip strength in children with spastic cerebral palsy. A randomized clinical trial was carried out on 42 children of both genders with spastic cerebral palsy, aged 5-15 years. The childrenwere dividedat random into three groups (14 in each group).In Group A, there were three (21.42%) males and 11 (78.57%) females, in Group B, eight (57.14%) were males and six (42.85%) were females, and in Group C, six (42.85%) children were males and eight (57.14%) were females. Group A received WBVT only, Group B received WBVT and FES, and Group C received WBVT and tDCS. The intervention was applied four times a week for four consecutive weeks. The data was collected two times before and immediatelyafter four weeks of intervention. Lower extremity ROM was measured by a goniometer, functional mobility or dynamic balance was measured by a Time Up and Go test, isometric muscle strength was measured by a digital force gauge, and hand grip strength was assessed by a digital hand-held dynamometer. IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) was utilized for statistical analysis. The mean age of the children in groups A, B, and C was 12.21±2.11 years, 11.71±2.01, and 11.07±2.01 years respectively. Intergroup analysis revealed a statistically significant difference (p<0.05) in the lower extremity range of motion, and functional mobility. Hand grip strength and isometric muscle strength between three groups. Post hoc analysis revealed that WBVT with transcranial direct current stimulation combined showed the most improvement. The study concluded that positive effects were seen in all three groups but tDCS with WBVT was found to be most effective in improving lower extremity ROM, functional mobility or dynamic balance, isometric muscle strength, and hand grip strength in children with spastic CP. The differences between the groups were statistically significant. The effect size was substantial enough to surpass established clinical benchmarks, indicating that the observed improvements are likely to have meaningful and beneficial impacts on patient outcomes.

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 &amp; 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 &gt;50% agreed strongly agreed, while &lt;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.

Effects of Functional Electrical Stimulation and Transcutaneous Electrical Nerve Stimulation on Spasticity and Muscle Properties in Spinal Cord Injured Individuals

The goal is to investigate and evaluate the effects of FES and TENS, individuals who have suffered spinal cord injury, spasticity of paresis or plethora leg muscles, and muscle characteristics. The study was conducted in the homes of the persons. Before and after stimulation, spasticity and muscle properties were measured using the myotonometer “Myoton”. Using Compex Cefar and Compex Mini stimulants, 30 min. FES was applied to the left leg and 30 min. of the TENS program to the right leg. The study involved 10 individuals who suffered spinal cord injury. Tens showed a statistically significant increase in the elasticity of the quadriceps thigh muscle (p &lt; 0.05), which means that the ability of the muscles to resist muscle contraction and the effects of external factors increased. All other measurements did not have a statistically reliable difference (p &gt; 0.05). No statistically significant difference was also found between the FES and TENS groups (p &gt; 0.05). Although FES and TENS did not have a statistically significant impact on elasticity and muscle tone, tens had a statistically significant deterioration in the muscle property of elasticity, which means that spasticity increased.

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