Effects Of Functional Electrical Stimulation Research Articles

Effectiveness of Single Functional Electrical Stimulation in Neurological Patients with Ankle-Foot Orthoses

Background: Drop foot is a distal deficiency common in patients with central nervous system diseases that makes clearance difficult during swing phase, contributes to inefficient gait compensations contribute to increase incidence of falls and energy expenditure. Aim of this study is to evaluate the effectiveness of a single application of functional electrical stimulation compared with ankle-foot orthoses in patients with drop foot. Methods: Patients enrolled were unable to walk and to perform test without ankle-foot orthoses. They were evaluated by 10-meters walk test, obstacles test, up-and-down stair test, six-minute walk test and gait analysis with inertial sensors. All tests were performed with ankle-foot orthoses and with no ankle-foot orthoses and application of single functional electrical stimulation. Results: Thirteen patients (8 males and 5 females) were recruited for this study out of 41 potential subjects. Data collected were processed by Student’s t test and by Wilcoxon test for paired observations and by Student’s t test and Mann-Whitney test for independent samples. P ≤ 0.05 were considered significant. For each test suitable effect sizes (Cohen’s d, and Pearson’s r) were calculated. Analysis of results with ankle-foot orthoses and with no anklefoot orthoses and application of single functional electrical stimulation showed no statistically significant difference in all test. Conclusions: The use of single functional electrical stimulation showed same effects of ankle-foot orthoses on walking capacity and motor performance in chronic neurological diseases. More studies would be required to assess the long term effectiveness of functional electrical stimulation and to evaluate if its application in acute-phase may be used in association with traditional treatment.

Therapeutic effects of functional electrical stimulation on gait, motor recovery, and motor cortex in stroke survivors

Abstract Background Many stroke survivors continue to experience gait deficits. Functional electrical stimulation may be a viable method to improve gait post-stroke. Objective The purpose of this parallel group controlled clinical trial was to investigate the therapeutic effect of functional electrical stimulation (FES) on gait, motor recovery, and motor cortex activity. Methods Adults experiencing foot drop n = 14) or the control group (physiotherapy, n = 14). Each group received their respective therapy 5 days/week for 12 weeks. Gait, surface electromyography (sEMG) of the tibialis anterior muscle in the affected leg, and electroencephalogram (EEG) signals from the foot motor area were assessed at baseline and again after the 12-week intervention. Results The results showed that the FES intervention induced significantly more changes in various gait swing parameters such as foot pulling acceleration (measured in unit of gravitational constant G; net between-group difference: 0.11 ± 0.02 G, p = 0.021), swing power (0.11 ± 0.03 G, p = 0.027) and ground impact (0.12 ± 0.04 G, p = 0.046) than the control group. EEG analysis revealed that the FES group had significantly altered beta-3 mean (0.50 ± 0.09, p = 0.021), beta-4 mean (0.60 ± 0.05, p = 0.024) and alpha peak frequency (0.15 ± 0.02, p = 0.035). Finally, analysis of sEMG data showed a significantly greater increase in amplitude (in root mean square; 13.2 ± 2.11 μV, p = 0.033), mean power frequency (5.5 ± 0.80 Hz, p = 0.024) and median power frequency (6.5 ± 0.90 Hz, p = 0.021) of the tibialis anterior muscle on the affected side in the FES group. Conclusion FES combined with physiotherapy induced better outcomes in the swing phase of the gait cycle, activation of the affected ankle dorsiflexor muscles and cortical function when compared with conventional physiotherapy alone.

Functional Electrical Stimulation for Foot Drop in Multiple Sclerosis

Functional electrical stimulation is an effective treatment strategy for the management of foot drop in various neurologic conditions, as demonstrated in improvements in gait performance, mobility, physiologic cost, perceived walking ability, balance, fall frequency, and quality of life. In this article, we review the current literature on the effects of functional electrical stimulation for foot drop in persons with multiple sclerosis.

Immediate Effects of Functional Electrical Stimulation on Kinematic and Kinetic Variables and Oxygenation in Medial Sensorimotor Cortices during Gait in Patients with Acute Cerebral Infarction

Immediate Effects of Functional Electrical Stimulation on Kinematic and Kinetic Variables and Oxygenation in Medial Sensorimotor Cortices during Gait in Patients with Acute Cerebral Infarction

Effect of Functional Electrical Stimulation on Improving Upper Extremity Motor Function in Stroke Patients Revealed by fMRI: a Controlled Study

Effect of Functional Electrical Stimulation on Improving Upper Extremity Motor Function in Stroke Patients Revealed by fMRI: a Controlled Study

Effects of a multichannel dynamic functional electrical stimulation system on hemiplegic gait and muscle forces.

[Purpose] The purpose of the study was to design and implement a multichannel dynamic functional electrical stimulation system and investigate acute effects of functional electrical stimulation of the tibialis anterior and rectus femoris on ankle and knee sagittal-plane kinematics and related muscle forces of hemiplegic gait. [Subjects and Methods] A multichannel dynamic electrical stimulation system was developed with 8-channel low frequency current generators. Eight male hemiplegic patients were trained for 4 weeks with electric stimulation of the tibia anterior and rectus femoris muscles during walking, which was coupled with active contraction. Kinematic data were collected, and muscle forces of the tibialis anterior and rectus femoris of the affected limbs were analyzed using a musculoskelatal modeling approach before and after training. A paired sample t-test was used to detect the differences between before and after training. [Results] The step length of the affected limb significantly increased after the stimulation was applied. The maximum dorsiflexion angle and maximum knee flexion angle of the affected limb were both increased significantly during stimulation. The maximum muscle forces of both the tibia anterior and rectus femoris increased significantly during stimulation compared with before functional electrical stimulation was applied. [Conclusion] This study established a functional electrical stimulation strategy based on hemiplegic gait analysis and musculoskeletal modeling. The multichannel functional electrical stimulation system successfully corrected foot drop and altered circumduction hemiplegic gait pattern.

Effectiveness of functional electrical stimulation in improving clinical outcomes in the upper arm following stroke: a systematic review and meta-analysis.

Background. Different therapeutic methods are being used to prevent or decrease long-term impairments of the upper arm in stroke patients. Functional electrical stimulation (FES) is one of these methods, which aims to stimulate the nerves of the weakened muscles so that the resulting muscle contractions resemble those of a functional task. Objectives. The objective of this study was to review the evidence for the effect of FES on (1) shoulder subluxation, (2) pain, and (3) upper arm motor function in stroke patients, when added to conventional therapy. Methods. From the 727 retrieved articles, 10 (9 RCTs, 1 quasi-RCT) were selected for final analysis and were rated based on the PEDro (Physiotherapy Evidence Database) scores and the Sackett's levels of evidence. A meta-analysis was performed for all three considered outcomes. Results. The results of the meta-analyses showed a significant difference in shoulder subluxation in experimental groups compared to control groups, only if FES was applied early after stroke. No effects were found on pain or motor function outcomes. Conclusion. FES can be used to prevent or reduce shoulder subluxation early after stroke. However, it should not be used to reduce pain or improve upper arm motor function after stroke.

Effects of functional electrical stimulation on gait function and quality of life for people with multiple sclerosis taking dalfampridine.

Multiple sclerosis (MS) can adversely affect gait, causing gait slowing, loss of balance, decreased functional mobility, and gait deficits, such as footdrop. Current treatments for gait dysfunction due to MS are pharmacologic, using dalfampridine, or orthotic, using an ankle-foot orthosis. Functional electrical stimulation (FES) to the fibular nerve stimulates active dorsiflexion and provides an alternative treatment for gait dysfunction caused by footdrop. The objective of this study was to determine the effect of FES on gait function and the impact of MS on walking and quality of life for people with MS taking a stable dalfampridine dose. Participants demonstrating gait slowing and footdrop completed the Timed 25-Foot Walk (T25FW) test, 6-Minute Walk (6MW) test, GaitRite Functional Ambulation Profile, 12-item Multiple Sclerosis Walking Scale (MSWS-12), and 36-item Short Form Health Status Survey (SF-36) at screening without FES; the measures were repeated with FES at baseline, 1 month, and 3 months. Twenty participants (8 men and 12 women) completed this unblinded case series study. The mean age, duration of MS, and time taking dalfampridine were 51.7, 15.8, and 1.4 years, respectively. Changes from screening to baseline and screening to 3 months were analyzed. Significant improvement was noted from screening to baseline for the MSWS-12 (P = .024) and SF-36 Physical Function domain (P = .028) and from screening to 3 months for the T25FW (P = .015), MSWS-12 (P = .003), and SF-36 Physical Function (P = .032) and Role Limitation-Physical Health (P = .012) domains. Improvements above those induced pharmacologically suggest that FES can augment pharmacologic intervention and significantly improve gait function, decrease the impact of MS on walking, and improve quality of life for people with MS.

Effectiveness of Functional Electrical Stimulation on Walking Speed, Functional Walking Category, and Clinically Meaningful Changes for People With Multiple Sclerosis

ObjectiveTo determine the effectiveness of functional electrical stimulation (FES) on drop foot in patients with multiple sclerosis (MS), using data from standard clinical practice. DesignCase series with a consecutive sample of FES users collected between 2008 and 2013. SettingSpecialist FES center at a district general hospital. ParticipantsPatients with MS who have drop foot (N=187) (117 women, 70 men; mean age, 55y [range, 27–80y]; mean duration since diagnosis, 11.7y [range, 1–56y]). A total of 166 patients were still using FES after 20 weeks, with 153 patients completing the follow-up measures. InterventionsFES of the common peroneal nerve (178 unilateral, 9 bilateral FES users). Main Outcome MeasuresClinically meaningful changes (ie, >.05m/s and >0.1m/s) and functional walking category derived from 10-m walking speed. ResultsAn increase in walking speed was found to be highly significant (P<.001), both initially where a minimum clinically meaningful change was observed (.07m/s) and after 20 weeks with a substantial clinically meaningful change (.11m/s). After 20 weeks, treatment responders displayed a 27% average improvement in their walking speed. No significant training effect was found. Overall functional walking category was maintained or improved in 95% of treatment responders. ConclusionsFES of the dorsiflexors is a well-accepted intervention that enables clinically meaningful changes in walking speed, leading to a preserved or an increased functional walking category.

The electronic counting arm movement test (eCAM test)

A novel transportable electronic platform aiming to characterize the performance of successive fast vertical visually guided pointing movements toward two fixed targets (eCAM test: electronic counting arm movement test) is described and one validation test is presented. This platform is based on an Arduino® micro-controller and a Processing® routine. It records both the pointing performance (number of clicks) and the elapsed time between two successive pointing movements. Using this novel platform, we studied the effects of functional electrical stimulation (FES) applied on the dominant upper limb in 15 healthy volunteers (mean age ± SD: 22·3 ± 4·3 years; 5 males/10 females). The following muscles were stimulated: flexor carpi radialis (FCR), extensor carpi radialis (ECR), biceps brachii (BB), and triceps brachii (TB). The intensities of the stimulation were 2 and 3 mA above the sensory threshold (ST). Movement times were lesser when performed against gravity and pointing performance improved with FES. We provide the first demonstration that low-intensity FES impacts on motor performances during successive vertical goal-directed pointing movements under visual guidance. The eCAM test is currently the sole electronic tool to assess quickly and easily the performances of successive vertical pointing movements. Future potential applications include, in particular, the follow-up of the effects of neurorehabilitation of neurological/neurosurgical disorders associated with hand–eye incoordination, the functional evaluation of upper limb prosthesis or orthosis, and the analysis of the effects of FES in central or peripheral nervous system disorders.

Effects of functional electrical stimulation on gait recovery post-neurological injury during inpatient rehabilitation.

This stage 2 trial investigated the therapeutic effect of single channel, peroneal functional electrical stimulation (FES) for improving gait and muscle activity in people with neurological injuries who were enrolled in an inpatient rehabilitation program. Twenty-six patients (16 male; M age = 51.3 yr., SD = 16.2; 2-33 days post-injury) completed the study. Participants were randomly assigned to an experimental group (n = 13) or control group (n = 13). The experimental group received FES and the control group received sensory stimulation during 45-min. gait training sessions three times a week for the duration of their stay in a rehabilitation facility (average of four sessions for both groups). Changes in gait speed, tibialis anterior muscle electromyography (EMG), and FIM™ locomotion scores were compared between groups. No significant differences were found, as both groups demonstrated similar improvements. The current results with this small sample suggest a low dose of gait training with single channel FES did not augment gait nor EMG activity beyond gait training with sensory stimulation; therefore, clinicians will likely be better served using a larger dose of FES or multichannel FES in this clinical population.

Effects of Functional Electrical Stimulation (FES) on Motor Functions and Functional Mobility in Hemiparetic Individuals

This study was designed to observe the effects of functional electrical stimulation on the promotion of motor function and functional mobility in individuals with hemiparesis who have regained walking ability, yet demonstrate ankle and knee dysfunction. We hypothesised that single channel FES would augment the motor function and functional mobility beyond the benefits of conservative management.

Neuroanatomical Predictors for Dysphagia Severity After First-Ever Acute Ischemic Stroke

Objective: This study was designed to observe the effects of functional electrical stimulation on the promotion of motor function and functional mobility in individuals with hemiparesis who have regained walking ability, yet demonstrate ankle and knee dysfunction. We hypothesised that single channel FES would augment the motor function and functional mobility beyond the benefits of conservative management. Design: Quasi experimental study Design Setting: Vidyasagar Institute of Mental Health, Neuro and Allied Sciences (VIMHANS), New Delhi, India. Participants: 28 right-handed subjects with hemiplegia were included in the study Interventions: All the participants who fulfilled the inclusion criteria were included in the study and divided into two respective groups (13 in experimental and 15 in control). Both the groups received conservative physiotherapy treatment in the form of exercises for 45 minutes for 3 weeks (5 days/week). However, the participants in experimental group underwent additionally for FES therapy for 30 minutes. Main Outcome Measure(s): Participants were assessed on ten meter walking test (10MWT), dynamic gait index (DGI), and composite spasticity index (CSI), pre and post 3 weeks of functional electrical stimulation (FES) therapy. Results: The group with FES therapy resulted in better improvement on 10MWT, DGI and CSI, when compared with the control group who were treated conservatively. Conclusions: This study provides an evidence to support the use of functional electrical stimulation on hemiparetic individuals as an adjunct with other rehabilitation program.

The influence of functional electrical stimulation on hand motor recovery in stroke patients: a review

Neuromuscular stimulation has been used as one potential rehabilitative treatment option to restore motor function and improve recovery in patients with paresis. Especially stroke patients who often regain only limited hand function would greatly benefit from a therapy that enhances recovery and restores movement. Multiple studies investigated the effect of functional electrical stimulation on hand paresis, the results however are inconsistent. Here we review the current literature on functional electrical stimulation on hand motor recovery in stroke patients. We discuss the impact of different parameters such as stage after stoke, degree of impairment, spasticity and treatment protocols on the functional outcome. Importantly, we outline the results from recent studies investigating the cortical effects elicited by functional electrical stimulation giving insights into the underlying mechanisms responsible for long-term treatment effects. Bringing together the findings from present research it becomes clear that both, treatment outcomes as well as the neurophysiologic mechanisms causing functional recovery, vary depending on patient characteristics. In order to develop unified treatment guidelines it is essential to conduct homogenous studies assessing the impact of different parameters on rehabilitative success.

Controlled clinical research on cognitive function of long-term bed patients improved by functional electrical stimulation

Objective The study and explore the clinical effect of functional electrical stimulation (FES) for patients with cognitive function declined due to long-term bed.Methods Sixty patients with cognitive function declined,were randomly divided into two groups:the control group and the FES treatment group.Two groups were all treated by conventional treatment way,on this basis,the FES group was treated by functional electrical stimulation extra,but not in control group.Two groups before and after treatment,the Montreal cognitive assessment (MOCA) score and auditory event related potentials P300 were tested respectively,to assess the clinical efficacy.Results There was no statistical significant difference in results of MOCA and P300 test before treatment (P ＞ 0.05).After 3 weeks,the MOCA of FES group were higher than those in the control group (P ＜ 0.05),the results of P300 test of FES group were obviously lower than those of control group,especially in P2,P3 latency and P2 amplitude (P ＜ 0.05).Conclusion The therapeutic method of FES can not only improve patients' scores of MOCA,but also decrease the results of P300 test,which can improve the cognitive function of those patients. Key words: Functional electrical stimulation; Cognitive function; Rehabilitation

Functional electrical stimulation as a component of activity-based restorative therapy may preserve function in persons with multiple sclerosis

ObjectiveTo examine the effect of functional electrical stimulation (FES) cycling on disability progression in persons with multiple sclerosis (MS).DesignRetrospective cohort, 40 participants with mean follow-up of 15 months.SettingInternational Center for Spinal Cord Injury at Kennedy Krieger Institute in Baltimore, a rehabilitation referral center.ParticipantsForty consecutive persons with MS undergoing rehabilitation from 2007 to 2011, with at least two evaluations based on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).InterventionsFES cycling as part of activity-based restorative therapy interventions.Outcome measuresChange in Expanded Disability Status Scale (EDSS) and ISNCSCI motor, light touch, and pin prick scores from baseline to latest evaluation.ResultsIn 71% of patients, activity-based rehabilitation included FES cycling. There was no disability progression on the EDSS. Lower extremity motor scores improved or stabilized in 75% of patients with primary progressive MS (PPMS), 71.4% with secondary progressive MS (SPMS), and 54.5% with relapsing remitting MS (RRMS). Among patients with improved or stabilized lower extremity motor function, PPMS recorded a mean 9% improvement, SPMS 3% and RRMS 6%. In PPMS, use of FES showed trend towards improvement in motor scores (P = 0.070).ConclusionsFES as part of activity-based rehabilitation may help preserve or improve neurological function in patients with MS.

Therapeutic effect of functional electrical stimulation-triggered gait training corresponding gait cycle for stroke

The purpose of this study was to determine the therapeutic effects of functional electrical stimulation (FES) applied to the gluteus medius and tibialis anterior muscles during the gait cycle in individuals with hemiparetic stroke. Eighteen patients who had suffered a stroke were enrolled in this study. The participants were divided into either the gluteus medius and tibialis anterior (GM+TA) training group (n=9) or the control group (n=9). The GM+TA group received FES-triggered gait training to the gluteus medius (GM) in the stance phase and the tibialis anterior (TA) in the swing phase for 30min, 5 session a week over a 6-week period, and control group who received only gait training without FES-triggered for the same duration of time. A foot-switch sensor was used to trigger the device in the stance (GM) and swing (TA) phases of the gait cycle reciprocally. This study measured three types of outcome measures, including spatiotemporal gait parameters, muscles activities, and balance function. After 6 weeks training, there was a significant improvement in gait velocity, cadence, stride length, and gait symmetry in the GM+TA training group compared to the control group. Dynamic balance function was significantly improved in the GM+TA training group compared to the control group. The mean changeable values of the GM was significantly greater strength in the GM+TA training group than the control group. These findings suggest that FES-triggered gait training of the GM in the stance phase and TA in the swing phase may improve the spatiotemporal parameters of gait in persons with hemiparetic stroke.

The Effectiveness of Functional Electrical Stimulation Based on a Normal Gait Pattern on Subjects with Early Stroke: A Randomized Controlled Trial

Objective. To investigate the effectiveness of four-channel FES based on a normal gait pattern on improving functional ability in subjects early after ischemic stroke. Methods. Forty-five subjects were randomly assigned into a four-channel FES group (n = 16), a placebo group (n = 15), or a dual-channel group (n = 14). Stimulation lasted for 30 min in each session with 1 session/day, 5 days a week for 3 weeks. All subjects were assessed at baseline, at 3 weeks of treatment, and at 3 months after the treatment had finished. The assessments included Fugl-Meyer Assessment (FMA), the Postural Assessment Scale for Stroke Patients (PASS), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), and the Modified Barthel Index (MBI). Results. All 3 groups demonstrated significant improvements in all outcome measurements from pre- to posttreatment and further gains at followup. The score of FMA and MBI improved significantly in the four-channel group at the end of the 3 weeks of training. And the scores of PASS, BBS, MBI, and FAC in the four-channel group were significantly higher than those of the placebo group. Conclusions. This study indicated that four-channel FES can improve motor function, balance, walking ability, and performance of activities of daily living in subjects with early ischemic stroke.

Functional electrical stimulation to ankle dorsiflexor and plantarflexor using single foot switch in patients with hemiplegia from hemorrhagic stroke.

ObjectiveTo evaluate the effects of functional electrical stimulation (FES) to ankle dorsiflexor (DF) and ankle plantarflexor (PF) on kinematic and kinetic parameters of hemiplegic gait.MethodsFourteen post-stroke hemiplegic patients were considered in this study. Electrical stimulation was delivered to ankle DF during the swing phase and ankle PF during the stance phase via single foot switch. Kinematic and kinetic data were collected using a computerized motion analysis system with force plate. Data of no stimulation (NS), DF stimulation only (DS), DF and PF stimulation (DPS) group were compared among each other.ResultsPeak ankle dorsiflexion angle during swing phase is significantly greater in DS group (-1.55°±9.10°) and DPS group (-2.23°±9.64°), compared with NS group (-6.71°±11.73°) (p<0.05), although there was no statistically significant difference between DS and DPS groups. Ankle plantarflexion angle at toe-off did not show significant differences among NS, DS, and DPS groups. Peak knee flexion in DPS group (34.12°±13.77°) during swing phase was significantly greater than that of NS group (30.78°±13.64°), or DS group (32.83°±13.07°) (p<0.05).ConclusionIn addition to the usual FES application stimulating ankle DF during the swing phase, stimulation of ankle PF during stance phase can help to increase peak knee flexion during the swing phase. This study shows the advantages of stimulating the ankle DF and PF using single foot switch for post-stroke gait.

Effect of functional electrical stimulation on activity in children with cerebral palsy: a systematic review.

To determine whether functional electrical stimulation (FES) is effective and whether it is more effective than activity training alone. MEDLINE, CINAHL, EMBASE, Cochrane, Web of Science, and PEDro databases were searched for randomized trials. Studies of randomized trials were included if the participants were children (<18 years old) with spastic cerebral palsy, who underwent a program of FES that involved electrical stimulation during practice of an activity. Measures of activity that best reflected the activity trained were examined. Five randomized trials were included. Three trials reported statistically significant between-group differences in favor of FES compared with no FES. Two trials reported no statistically significant between-group differences of FES compared with activity training alone. The available evidence suggests that FES is more effective than no FES but that it has a similar effect as activity training alone in cerebral palsy.