Functional Electrical Stimulation Group Research Articles

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.

Resistance band training with functional electrical stimulation improves force control capabilities in older adults: a preliminary study.

Resistance band training (RBT) with functional electrical stimulation (FES) may be an effective exercise regimen for improving age-related motor impairments. This preliminary study investigated the potential effects of bimanual RBT with FES on upper limb motor functions in older adults. This study randomly assigned 22 elderly people to the bimanual RBT with FES (Bi-RBT+FES) group and the RBT without FES (Bi-RBT) group. All participants performed isometric hand-grip force control tasks in unimanual (dominant and non-dominant) and bimanual conditions before and after four weeks of exercise for each group. We quantified the mean force, force accuracy, force variability, and force regularity at two targeted force levels (i.e., 10 % and 40 % of maximum voluntary contraction; MVC) to estimate changes in force control capabilities. The results revealed that the Bi-RBT+FES group demonstrated a greater force accuracy in the dominant hand at 10 % of MVC after training. Non-dominant hands in the Bi-RBT+FES group increased force accuracy at 40 % of MVC and reduced force variability collapsed across two targeted force levels. Both groups showed a decrease in force regularity after training. These preliminary results indicate that Bi-RBT+FES may be a viable option to facilitate functional recovery of the upper limbs in older adults.

Effectiveness of Passive Movement Training in Patients with Cerebral Palsy: A Comparative Analysis of Robot-Assisted Therapy and Electrical Stimulation in Hand Rehabilitation

Background: Cerebral palsy is a non-progressive neurodevelopmental condition that re-sults in varied degrees of disability, with upper limb functioning affected in over 80% of cases. The objective of this study was to investigate the impact of passive movement train-ing of the hand (PMT) with robot-assisted therapy (RAT) compared to PMT with function-al electrical stimulation (FES). Methods: Fifty-eight patients diagnosed with CP, aged be-tween 7 and 14 years, participated in a two-week rehabilitation program involving physi-cal therapy (PT) combined with either RAT or FES. Post-rehabilitation, we assessed the evolution of cylinder grip, finger extension, pinch grips, lateral grip, and three-point grip in each therapy group to determine the more effective passive movement training. Results: Both the RAT group (p &lt; 0.001) and the FES group (p &lt; 0.01) demonstrated a statistically significant improvement in all parameters. Patients who received PT and FES exhibited more significant improvement in each movement, except for the pinch index grip, where the RAT group showed superior results. Conclusions: Our findings indicate the positive effects of both PMTs on hand function rehabilitation. We recommend incorporating both therapies into rehabilitation programs for enhanced outcomes.

Specialized Manual Therapy Techniques Can Improve Neuromotor Outcome in Patients with Foot-Drop Syndrome

Introduction: Functional rehabilitation of foot-drop syndrome due to lumbar disc herniation it is a problem that concerns many researchers. Study objective was to investigate if specialized manual therapy techniques and functional electrical stimulation alone and combined can influence the overall neuromotor outcome. Methods: 90 subjects were randomized to 3 groups, 30 subjects allocated to control group (CG) which received physical therapy, 30 subjects in functional electrical stimulation group (FES) and 30 subjects in combined FES with manual therapy techniques (FES-MT). All groups received a number of 20 sessions. We evaluated nerve conduction study, dynamometry, goniometry, functional ankle disability index (FADI), Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS). Results: For Compound muscle action potential we have found significant modifications when comparing FES-MT vs CG (p&lt;0.011). For dynamometry we registered as follows: FES-MT vs CG (0.0001), FES-MT vs FES (p&lt;0.003). ODI and FADI scores were more significant in FES-MT and FES compare with CG. Conclusions: Manual therapy techniques utilized for increasing the excitability of neuromuscular spindle can increase the overall functionality of the tibialis muscle in case of foot drop syndrome. The combination between FES and MT showed better functional results than physical therapeutic exercises and FES alone.

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.

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.

Effects of repetitive transcranial magnetic stimulation combined with functional electrical stimulation on hand function of stroke: A randomized controlled trial

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that has been widely used for hand function recovery in patients with subacute and chronic stroke. To observe the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with functional electrical stimulation (FES) on hand function recovery during convalescence of stroke. Patients were divided into3 groups of 20 patients in each. All patients received routine training. rTMS group was treated with low-frequency repetitive transcranial magnetic stimulation (rTMS). FES group received functional electrical stimulation (FES) therapy. Observation group was treated with low-frequency rTMS and FES. The changes of TMS-MEP in the 3 groups were observed at the time of enrollment and after 2 courses of treatment, respectively, and the total active activity of fingers (TAM) and Fugl-Meyer assessment (FMA) rating scale were evaluated in wrist and hand parts. The amplitude of TMS-MEP was significantly higher than that of FES group. FMA score and TAM score in the observation group were significantly better than that of rTMS group and FES group. Low-frequency rTMS combined with FES treatment can effectively improve the range of motion of fingers, and significantly improve the grasp, pinching and other functions of hands.

EEG-Based Brain Network Analysis of Chronic Stroke Patients After BCI Rehabilitation Training.

Traditional rehabilitation strategies become difficult in the chronic phase stage of stroke prognosis. Brain–computer interface (BCI) combined with external devices may improve motor function in chronic stroke patients, but it lacks comprehensive assessments of neurological changes regarding functional rehabilitation. This study aimed to comprehensively and quantitatively investigate the changes in brain activity induced by BCI–FES training in patients with chronic stroke. We analyzed the EEG of two groups of patients with chronic stroke, one group received functional electrical stimulation (FES) rehabilitation training (FES group) and the other group received BCI combined with FES training (BCI–FES group). We constructed functional networks in both groups of patients based on direct directed transfer function (dDTF) and assessed the changes in brain activity using graph theory analysis. The results of this study can be summarized as follows: (i) after rehabilitation training, the Fugl–Meyer assessment scale (FMA) score was significantly improved in the BCI–FES group (p < 0.05), and there was no significant difference in the FES group. (ii) Both the global and local graph theory measures of the brain network of patients with chronic stroke in the BCI–FES group were improved after rehabilitation training. (iii) The node strength in the contralesional hemisphere and central region of patients in the BCI–FES group was significantly higher than that in the FES group after the intervention (p < 0.05), and a significant increase in the node strength of C4 in the contralesional sensorimotor cortex region could be observed in the BCI–FES group (p < 0.05). These results suggest that BCI–FES rehabilitation training can induce clinically significant improvements in motor function of patients with chronic stroke. It can improve the functional integration and functional separation of brain networks and boost compensatory activity in the contralesional hemisphere to a certain extent. The findings of our study may provide new insights into understanding the plastic changes of brain activity in patients with chronic stroke induced by BCI–FES rehabilitation training.

A pilot study of synergy-based FES for upper-extremity poststroke rehabilitation

A previous study indicated that synergy-based functional electrical stimulation (FES) may improve instantaneous upper-limb motor performance for stroke survivors. However, it remains unclear whether the improvements will sustain over time to achieve functional gains associated with a task-oriented training (TOT). This pilot study was designed to investigate whether there is any promising sign of functional benefits. A TOT protocol with repeated forward and lateral reaching movements assisted by synergy-based FES was conducted in 16 patients (9 FES, 7 Sham) with post-stroke hemiparesis. FES stimuli were applied to 7 upper-extremity muscles of elbow and shoulder during patient movements. Envelopes of stimuli were individualized by re-composing the muscle synergies extracted from a healthy subject. After a five-day training for one hour each day, synergy-based FES induced higher increases in Fugl-Meyer scores (6.67 ± 5.20) than did the Sham (2.00 ± 2.38, p < 0.05). Peak velocity of forward reaching movements increased with a slope 73% steeper in FES group than Sham. In lateral reaching movements, the change in synergy similarity correlated with the change in elbow flexion for the FES group, but not the Sham group. Our results indicate that synergy-based FES therapy induced clinically traceable signs of improvements in poststroke motor performance. The muscle activation in patients also showed promising sign of alteration by FES. Results suggest that a larger scale clinical trial of synergy-based FES may be feasible towards an individualized therapeutic regimen.

Effect of tDCS Synchronized FES on Lower Limb Motor and Balance Function of Traumatic Brain Injury Patients with Hemiplegia

<sec><title>Objective</title> To observe the effect of transcranial direct current stimulation (tDCS) synchronized with normal walking pattern based on multi-channel functional electrical stimulation (FES) on lower limb motor and balance function in patients with traumatic brain injury hemiplegia. </sec><sec><title>Methods</title> A total of 56 patients with TBI and hemiplegia were divided into synchronous group (<italic>n</italic>=21), FES group (<italic>n</italic>=20), and tDCS group (<italic>n</italic>=15) by using sealed-envelope randomization. The tDCS group was given head tDCS treatment and lower extremity sham FES treatment, the FES group was given head sham tDCS treatment and lower extremity FES treatment, and the synchronous group was given head tDCS treatment and lower extremity FES treatment. The treatment was 20 min/time, 1 time/d, for 12 days. Before treatment, after 6 days treatment and after 12 days treatment, the following scales were used to evaluate: Fugl-Meyer assessment of lower extremity (FMA-LE), Berg balance scale (BBS), and Neurocom Balance Manager System. </sec><sec><title>Results</title> There was no significant differences among the evaluation results of the three groups before treatment. After treatment, compared with those before treatment, the FMA-LE scores of three groups were significantly different (<italic>P</italic><0.05), but there was no significant differences in FMA-LE among the three groups (<italic>P</italic>>0.05). Compared with the three groups before and after treatment, BBS scores of the three groups were significantly different respectively (<italic>P</italic><0.05). Compared the tDCS group with the FES group, the differences in BBS scores of the synchronization group were significant (<italic>P</italic><0.05). In balance assessment, compared with those before treatment, visual cues (VIS), vestibular cues (VEST), sensory organization test composite (SOTC) and motion control test composite (MCTC) were significantly different in the synchronous group after treatment (<italic>P</italic><0.05); MCTC was significantly different in the FES group (<italic>P</italic><0.05); VIS and SOTC was significantly difference in the tDCS group (<italic>P</italic><0.05). Compared among the three groups, the change rate of MCTC was significantly difference (<italic>P</italic><0.05); there were no significant differences in other indicators (<italic>P</italic>>0.05). </sec><sec><title>Conclusion</title> The three methods can effectively improve the lower limb motor and balance function of patients with traumatic brain injury in chronic period. The treatment of tDCS with FES is better than the treatment of tDCS or FES alone in terms of some evaluation indicators. </sec>

A Study on the Effect of Functional Electrical Stimulation on Hand Function in Stroke Patients with Flexor Synergy in Upper Limb

Background and Purpose: To determine whether Functional Electrical Stimulation can improve motor function of hand in spastic hemiplegics and whether any improvements are maintainedMethods: 30 subjects of stroke with spastic hemiplegia with flexor synergy upper limb. 15 patients in each group, Group A (Functional Electrical Stimulation group) &amp; Group B (Control group). GroupA received Functional Electrical Stimulation plus standard inpatient/outpatient stroke rehabilitation program. Group-B received only standard inpatient/outpatient stroke rehabilitation program. Assessment data were recorded before treatment, at 4, 8, 12 and 24 weeks. Outcome Measures were Action Research Arm Test Score, Range Of Motion of Active Wrist extension, Functional independence measure, Modified Ashworth Scale.Results: Use of Functional Electrical Stimulation resulted in improvement of hand functions in patients. There was decrease in wrist flexors muscle tone and subsequent improvement in activities of daily livings observed. There was no significant improvement observed in Active Wrist extension.Conclusion: Functional Electrical Stimulation is an important intervention in the treatment of stroke with spastic hemiplegia. It can help in the improvement of hand functions when prescribed along with exercises.

The effectiveness of functional electrical stimulation of the legs in patients with heart failure: A systematic review and meta-analysis of randomized controlled trials

Objective To investigate the effectiveness of functional electrical stimulation of the legs in patients with heart failure. Methods Data were obtained from PubMed, Cochrane Library, and Embase databases until August 12, 2021. We included randomized controlled trials that evaluated the effects of functional electrical stimulation applied to the legs of patients with heart failure, namely changes in cardiopulmonary function, muscle strength, and quality of life. Results In total, 14 randomized controlled trials (consisting of 518 patients) were included in our article. Pooled estimates demonstrated that functional electrical stimulation significantly improved peak oxygen consumption (peak VO2; standardized mean difference = 0.33, 95% confidence interval = 0.07–0.59, eight randomized controlled trials, n = 321), 6-min walking distance (mean difference = 48.03 m, 95% confidence interval = 28.50–67.57 m, 10 randomized controlled trials, n = 380), and Minnesota Living with Heart Failure Questionnaire quality of life score (mean difference = − 8.23, 95% confidence interval = − 12.64 to − 3.83, nine randomized controlled trials, n = 383). Muscle strength of lower extremities was not significantly improved in the functional electrical stimulation group compared with that in the control group (standardized mean difference = 0.26, 95% confidence interval = − 0.18 to 0.71, five randomized controlled trials, n = 218). Furthermore, the subgroup analysis revealed that functional electrical stimulation significantly improved peak VO2, 6-min walking distance, and Minnesota Living with Heart Failure Questionnaire quality of life score in the heart failure with reduced ejection fraction and heart failure with preserved ejection fraction subgroups. Conclusion Functional electrical stimulation can effectively improve the cardiopulmonary function and quality of life in patients with heart failure. However, functional electrical stimulation did not significantly improve muscle strength in the legs.

Aerobic Responses to FES-Assisted and Volitional Cycling in Children with Cerebral Palsy.

Recumbent stationary cycling is a potential exercise modality for individuals with cerebral palsy (CP) that lack the postural control needed for upright exercises. Functional electrical stimulation (FES) of lower extremity muscles can help such individuals reach the cycling intensities that are required for aerobic benefits. The aim of this study was to examine the effect of cycling with and without FES assistance to that of a no-intervention control group on the cardiorespiratory fitness of children with CP. Thirty-nine participants were randomized to a FES group that underwent an 8-week FES-assisted cycling program, the volitional group (VOL), who cycled without FES, or a no-intervention control group (CON) (15 FES, 11 VOL, 13 CON). Cadence, peak VO2, and net rise in heart rate were assessed at baseline, end of training, and washout (8-weeks after cessation of training). Latent growth curve modeling was used for analysis. The FES group showed significantly higher cycling cadences than the VOL and CON groups at POST and WO. There were no differences in improvements in the peak VO2 and peak net HR between groups. FES-assisted cycling may help children with CP attain higher cycling cadences and to retain these gains after training cessation. Higher training intensities may be necessary to obtain improvements in peak VO2 and heart rate.

The Effect of Transcranial Direct Current Stimulation and Functional Electrical Stimulation on the Lower Limb Function of Stroke Patients.

Objective: This study aimed to research the effect of transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) on the lower limb function of post-convalescent stroke patients.Methods: A total of 122 patients in the stroke recovery stage who suffered from leg dysfunction were randomly divided into two groups: a tDCS group (n = 61) and a FES group (n = 61). All patients received same routine rehabilitation and equal treatment quality, the tDCS group was treated with tDCS, while the FES group received FES. The lower limb Fugl-Meyer assessment (FMA), modified Barthel index (MBI), functional ambulatory category (FAC), and somatosensory evoked potential (SEP) were used to assess the patients at three different stages: prior to treatment, 4 weeks after treatment, and 8 weeks after treatment.Results: The assessment scores for FMA, MBI, and FAC for the lower extremities after treatment (P > 0.05) were compared with those before treatment. The FMA, MBI, and FAC scores of the tDCS group were significantly higher than those of the FES group in all three stages (P < 0.05). The FMA, MBI, and FAC assessment scores of both groups were significantly higher after 4 weeks of treatment than that before treatment, and the scores after 8 weeks of treatment were significantly higher than those after 4 weeks after treatment (P < 0.05). The P40, N45 latencies decreased and the P40, N45 amplitudes increased, but there was no significant difference before treatment and after treatment (P >0.05), and there was no significant difference of the tDCS and FES groups before treatment and after treatment.Conclusion: In conclusion, FMA, MBI, and FAC indicate that both tDCS and FES can significantly promote the recovery of a patient’s leg motor function and tDCS is more effective than FES in the stroke recovery stage. The application value of SEP in stroke patients remains to be further studied.

Effects of functional electro-stimulation combined with blood flow restriction in affected muscles by spinal cord injury.

Muscle atrophy is a great consequence of spinal cord injuries (SCI) due to immobility. SCI's detrimental effects on large muscle groups may lead to secondary effects such as glucose intolerance, increased risk of metabolic syndrome, and diabetes. Exercising with blood flow restriction (BFR) has been proposed as an effective method to induce hypertrophy using low training loads, with little or no muscle damage. This study investigated acute and chronic effects of low-intensity functional electrical stimulation (FES) combined with BFR on muscles affected by spinal cord injury. The acute effects of one bout of FES with (FES + BFR group) and without BFR (FES group) on muscle thickness (MT) and edema formation were compared. The chronic effects on MT and edema following 8 weeks of twice weekly training with and without BFR were also compared. The FES + BFR group showed MT and edema increases compared to the FES only group (p< 0.05). The FES + BFR showed a chronic MT increase after 4 weeks of training (p <0.05), with no further MT increases from the 4th to the 8th week (p>0.05). Following 3 weeks of detraining, MT decreased to baseline. No MT changes were observed in the FES (p>0.05). The FES + BF stimuli induced MT increases on the paralyzed skeletal muscles of SCI. The acute effects suggest that FES causes a greater metabolite accumulation and edema when combined with BFR. The early increases in MT can be attributed to edema, whereas after the 4th week, it is likely to be related to muscle hypertrophy. Register Clinical Trial Number on ReBeC: RBR-386rm8.

Energy Expenditure, Cardiorespiratory Fitness, and Body Composition Following Arm Cycling or Functional Electrical Stimulation Exercises in Spinal Cord Injury: A 16-Week Randomized Controlled Trial.

Background: Physical deconditioning and inactivity following spinal cord injury (SCI) are associated with multiple cardiometabolic risks. To mitigate cardiometabolic risk, exercise is recommended, but it is poorly established whether arm cycling exercise (ACE) or functional electrical stimulation (FES) leg cycling yields superior benefits. Objectives: To determine the adaptations of 16 weeks of FES cycling and ACE on exercise energy expenditure (EEE), cardiorespiratory fitness (CRF), and obesity after SCI. Methods: Thirteen physically untrained individuals were randomly assigned to FES (n = 6) or ACE (n = 7) exercise 5 days/week for 16 weeks. Pre- and post-intervention EEE, peak oxygen consumption (absolute and relative VO2Peak), and work were assessed using indirect calorimetry, while body composition was measured by dual-energy x-ray absorptiometry. Results: Main effects were found for peak power (p < .001), absolute (p = .046) and relative (p = .042) VO2Peak, and peak work (p = .013). Compared to baseline, the ACE group increased in EEE (+85%, p = .002), peak power (+307%, p < .001), VO2Peak (absolute +21%, relative +22%, p ≤ .024), peak work (19% increase, p = .003), and total body fat decreased (-6%, p = .05). The FES group showed a decrease in percentage body fat mass (-5%, p = .008). The ACE group had higher EEE (p = .008), peak power (p < .001), and relative VO2Peak (p = .025) compared to postintervention values in the FES group. Conclusion: In the current study, ACE induced greater increases in EEE and CRF, whereas ACE and FES showed similar results on body fat. Exercise promotional efforts targeting persons with SCI should use both FES and ACE to reduce sedentary behavior and to optimize different health parameters after SCI.

Ankle exercise with functional electrical stimulation affects spasticity and balance in stroke patients.

Stroke patients have limited motor function due to ankle spasticity, and various interventions are applied to solve this problem. The purpose of this study was to investigate the effects of functional electrical stimulation (FES) with ankle exercise on spinal cord motor neuron excitability and balance in stroke patients. Twenty-five stroke patients were divided into the three groups. For the intervention, the control group applied general physiotherapy, the experimental group I applied a sham FES with ankle exercise, and the experimental group II applied a FES with ankle exercise. All groups applied the intervention for 30 min per session, 5 times a week, for a total of 8 weeks. The functional reaching test (FRT), Timed Up and Go test was used to measure balance ability, and H-reflex was used to measure spinal motor neuron excitability. All tests were measured before and after the intervention. In the ankle exercise with FES group, spinal motor neuron excitability significantly decreased (P<0.05), and FRT was significantly increased (P<0.05). Therefore, FES with ankle exercise for stroke patients could be suggested as an effective intervention for improving motor function.

Therapeutic effectiveness of a single exercise session combined with WalkAide functional electrical stimulation in post-stroke patients: a crossover design study.

A growing body of evidence has suggested that the imbalance of epigenetic markers and oxidative stress appears to be involved in the pathophysiology and progression of stroke. Thus, strategies that modulate these biomarkers might be considered targets for neuroprotection and novel therapeutic opportunities for these patients. Physical exercise has been reported to induce changes in these epigenetic markers and improve clinical outcomes in different populations. However, little is reported on this in post-stroke patients. The purpose of this study was to investigate the effect of a single exercise session with WalkAide functional electrical stimulation (FES) on cognitive performance, clinical functional parameters, oxidative stress and epigenetic modulation in post-stroke individuals. In this crossover design study, 12 post-stroke individuals aged 54-72 years of either sexes were included and subjected to a single session of exercise (45 minutes) without WalkAide functional electrical stimulation (EXE alone group), followed by another single session of exercise (45 minutes) with WalkAide functional electrical stimulation (EXE + FES group). The clinical functional outcome measures, cognitive performance and blood collections for biomarker measurements were assessed pre- and post-intervention. After intervention, higher Berg Balance Scale scores were obtained in the EXE + FES group than in the EXE alone group. There was no significant difference in the Timed Up and Go test results post-intervention between EXE alone and EXE + FES groups. After intervention, a better cognitive performance was found in both groups compared with before the intervention. After intervention, the Timed Up and Go test scores were higher in the EXE + FES group than in the EXE alone group. In addition, the intervention induced lower levels of lipid peroxidation. After intervention, carbonyl level was lower, superoxide dismutase activity and superoxide dismutase/catalase activity ratio were higher in the EXE + FES group, compared with the EXE group alone. In each group, both histone deacetylase (HDAC2) and histone acetyltransferase activities were increased after intervention compared with before the intervention. These findings suggest that a single exercise session with WalkAide FES is more effective on balance ability and cognitive performance compared with conventional exercise alone in post-stroke patients. This is likely to be related to the regulation of oxidative stress markers. The present study was approved by the Research Ethics Committee of the Methodist University Center-IPA (approval No. 2.423.376) on December 7, 2017 and registered in the Brazilian Registry of Clinical Trials-ReBEC (RBR-9phj2q) on February 11, 2019.

Effects of functional electrical stimulation on neuromuscular function after targeted muscle reinnervation surgery in rats.

the purpose of targeted muscle reinnervation (TMR) surgery is to provide more electromyography information for prosthetic control by reconstructing the deconstructed structure between the distal nerve and the stump muscle. Functional electrical stimulation (FES) of denervated muscles or proximal nerve stump after peripheral nerve surgery can effectively promote nerve regeneration and muscle function recovery. This pilot divided SD adult male rats into normal control group, denervation group, TMR group, and FES group according to whether they received TMR surgery and whether they received FES after surgery. The results showed that low-frequency electrical stimulation treatment could effectively promote transplanted nerve regeneration and significantly enhances motor function of target muscles.Clinical Relevance-This experiment successfully established TMR rat models, and explored the recovery of injured neuromuscular function by using electrodes implanted intramuscularly and analyzing myoelectric signals, and the use of low-frequency electrical stimulation treatment had a positive effect on the regeneration of the transplanted nerve.

Abstract TP162: The Therapeutic Effects of Peroneal Nerve Functional Electric Stimulation for Lower Extremity in Patients With Sub-Acute Post-Stroke Hemiplegia: A Randomized Controlled Study

Background and Aims: The functional electrical stimulation (FES) is the electrical stimulation of a muscle deprived of nervous control for providing muscular contraction and thereby producing a functionally useful movement. FES is particularly effective for treating foot drop caused by stroke. The purpose of this study was to investigate the effect of WalkAide FES system on functional recovery and activities of daily living (ADL) in stroke patients with foot drop. Methods: Participants (n=203; 49 females and 154 males; time after stroke 61.6±31.5 days) were randomized to either FES group or the control group. All subjects participated in the same standard rehabilitation program. In addition, FES group participated in FES training for 40 mins per day, five times a week, for 8 weeks, and those in the control group participated in the usual physical therapy including gait re-education, gait training with an orthotic device, and muscle stretching. Functional recovery was assessed using 6-min walk test (6MWT), active range of motion of ankle dorsiflexion (A-ROM), and Timed Up and Go test (TUG). ADL was assessed using 10-m walk test (10MWT), Stroke Impact Scale (SIS), and patient satisfaction. Results: After intervention, there were significant improvements in 6MWT, TUG, 10MWT, SIS compared to baseline in both groups (p&lt; 0.0001). The significant improvement in A-ROM was demonstrated only in FES group. At follow-up, AROM showed significant improvements in the FES group compared to the control group (p= 0.0011). However, when comparing average change scores from baseline to end of treatment, significant differences were noted only for the A-ROM scores. Stroke patients preferred the use of an electrical stimulation orthotic substitute device to an orthotic device, according to the questionnaire of patient satisfaction (p&lt; 0.0001). Conclusions: The findings of the current study demonstrated the efficacy of FES on the functional recovery and ADL, and also showed the feasibility of applying FES for dropped foot during the convalescent phase of recovery after stroke. These results suggest that long-term FES use may lead to additional improvements in walking endurance and functional ambulation; further research is needed to confirm these findings.