Functional Electrical Stimulation Therapy Research Articles

Determination of Optimal Conditions for Neuroprosthetic Functional Electrical Stimulation Therapy to Produce Wrist Dorsiflexion Movements Using the Versatility Index

Determination of Optimal Conditions for Neuroprosthetic Functional Electrical Stimulation Therapy to Produce Wrist Dorsiflexion Movements Using the Versatility Index

A Review of Current Perspectives on Motoric Insufficiency Rehabilitation following Pediatric Stroke.

Pediatric stroke (PS) is an injury caused by the occlusion or rupture of a blood vessel in the central nervous system (CNS) of children, before or after birth. Hemiparesis is the most common motoric deficit associated with PS in children. Therefore, it is important to emphasize that PS is a significant challenge for rehabilitation, especially since the consequences may also appear during the child's growth and development, reducing functional capacity. The plasticity of the child's CNS is an important predecessor of recovery, but disruption of the neural network, specific to an immature brain, can have harmful and potentially devastating consequences. In this review, we summarize the complexity of the consequences associated with PS and the possibilities and role of modern rehabilitation. An analysis of the current literature reveals that Constraint-Induced Movement Therapy, forced-use therapy, repetitive transcranial magnetic stimulation, functional electrical stimulation and robot-assisted therapy have demonstrated at least partial improvements in motor domains related to hemiparesis or hemiplegia caused by PS, but they are supported with different levels of evidence. Due to the lack of randomized controlled studies, the optimal rehabilitation treatment is still debatable, and therefore, most recommendations are primarily based on expert consensuses, opinions and an insufficient level of evidence.

Cycling using functional electrical stimulation therapy to improve motor function and activity in post-stroke individuals in early subacute phase: a systematic review with meta-analysis

BackgroundStroke necessitates interventions to rehabilitate individuals with disabilities, and the application of functional electrical stimulation therapy (FEST) has demonstrated potential in this regard. This study aimed to analyze the efficacy and effectiveness of cycling using FEST to improve motor function and lower limb activity in post-stroke individuals.MethodsWe performed a systematic review according to the recommendations of the PRISMA checklist, searching MEDLINE, Cochrane, EMBASE, LILACS, and PEDro databases by July 2022, without any date or language limitations. Studies were selected using the following terms: stroke, electrical stimulation therapy, cycling, and clinical trials. Randomized or quasi-randomized clinical trials that investigated the effectiveness of cycling using FEST combined with exercise programs and cycling using FEST alone for motor function and activity in subacute post-stroke individuals were included. The quality of included trials was assessed using the PEDro scores. Outcome data were extracted from eligible studies and combined in random-effects meta-analyses. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system.ResultsFive randomized clinical trials involving 187 participants were included. Moderate-quality evidence indicates that cycling using FEST combined with exercise programs promotes relevant benefits in trunk control (MD 9 points, 95% CI 0.36–17.64) and walking distance (MD 94.84 m, 95% CI 39.63–150.05, I = 0%), the other outcomes had similar benefits. Cycling using FEST alone compared to exercise programs promotes similar benefits in strength, balance, walking speed, walking distance, and activities of daily living.ConclusionThis systematic review provides low- to moderate-quality evidence that cycling using FEST may be an effective strategy to consider in improving motor function and activity outcomes for post-stroke individuals in the early subacute phase.Review registration: PROSPERO (CRD42022345282).

Research on the progress of neurorehabilitation

With the intensification of global aging problems, the incidence of central nervous system diseases such as stroke is getting higher and higher. At the same time, the number of disabled people has also increased. Amputation and neurological diseases are important causes of disability, and neurorehabilitation is an important method for restoring the nervous function and autonomous movement ability of the disabled. At present, neurorehabilitation methods commonly used in clinical treatment mainly include: wearing prosthetic limbs, functional electrical stimulation (FES) therapy, rehabilitation robots, and so on. The prosthetic limb refers to an artificial device used to replace the function of a lost limb. Many advanced technologies are being used to improve the motion control of prosthetics to achieve natural movement. FES is a technique that can improve physiological function or treat diseases by stimulating nerves or tissues through current, and has become one of the important means to promote nerve regeneration and restore motor function. Rehabilitation robots are the equipment that uses mechanical devices and advanced control technology to assist rehabilitation treatment and functional recovery. This article mainly discusses the current research progresses of prosthetic limbs, EFS and rehabilitation robots, so as to promote the development of neurorehabilitation.

Contralaterally controlled functional electrical stimulation video game therapy for hand rehabilitation after stroke: a randomized controlled trial

Purpose To estimate the effect of integrating custom-designed hand therapy video games (HTVG) with contralaterally controlled functional electrical stimulation (CCFES) therapy. Methods Fifty-two stroke survivors with chronic (>6 months) upper limb hemiplegia were randomized to 12 weeks of CCFES or CCFES + HTVG. Treatment involved self-administration of technology-mediated therapy at home plus therapist-administered CCFES-assisted task practice in the lab. Pre- and post-treatment assessments were made of hand dexterity, upper limb impairment and activity limitation, and cognitive function. Results No significant between-group differences were found on any outcome measure, and the average magnitudes of improvement within both groups were small. The incidence of technical problems with study devices at home was greater for the CCFES + HTVG group. This negatively affected adherence and may partially explain the absence of effect of HTVG. At end-of-treatment, large majorities of both treatment groups had positive perceptions of treatment efficacy and expressed enthusiasm for the treatments. Conclusion This study makes an important contribution to the research literature on the importance of environmental factors, concomitant impairments, and technology simplification when designing technology-based therapies intended to be self-administered at home. This study failed to show any added benefit of HTVG to CCFES therapy. Clinicaltrials.gov (NCT03058796).

Functional electrical stimulation therapy controlled by a P300-based brain-computer interface, as a therapeutic alternative for upper limb motor function recovery in chronic post-stroke patients. A non-randomized pilot study.

Up to 80% of post-stroke patients present upper-limb motor impairment (ULMI), causing functional limitations in daily activities and loss of independence. UMLI is seldom fully recovered after stroke when using conventional therapeutic approaches. Functional Electrical Stimulation Therapy (FEST) controlled by Brain-Computer Interface (BCI) is an alternative that may induce neuroplastic changes, even in chronic post-stroke patients. The purpose of this work was to evaluate the effects of a P300-based BCI-controlled FEST intervention, for ULMI recovery of chronic post-stroke patients. A non-randomized pilot study was conducted, including 14 patients divided into 2 groups: BCI-FEST, and Conventional Therapy. Assessments of Upper limb functionality with Action Research Arm Test (ARAT), performance impairment with Fugl-Meyer assessment (FMA), Functional Independence Measure (FIM) and spasticity through Modified Ashworth Scale (MAS) were performed at baseline and after carrying out 20 therapy sessions, and the obtained scores compared using Chi square and Mann-Whitney U statistical tests (𝛼 = 0.05). After training, we found statistically significant differences between groups for FMA (p = 0.012), ARAT (p < 0.001), and FIM (p = 0.025) scales. It has been shown that FEST controlled by a P300-based BCI, may be more effective than conventional therapy to improve ULMI after stroke, regardless of chronicity. The results of the proposed BCI-FEST intervention are promising, even for the most chronic post-stroke patients often relegated from novel interventions, whose expected recovery with conventional therapy is very low. It is necessary to carry out a randomized controlled trial in the future with a larger sample of patients.

Functional electrical stimulation therapy for upper extremity rehabilitation following spinal cord injury: a pilot study.

Pilot study. To examine if functional electrical stimulation therapy (FEST) improves neuromuscular factors underlying upper limb function in individuals with SCI. A tertiary spinal cord rehabilitation center specialized in spinal cord injury care in Canada. We examined 29 muscles from 4 individuals living with chronic, cervical, and incomplete SCI. The analysis was focused on the changes in muscle activation, as well as on how the treatment could change the ability to control a given muscle or on how multiple muscles would be coordinated during volitional efforts. There was evidence of gains in muscle strength, activation, and median frequency after the FEST. Gains in muscle activation indicated the activation of a greater number of motor units and gains in muscle median frequency the involvement of higher threshold, faster motor units. In some individuals, these changes were smaller but accompanied by increased control over muscle contraction, evident in a greater ability to sustain a volitional contraction, reduce the co-contraction of antagonist muscles, and provide cortical drive. FEST increases muscle strength and activation. Enhanced control of muscle contraction, reduced co-contraction of antagonist muscles, and a greater presence of cortical drive were some of the findings supporting the effects of FEST at the sensory-motor integration level.

MP71-17 CAN FUNCTIONAL ELECTRICAL STIMULATION BE AN EFFECTIVE TREATMENT FOR POST PROSTATECTOMY INCONTINENCE?

You have accessJournal of UrologyCME1 Apr 2023MP71-17 CAN FUNCTIONAL ELECTRICAL STIMULATION BE AN EFFECTIVE TREATMENT FOR POST PROSTATECTOMY INCONTINENCE? Pin Chun Liu, Yi-Sheng Lin, Yen-Chuan Ou, Chao-Yu Hsu, and Min-Che Tung Pin Chun LiuPin Chun Liu More articles by this author , Yi-Sheng LinYi-Sheng Lin More articles by this author , Yen-Chuan OuYen-Chuan Ou More articles by this author , Chao-Yu HsuChao-Yu Hsu More articles by this author , and Min-Che TungMin-Che Tung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-prostatectomy incontinence (PPI) is a bothersome complication after receiving radical prostatectomy. Incontinence may significantly interfere with quality of life and increase activity dependency. Functional electrical stimulation (FES) is one of the treatment tools of urinary incontinence. FES is the only conservative management in Taiwan National Health Insurance. The aim of this study was to analyze the effectiveness of FES in PPI treatment. METHODS: Patients who received robotic-assisted radical prostatectomy between 2019 to 2022 with complications of PPI were enrolled. The patient received FES twice every week (one course). Urinary distress inventory, short form (UDI-6), overactive bladder symptom score (OABSS) and Incontinence Impact Questionnaire, Short Form (IIQ-7) were applied for incontinence symptoms assessment and quantification. Measurements were obtained before and after 3 courses of FES treatment. Pre-FES and post-FES scores were collected and analyzed by pair sample T-test. RESULTS: Questionnaire data of 33 patients with PPI were collected in this study. No complication was noted during the whole treatment course of FES. Bothersome questionnaire scores significantly improved at follow up when compared to the baseline. The average score of OABSS (10.8 to 8.48, p=0.00017) and UDI-6 (8.18 to 5.65, p=0.00026) both got significant reductions. But there is no difference between pre and post-FES IIQ-7 score (10.26 to 8.46, p=0.09). CONCLUSIONS: Our study revealed the incontinence symptoms improvement after receiving functional electrical stimulation therapy. Functional electrical stimulation is a safe and effective treatment for post-prostatectomy incontinence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1021 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pin Chun Liu More articles by this author Yi-Sheng Lin More articles by this author Yen-Chuan Ou More articles by this author Chao-Yu Hsu More articles by this author Min-Che Tung More articles by this author Expand All Advertisement PDF downloadLoading ...

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

Therapists’ perspectives on using brain-computer interface-triggered functional electrical stimulation therapy for individuals living with upper extremity paralysis: a qualitative case series study

BackgroundBrain computer interface-triggered functional electrical stimulation therapy (BCI-FEST) has shown promise as a therapy to improve upper extremity function for individuals who have had a stroke or spinal cord injury. The next step is to determine whether BCI-FEST could be used clinically as part of broader therapy practice. To do this, we need to understand therapists’ opinions on using the BCI-FEST and what limitations potentially exist. Therefore, we conducted a qualitative exploratory study to understand the perspectives of therapists on their experiences delivering BCI-FEST and the feasibility of large-scale clinical implementation.MethodsSemi-structured interviews were conducted with physical therapists (PTs) and occupational therapists (OTs) who have delivered BCI-FEST. Interview questions were developed using the COM-B (Capability, Opportunity, Motivation—Behaviour) model of behaviour change. COM-B components were used to inform deductive content analysis while other subthemes were detected using an inductive approach.ResultsWe interviewed PTs (n = 3) and OTs (n = 3), with 360 combined hours of experience delivering BCI-FEST. Components and subcomponents of the COM-B determined deductively included: (1) Capability (physical, psychological), (2) Opportunity (physical, social), and (3) Motivation (automatic, reflective). Under each deductive subcomponent, one to two inductive subthemes were identified (n = 8). Capability and Motivation were perceived as strengths, and therefore supported therapists’ decisions to use BCI-FEST. Under Opportunity, for both subcomponents (physical, social), therapists recognized the need for more support to clinically implement BCI-FEST.ConclusionsWe identified facilitating and limiting factors to BCI-FEST delivery in a clinical setting according to clinicians. These factors implied that education, training, a support network or mentors, and restructuring the physical environment (e.g., scheduling) should be targeted as interventions. The results of this study may help to inform future development of new technologies and interventions.

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.

Multi-center, single-blind randomized controlled trial comparing functional electrical stimulation therapy to conventional therapy in incomplete tetraplegia.

BackgroundLoss of upper extremity function after tetraplegia results in significant disability. Emerging evidence from pilot studies suggests that functional electrical stimulation (FES) therapy may enhance recovery of upper extremity function after tetraplegia. The aim of this trial was to determine the effectiveness of FES therapy delivered by the Myndmove stimulator in people with tetraplegia.MethodsA multi-center, single-blind, parallel-group, two-arm, randomized controlled trial was conducted comparing FES to conventional therapy in adults (≥18 years) with C4–C7 traumatic incomplete tetraplegia between 4 and 96 months post-injury, and with a baseline spinal cord injury independence measure III -self-care (SCIM III-SC) score of ≤10. Participants were enrolled at four SCI-specialized neurorehabilitation centers in the U.S. and Canada. Participants were stratified by center and randomized in a 1:1 ratio to receive either 40 sessions of FES or conventional therapy targeting upper extremities over a 14-week period. Blinded assessors measured SCIM III, Toronto Rehabilitation Institute Hand Function Test, and Graded Redefined Assessment of Strength, Sensibility, and Prehension at baseline, after 20th session, after 40th session or 14 weeks after 1st session, and at 24 weeks after 1st session. The primary outcome measure was change in SCIM III-SC from baseline to end of the treatment. Based on the primary outcome measure, a sample size of 60 was calculated. Seventeen participants' progress in the study was interrupted due to the COVID-19 lockdown. The protocol was modified for these participants to allow them to complete the study.ResultsBetween June 2019 to August 2021, 51 participants were randomized to FES (n = 27) and conventional therapy (n = 24). Both groups gained a mean of 2 points in SCIM-SC scores at the end of treatment, which was a clinically meaningful change. However, there was no statistically significant difference between the groups on any outcomes.ConclusionForty sessions of FES therapy delivered by the MyndMove stimulator are as effective as conventional therapy in producing meaningful functional improvements that persist after therapy is completed. Limitations of this study include the impact of COVID-19 limiting the ability to recruit the target sample size and per-protocol execution of the study in one-third of the participants.RegistrationThis trial is registered at www.ClinicalTrials.gov, NCT03439319.

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.

A study to investigate the difference in functional activity, gait, and balance of stroke patients according to treatment methods

Purpose: This study was conducted to investigate the effect of therapeutic interventions in the field of physical therapy on the improvement of functional activity and gait and balance ability of the upper and lower extremities. Methods: Twenty subjects of the study participated in the study after hearing the explanation of the study, and were divided into Experimental Group 1 and Experimental Group 2 using a randomization method to participate in the study. Experimental group 1 received functional electrical stimulation treatment for the upper extremities and lower extremities for 20 minutes before PNF, and experimental group 2 received taping therapy to the upper extremities and lower extremities before PNF. In this study, FMA was used to evaluate the functional activity of the subject, walking ability was evaluated through TUG test, and balance was evaluated using BBS. Results: In the results of this study, there was a statistically significant difference in functional activity, gait, and balance between the pre- and post-evaluations. However, no statistically significant difference was found in the analysis comparing the size of the treatment effect between the two experimental groups. Conclusion: In conclusion, functional electrical stimulation therapy and taping therapy are therapeutic methods that are helpful in improving functional activity, gait, and balance ability in stroke patients. In addition, based on the results of this study, the necessary treatment can be selectively applied according to the patient's situation.

The Efficiency of Functional Electrical Stimulation and Balance-Weighted Rehabilitation Therapy in Stroke Patients with Foot-Drop: A Pilot Study

The Efficiency of Functional Electrical Stimulation and Balance-Weighted Rehabilitation Therapy in Stroke Patients with Foot-Drop: A Pilot Study

Post-stroke Rehabilitation of Severe Upper Limb Paresis in Germany - Toward Long-Term Treatment With Brain-Computer Interfaces.

Severe upper limb paresis can represent an immense burden for stroke survivors. Given the rising prevalence of stroke, restoration of severe upper limb motor impairment remains a major challenge for rehabilitation medicine because effective treatment strategies are lacking. Commonly applied interventions in Germany, such as mirror therapy and impairment-oriented training, are limited in efficacy, demanding for new strategies to be found. By translating brain signals into control commands of external devices, brain-computer interfaces (BCIs) and brain-machine interfaces (BMIs) represent promising, neurotechnology-based alternatives for stroke patients with highly restricted arm and hand function. In this mini-review, we outline perspectives on how BCI-based therapy can be integrated into the different stages of neurorehabilitation in Germany to meet a long-term treatment approach: We found that it is most appropriate to start therapy with BCI-based neurofeedback immediately after early rehabilitation. BCI-driven functional electrical stimulation (FES) and BMI robotic therapy are well suited for subsequent post hospital curative treatment in the subacute stage. BCI-based hand exoskeleton training can be continued within outpatient occupational therapy to further improve hand function and address motivational issues in chronic stroke patients. Once the rehabilitation potential is exhausted, BCI technology can be used to drive assistive devices to compensate for impaired function. However, there are several challenges yet to overcome before such long-term treatment strategies can be implemented within broad clinical application: 1. developing reliable BCI systems with better usability; 2. conducting more research to improve BCI training paradigms and 3. establishing reliable methods to identify suitable patients.

Comparing preference related to comfort in torque-matched muscle contractions between two different types of functional electrical stimulation pulses in able-bodied participants

Context/Objective Functional electrical stimulation (FES) is commonly used in rehabilitation to generate electrically-induced muscle contractions. FES has been shown to assist in the recovery of voluntary motor functions after stroke or spinal cord injury. However, discomfort associated with FES can motivate patients to withdraw their participation from FES therapy despite its benefits. To address this issue, a functional electrical stimulator, called MyndMove™ (MyndTec Inc., Canada), has been developed to generate more comfortable contractions than conventional stimulators. Design Cross-sectional, interventional, with two treatment arms. Setting A laboratory within a rehabilitation center. Participants Twelve able-bodied participants. Intervention FES delivered with two different stimulators, MyndMove™ and Compex Motion (Compex, Switzerland), during muscle contractions of high, moderate and low stimulation intensity. Outcome Measures Comfort-related preference to a given stimulator and the discomfort score rated through a Numeric Rating Scale (NRS-101) for both stimulators. Results Participants perceived a reduction in discomfort during high-intensity stimulation generated using MyndMove™. In addition, MyndMove™ stimulations were preferred in 60% of all contractions. The reduction in discomfort associated with MyndMove™ might be due the fact that MyndMove™ delivers less charge to generate contractions of equivalent intensity, compared to Compex Motion. Conclusion Reducing discomfort during FES may help in generating stronger and more clinically useful contractions, increasing accessibility of FES therapy to include individuals with low tolerance to FES.

Characterizing the stimulation interference in electroencephalographic signals during brain-computer interface-controlled functional electrical stimulation therapy.

The integration of brain-computer interface (BCI) and functional electrical stimulation (FES) has brought about a new rehabilitation strategy: BCI-controlled FES therapy or BCI-FEST. During BCI-FEST, the stimulation is triggered by the patient's brain activity, often monitored using electroencephalography (EEG). Several studies have demonstrated that BCI-FEST can improve voluntary arm and hand function after an injury, but few studies have investigated the FES interference in EEG signals during BCI-FEST. In this study, we evaluated the effectiveness of band-pass filters, used to extract the BCI-relevant EEG components, in simultaneously reducing stimulation interference. We used EEG data from eight participants recorded during BCI-FEST. Additionally, we separately recorded the FES signal generated by the stimulator to estimate the spectral components of the FES interference, and extract the noise in time domain. Finally, we calculated signal-to-noise ratio (SNR) values before and after band-pass filtering, for two types of movements practiced during BCI-FEST: reaching and grasping. The SNR values were greater after filtering across all participants for both movement types. For reaching movements, mean SNR values increased between 1.31 dB and 36.3 dB. Similarly, for grasping movements, mean SNR values increased between 2.82 dB and 40.16 dB, after filtering. Band-pass filters, used to isolate EEG frequency bands for BCI application, were also effective in reducing stimulation interference. In addition, we provide a general algorithm that can be used in future studies to estimate the frequencies of FES interference as a function of the selected stimulation pulse frequency, FSTIM , and the EEG sampling rate, FS .

The effect of skeletal muscle-derived cells implantation on stress urinary incontinence and functional urethral properties in female patients.

To evaluate improvement of stress urinary incontinence (SUI) and functional status of the urethra after autologous skeletal-muscle derived cell (aSMDC) implantation. Phase I-II, open, non-randomized, single-center study of ultrasound guided aSMDC implantation (dosed at 0.2×106 cells/2mL) into the external urethral sphincter to treat SUI. A total of 38 patients were treated and followed for 2years. SUI measured by Incontinence Episode Frequency score, short pad test, quality of life, patient's and clinician's perception significantly improved and remained improved after 2years. However, urodynamic urethral properties in general did not improve at 1-year after treatment. Subgroup analysis revealed that addition of an adjuvant functional electrical stimulation therapy discontinued 4weeks after injection in the compliant group, gave better urodynamic values and maintained the long-term SUI improvement at 2years. The aSMDC injection was safe and well-tolerated by patients. The status of SUI improved and with it the quality of life of patients, even if this was not necessarily reflected in the urodynamic urethral properties. Electrical stimulation, as an adjuvant therapy, could have an essential role in the success of the therapy. Clinical study was registered under Eudra-CT number: 2010-021867-34 at European Clinical Trial Database (EudraCT), accessible at: EudraCT (europa.eu).

Cortical Re-organization After Traumatic Brain Injury Elicited Using Functional Electrical Stimulation Therapy: A Case Report.

Functional electrical stimulation therapy (FEST) can improve motor function after neurological injuries. However, little is known about cortical changes after FEST and weather it can improve motor function after traumatic brain injury (TBI). Our study examined cortical changes and motor improvements in one male participant with chronic TBI suffering from mild motor impairment affecting the right upper-limb during 3-months of FEST and during 3-months follow-up. In total, 36 sessions of FEST were applied to enable upper-limb grasping and reaching movements. Short-term assessments carried out using transcranial magnetic stimulation (TMS) showed reduced cortical silent period (CSP), indicating cortical and/or subcortical inhibition after each intervention. At the same time, no changes in motor evoked potentials (MEPs) were observed. Long-term assessments showed increased MEP corticospinal excitability after 12-weeks of FEST, which seemed to remain during both follow-ups, while no changes in CSP were observed. Similarly, long-term assessments using TMS mapping showed larger hand MEP area in the primary motor cortex (M1) after 12-weeks of FEST as well as during both follow-ups. Corroborating TMS results, functional magnetic resonance imaging (fMRI) data showed M1 activations increased during hand grip and finger pinch tasks after 12-weeks of FEST, while gradual reduction of activity compared to after the intervention was seen during follow-ups. Widespread changes were seen not only in the M1, but also sensory, parietal rostroventral, supplementary motor, and premotor areas in both contralateral and ipsilateral hemispheres, especially during the finger pinch task. Drawing test performance showed improvements after the intervention and during follow-ups. Our findings suggest that task-specific and repetitive FEST can effectively increase cortical activations by integrating voluntary motor commands and sensorimotor network through functional electrical stimulation (FES). Overall, our results demonstrated cortical re-organization in an individual with chronic TBI after FEST.