Physical activity is known to provide broad health benefits, including reducing the risk of metabolic syndrome, diabetes and obesity, and it is therefore recommended as a pillar of cardiovascular disease prevention (1). Exercise also modulates the secretion of metabolic hormones and adipokines, such as adiponectin. This hormone is mainly secreted from adipose tissue and contributes to energy homeostasis by stimulating fatty acid oxidation in skeletal muscle and by inhibiting hepatic glucose production (2). Although many studies have investigated adiponectin release following aerobic training (3-5), less is known about its modulation when neuromuscular electrical stimulation (NMES) is applied during exercise. In this study, we examined both acute and chronic responses of plasmatic adiponectin concentration following 6-week cycling program (14 sessions) with or without percutaneous NMES. Electrical stimulation was delivered by a novel technology of Adaptive Functional Electrical Stimulation Kinesitherapy (AFESK™) through the VIK8 device (AFESK™ technology, VIK8, VIKTOR S.r.l., Italy). Sixteen healthy, physically active males matched for V'O2peak and age were assigned to either a cycling group or an AFESK group. Both groups completed the same interval training: 4x5m intervals at 60% peak power output (PPO) (achieved during an incremental test to exhaustion) interspersed with 3m recovery at 40% PPO. In the AFESK group, the VIK8 device provided electrical stimulation synchronized with voluntary contraction of the targeted skeletal muscles on lower limbs. Blood samples were collected at baseline and 15 min, 24h and 48h after the first (S1) and the last (S14) training session. Plasma adiponectin levels were detected by ELISA assay. After S1, adiponectin significantly increased at 15 min in both groups (+8,6% in the cycling group; +9,6% in the AFESK group). In the AFESK group only, adiponectin levels remained elevated at 24h (+8,5% compared to baseline), returning to basal levels after 48h in both groups. After S14, adiponectin increased after 15 min and 24 h post-exercise in both groups; however, the AFESK group displayed a greater rise (up to 15%, p

This case report details the potential benefits of an implanted neural stimulation system for walking to assist stair climbing after stroke. A 12-channel stimulation system was implanted in a stroke survivor for walking. Despite biweekly gait training with functional electrical stimulation (FES) that yielded locomotor improvements, the participant did not feel comfortable attempting stair climbing due to the lack of stability and fear of falling. During physical therapy, he previously limited his attempts at stair climbing to a step-to strategy with the paretic limb. The participant agreed to attempt stair climbing in a controlled environment with and without FES and displayed a marked improvement with stimulation, including increased hip/knee flexion, higher toe clearance, and the ability to use a step-over-step strategy which reduced his ascent time. This case report highlights the potential of using a multi-joint FES system for improving functions beyond walking in individuals with hemiplegia.

Trunk control has consistently been rated as a priority for recovery by individuals with spinal cord injury due to its role in facilitating interactions with the environment from a seated position. Feedback control of functional neuromuscular stimulation with the networked neuroprosthesis is a promising solution for automatically stabilizing seated posture after spinal cord injury by controlling the activation of paralyzed trunk muscles via accelerometers embedded in implanted modules. This study examined the design of a control system for implanted stimulation in an individual with cervical spinal cord injury who received an Networked Neuroprosthesis. A tilt-based threshold feedback controller modulated the stimulation that activated the paralyzed hip and trunk muscles such that the controller prevented the individual's trunk from moving beyond arbitrarily defined limits of seated leaning in the sagittal and coronal planes. Findings suggest that such a controller for the networked neuroprosthesis can enable individuals with spinal cord injury to complete returns to erect sitting from approximately 30° of forward or lateral flexion without external sensors and confirms the feasibility of deploying feedback-controlled functional neuromuscular stimulation to restore motor function using the fully implanted networked neuroprosthesis system.

A data-driven sensor fault tolerance approach for functional electrical stimulation in healthy and spinal cord injury individuals

Paraplegia, resulting from spinal cord injury or neurological disease, presents significant challenges in long-term care and rehabilitation. Effective therapeutic strategies are crucial for improving mobility, reducing complications, and enhancing quality of life. To systematically analyze clinical trials registered on ClinicalTrials.gov that investigate pharmacological, device-based, and procedural interventions for individuals with paraplegia. A retrospective analysis of 84 paraplegia-related clinical trials registered on ClinicalTrials.gov was conducted on July 3, 2025. Studies were categorized by type (interventional or observational), intervention class (pharmacological, device-based, behavioral, biological, or procedural), and primary outcome focus. Emphasis was placed on interventional trials (n = 61), with descriptive analyses of sample size, enrollment range, and outcome categories. Among the 84 included studies, 61 (73%) were interventional and 23 (27%) were observational. Device-based interventions (n = 30) were the most frequently investigated and included exoskeleton-assisted walking, functional electrical stimulation, and robotic rehabilitation systems. Pharmacological interventions (n = 10) targeted spasticity, neuroprotection, and cardiovascular regulation. Behavioral interventions (n = 7) emphasized patient engagement and rehabilitation planning, while biological and procedural therapies (n = 7) focused on neurostimulation and regenerative strategies. Primary outcomes most commonly assessed mobility/function (n = 13), safety (n = 9), and cardiometabolic parameters (n = 6), with many studies reporting small sample sizes. Clinical trials in paraplegia research are increasingly centered on pharmacological and device-supported interventions aimed at enhancing motor recovery and minimizing secondary disability. While variability in sample size and outcome measures exists, this analysis highlights promising directions for optimizing long-term management of paraplegia. Greater standardization in trial design and outcome reporting will be essential for advancing therapeutic effectiveness and clinical applicability.

This paper investigated the suitability of the integrated Recursive Rehabilitation Control Network (RRC-Net)/ High-Density Electrode Array (HDE-Array) system for performing two multi-Degree of Freedom (DoF) control tasks, developed as proxies for Functional Electrical Stimulation control: (1) a cursor-based task and (2) a 3-DoF hand kinematic model control task. The goal of this study is enhancing rehabilitation independence for individuals with spinal cord injuries. The system was validated on both healthy and tetraplegic subjects. The hypotheses that users could successfully perform these tasks using the system and that there would be no significant performance differences between healthy and tetraplegic participants were assessed. The experiment involved 10 tetraplegic and 8 healthy subjects who completed a training phase followed by two testing phases. High-Density surface Electromyography (HD-sEMG) signals recorded from the neck during the training phase were used to train RRC-Net, a neural network designed to estimate multi-DoF movements. Subjects then performed the two control tasks in the testing phase, and performance metrics were analysed and compared between groups. Healthy and tetraplegic subjects achieved high performance in both control tasks. Hand position control performance between the two groups presented no statistically significant differences in Mean Global Distance (MGD) (p = 0.93) or Mean Angular Distance (MAD) (p = 0.77). Similarly, cursor control task performance showed no significant differences in Task Completion Score (TCS) (p = 0.68) or Normalised Distance (ND) (p = 0.63). The system's simplicity, comfort, and effectiveness highlight its potential for rehabilitation, providing a non-invasive method for controlling assistive devices.

Functional Electrical Stimulation (FES) for post-stroke drop foot is commonly applied in acute and subacute stroke rehabilitation or as part of long-term home-based programs in chronic patients. Evidence supporting short facility-based rehabilitation programs incorporating FES in chronic populations remains limited. The aim of this study was to explore functional outcomes associated with such a program in a chronic population. A 10-day facility-based rehabilitation program incorporating FES therapy followed by 3-month follow-up was delivered to 14 chronic post-stroke patients with foot drop (8 women; aged 62.6 ± 12.2 years). FES was applied during walking with stimulation synchronized to the swing phase of gait (35 Hz, 300 μs, 15 min per session). Activities of daily living and mobility were assessed using clinical outcome measures. Statistical significance (p < 0.05), effect sizes, and minimal clinically important difference (MCID) responder rates were evaluated. Statistically significant improvements were observed across all outcome measures post-treatment and at follow-up, with MCID responder rates exceeding 50%. A short facility-based multimodal rehabilitation program incorporating FES was associated with functional improvements in chronic post-stroke patients. Given the multimodal design, these findings cannot be attributed to FES alone and should be interpreted as exploratory.

Background: Upper-limb rehabilitation is a decisive factor in improving the quality of life for patients who have experienced a stroke. Modern rehabilitation techniques promote the recovery of upper-limb functionality and prehension, contributing to a reduction in disability. Materials and Methods: This retrospective observational study aimed to highlight improvements in prehension through the application of current actual and modern rehabilitation techniques targeting key muscle groups involved in upper-limb recovery. Data from a total of 52 patients were identified and categorized into two groups based on the specific rehabilitation protocols they received during their hospitalization: a study group and a control group. Both groups underwent individualized rehabilitation, differing only in the type of electrotherapy applied: the study group received functional electrical stimulation (FES) and shock wave therapy (RSWT), while the control group received conventional electrical stimulation. Results: After adjusting for baseline differences in severity and time since stroke, patients in the study group demonstrated a significantly greater improvement in functional parameters compared to the control group. The results show us a significant improvement of functionality after RSWT and FES in the study group, with values from 0.28 ± 0.28 to 0.99 ± 0.36 (p-value < 0.001) regarding Hand Grip, suggesting that the treatment effect persists even when initial clinical advantages in the control group are accounted for. Muscle force increased from 0.39 ± 0.54 to 7.67 ± 3.89, p-value < 0.001. Conclusions: The combined application of functional electrical stimulation and shock wave therapy, as modern rehabilitation interventions, provided additional benefits in upper-limb and prehension rehabilitation compared to classical electrical stimulation alone. Our findings suggest that the combined application of RSWT and FES is strongly associated with improved upper-limb recovery, even after adjusting for baseline clinical imbalances. While these results support the integration of these modern techniques into stroke protocols, further prospective randomized controlled trials are needed to confirm the definitive treatment advantage over conventional methods.

A spinal cord injury (SCI) is a neurological disorder that impairs motor and physiological functions and leads to a reduced quality of life and autonomy for the person affected. In this scenario, human-machine interfaces (HMIs) have emerged as an effective tool to leverage residual motor capabilities and benefit injured persons. This work aims to develop a closed-loop HMI system for lower-limb rehabilitation composed of an in-house multi-channel Functional Electrical Stimulation (FES), which is activated by considering gait and pedaling cycles measured by an Inertial Measurement Unit. Two experiments were conducted with individuals suffering partial SCI who performed cycling and walking activities by using our proposed HMI, while inertial and electroencephalography signals were collected for further analysis and validation. Relative power changes were observed in mu (8-13Hz) and high beta (20-30Hz) bands over the foot area (Cz location), comparing both FES and non-FES conditions during gait and pedaling. This comparison also showed that the volunteers performed physical activities with greater speed and cadence by using the proposed HMI system, which correctly identified the movement phases.

Hemiplegic patients often experience weakness in key muscle groups during gait, significantly impairing walking and balance. To address this, we developed a novel gait phase-specific functional electrical stimulation (FES) delivered through a lower limb rehabilitation robot. This pilot study investigated the effects of combining gait phase-specific FES with robot-assisted gait training (RAGT) in subacute stroke patients. Fifty-one hemiplegic stroke patients were randomized into experimental, control, and placebo groups (17 each). The experimental group received conventional training plus gait phase-specific FES with RAGT. The control group underwent conventional training, traditional FES, and RAGT. The placebo group received conventional training with sham FES and RAGT. Interventions were administered daily, five times weekly, for three weeks. Assessments were conducted at baseline, weekly during treatment, and five weeks post-treatment completion. The primary outcomes were the 10-Meter Walk Test (10MWT) and the Berg Balance Scale (BBS). Secondary outcomes included the Fugl-Meyer Assessment (FMA-LE), the Manual Muscle Test (MMT), and the Modified Ashworth Scale (MAS). Forty-eight patients completed the trial. Two-way repeated-measures ANOVA revealed significant time, group, and time × group interaction effects for primary outcomes (10MWT and BBS, P < 0.01). The experimental group showed significantly greater improvements in 10MWT versus control and placebo groups at week 2, 3, and 5th-week follow-up (P < 0.05). Similarly, BBS scores were highest in the experimental group at week 3 and follow-up (P < 0.01), with control also outperforming placebo (P < 0.05). Secondary outcomes (FMA-LE, MMT, MAS) improved across all groups (P < 0.0001), but the experimental group exhibited superior gains at the follow-up (P < 0.01). No significant differences were observed between control and placebo groups (P > 0.05). Combining gait phase-specific FES with RAGT can effectively improve walking and balance function in stroke patients.

The global rise in non-communicable diseases, alongside an aging population, is expected to increase the prevalence of motor impairments and, therefore, the need for assistive care. Upper limb impairments can significantly affect independent living and increase long-term care costs. Wearable assistive devices incorporating electrical stimulation (ES) offer a promising solution to support independence and help alleviate pressures on both formal and informal care provision. The development of hybrid systems, which integrate aspects of robotics and electrical stimulation, aim to overcome the limitations associated with single-modality devices. However, there is limited information on the most appropriate electrical stimulation protocols to use, or on what challenges may be faced in doing so. Correspondingly, this narrative review addresses this gap through assessing the role of electrical stimulation in upper limb assistive technology. By evaluating user requirements and identifying challenges with current stimulation strategies, this review highlights the potential benefits of exploring alternative protocols, beyond conventional functional electrical stimulation (FES) techniques, for upper limb assistance. In particular, addressing practical difficulties of stimulation is likely to be critical for successful user uptake and minimizing device abandonment. The paper subsequently reviews several stimulation strategies which may offer novel research directions and opportunities in the development of upper limb assistive technologies.

Individuals with incomplete spinal cord injury (iSCI) often fall due to decreased sensorimotor integration. Functional electrical stimulation (FES) therapy combined with visual feedback balance training (VFBT), termed FES+VFBT, can effectively improve standing balance in iSCI populations. Although promising, the need for force plates (FP), which are expensive and bulky, limits the translation of these methods to clinical and home settings. In this work, we propose a solution by replacing FP with Wii Balance Board (WBB), allowing for more accessible FES+VFBT at a lower cost in both clinical and community settings. Our investigations on ten non-injured participants reveal that WBB-based estimated center of mass (COM) has low prediction error and high correlation in both anteroposterior (RMSE: 4.13 ± 0.69 mm, r: 0.94 ± 0.02) and mediolateral directions (RMSE: 6.25 ± 1.80 mm, r: 0.92 ± 0.04) with ground FP-estimated COM, resulting in similar stimulation patterns obtained with the WBB-based approach, indicating that the WBB-based FES+VFBT system could yield a more accessible therapeutic strategy for balance rehabilitation in iSCI.

Effect of functional electrical stimulation on maximum joint angles and gait asymmetry in female athletes post-anterior cruciate ligament reconstruction when crossing obstacles

Functional electrical stimulation (FES) is widely used to improve gait in individuals with neurological impairments; however, early responses in adults with congenital conditions, such as cerebral palsy, who are newly exposed to FES, remain poorly understood. This study investigated the orthotic and therapeutic effects of FES in short- and long-term users using standardized three-dimensional gait analysis. In this longitudinal study, short-term users (G1; n = 13; mean age 31.7 ± 18.1 years) were evaluated both without and with FES and followed over a 4-12-week insurance-covered trial period. Long-term users (G2; n = 11; mean age 32.2 ± 11.0 years), who had used FES for at least one year, were reassessed over a standardized 12-week interval. Linear mixed-effects models assessed the effects of FES and time, with subjects included as random effects to account for inter-individual variability. G1 showed significant therapeutic adaptations, including increased walking speed and step length and reduced step width, accompanied by decreased dorsiflexion during stance and swing, while no significant orthotic effects were observed. G2 demonstrated clear orthotic responses, such as increased dorsiflexion at heel strike and during swing and improved walking speed and step length, with minimal evidence of additional therapeutic adaptation. The initial reduction in dorsiflexion in G1 warrants further investigation. These findings suggest that evaluation timelines may need to be extended and that outcome measures beyond foot clearance should be considered, particularly given the heterogeneity and severity of congenital neurological conditions.

Functional electrical stimulation is widely applied in the rehabilitation of individuals with cerebrovascular disease or spinal cord injury but is limited by rapid muscle fatigue. We present a novel stimulation strategy based on real-time motor point tracking using a wearable functional electrical stimulation device with a movable electrode. A crank-slider mechanism drives the electrode to follow the biceps brachii motor point trajectory according to elbow joint angle, aiming to optimize stimulation site and reduce fatigue. Seven healthy male participants compared this approach with time-shifted and joint angle-shifted stimulation. Muscle performance was evaluated by maximum voluntary contraction, change in elbow joint angle, and subjective comfort assessed on a visual analogue scale. Results showed that motor point tracking significantly reduced fatigue and improved comfort compared with conventional methods, supporting its potential to enhance functional electrical stimulation-based upper limb rehabilitation.

BackgroundMultiple Sclerosis (MS) is a chronic neurodegenerative disease in which the immune system attacks the myelin sheaths around nerves. People with MS (pwMS) often experience pain, fatigue, cognitive dysfunction, and reduced mobility. Today, MS is incurable, and treatments can at best slow the progression of the disease and manage symptoms. We conducted a preliminary, single-arm study using a motor-imagery brain–computer interface (MI-BCI) with functional electrical stimulation (FES) and virtual reality avatar targeting gait in pwMS.MethodsTwenty-six pwMS were enrolled; 24 completed 30 BCI sessions. Outcomes were assessed at Baseline, immediately post-treatment (Post1, week 13) and during follow-up (Post2, week 17; Post3, week 37). Change from baseline was analyzed using mixed models for repeated measures (with log-ratio models for skewed measures) and multiplicity control. This uncontrolled study is hypothesis-generating.ResultsPatients treated with the BCI-based intervention obtained significant improvements that were largely maintained to 6 months after the therapy. The walking endurance, assessed by the 6-minute walking test (6MWT), increased by 37.3 m (95% CI 21.50–53.10) after the treatment (p < 0.001), exceeding the minimal clinically important difference (MCID). This improvement in the walking endurance was maintained during the following 6 months after the intervention. Mobility/speed improved: TUG and T25FW times decreased by −15.5% and −16.4% after the last BCI session (both p < 0.001), with benefits persisting after 6 months. Spasticity (MAS) declined by about 1 point, and patient-reported outcomes improved statistically and clinically (MSIS-29 10.18 points, MFIS 7.29 points). Pairwise post-visit contrasts were not significant, consistent with maintenance. Exploratory models found no consistent MS-subtype effect on 6MWT change and suggested larger gains with higher baseline EDSS. Two discontinuations were due to participant availability, not concerns with fatigue or safety.ConclusionIn this preliminary, single-arm study, a MI-BCI + FES system was associated with statistically significant, clinically meaningful gains in gait endurance, mobility/speed, spasticity, and patient-reported outcomes, sustained up to 6 months after the intervention.

Background: Spinal cord injury (SCI) causes sensorimotor deficits and functional impairments that compromise quality of life in people with SCI (PwSCI). Although neuroplasticity-based therapies such as functional electrical stimulation (FES) are promising, accessibility barriers hinder their translation and long-term use. Objectives: To evaluate the effectiveness and usability of a home-based multidisciplinary rehabilitation protocol combining FES neuromodulation and virtual-based therapy for PwSCI. Methods: Eighty PwSCI received a hybrid intervention (synchronous and asynchronous), using a portable, app-based FES system with cloud monitoring. Outcome measures included SCIM-III, Motor Index Score (MIS), Timed Up &amp; Go, five times sit-to-stand, and American Spinal Injury Association Impairment Scale (AIS) changes, along with feasibility and usability measures such as adherence, patient satisfaction, heuristic analysis, among others. Results: Motor incomplete paraplegia (AIS C/D) showed significant SCIM-III improvements (Δ+10 points, P &amp;lt; .001) and enhanced motor scores (MIS: Δ+4 points, P &amp;lt; .001), along with high adherence (70%) and satisfaction (84%). AIS changes showed in 32.5% of the patients. Motor complete injuries exhibited limited gains, highlighting thresholds for residual plasticity. Conclusion: A multidisciplinary protocol combining virtual therapy and FES may enhance motor recovery and independence in PwSCI, providing a scalable, accessible alternative to conventional rehabilitation. These results underscore the potential of technology-driven strategies to overcome barriers to care.

Objective: This study investigated the efficacy and neural mechanisms of robot-assisted mirror therapy (RMT) for post-stroke upper limb rehabilitation. RMT integrates the multimodal feedback of mirror therapy with robotic precision and repetition to enhance cortical activation and neuroplasticity. Methods: Seventy-eight stroke patients were randomly assigned to control, mirror therapy (MT), or RMT groups. All received conventional rehabilitation; the MT group additionally underwent mirror therapy, and the RMT group received robot-assisted mirror therapy combined with functional electrical stimulation. The primary outcome was the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), with secondary measures including spasticity, dexterity, daily living, and quality of life. Functional near-infrared spectroscopy (fNIRS) was applied to assess cortical activation and connectivity at baseline, post-intervention, and one-month follow-up. Results: All groups showed significant time effects, though between-group differences were limited. Subgroup analysis revealed that patients at Brunnstrom stages I-II in the MT group achieved greater improvements in upper limb function, dexterity, and daily living ability. fNIRS findings showed enhanced activation in the right sensory association cortex and increased prefrontal-sensory connectivity. Conclusions: While all interventions improved motor outcomes, MT yielded slightly superior recovery associated with neuroplastic changes. RMT demonstrated high safety, compliance, and potential benefit for patients with severe motor deficits.

Functional electrical stimulation (FES) is commonly used in clinical practice to induce muscle contractions for rehabilitation therapy. However, the collected electromyography (EMG) under FES is a mixed signal containing voluntary electromyography (VEMG), which is generated by neural system recruited motor units, and FES response, which is composed of initial spikes generated by current passage and M-waves generated by stimulation recruited motor units. To realize close-loop control of FES system or to reveal the mechanism of FES through EMG signal, it is necessary to separate the three components from mixed signal. Based on the assumption that signal sources of initial spikes and action potentials related signals (VEMG and M-waves) are independent of each other, this study presents a novel mixed FES signal decomposition algorithm termed FastICA-Comb. Specifically, in order to achieve high-quality separation of VEMG, M-waves and initial spikes, the algorithm is designed as a unique scheme combining one-stage comb filtering and two-stage fast independent component analysis (FastICA) decomposition and classification. To evaluate the proposed algorithm's effectiveness, FES data collection experiment was conducted on 6 healthy subjects. The experimental results confirm that the FastICA-Comb algorithm has better VEMG and M-wave extraction capabilities than the classical methods including comb filter, GS-PEF, EMD-notch and blanking window in both simulated and real mixed FES signal. Therefore, the research findings provide an effective signal analysis tool for exploring the therapeutic mechanism of FES.

In the last few years, recent advances in alternative methods for neurorehabilitation have witnessed outstanding progress including electrical stimulation (ES) and its derivative functional electrical stimulation (FES), a treatment that applies a transcutaneous electrical current to induce muscle contractions and is commonly used in individuals with motor disabilities, such as poststroke, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and spinal cord injury (SCI). Similarly, brain–computer interfaces (BCIs) have been shown to be a powerful tool in rehabilitation processes specifically for people in motor disabilities situations or injuries associated with the brain. By doing a bibliometric analysis, this work presents some of the most important advances in the integration of these two approaches, BCI and FES, for motor recovery showing at the same time their main aspects, the most used methods and future challenges. The bibliometric analysis allows researchers to identify possible ways to explore current developments, challenges and future perspectives of a specific field of study. Scopus tool and open software VOSviewer were used. As a result, it is concluded that FES is a technique applied in different scenarios from sports and fitness, robotics, and physical therapy, among others, and that the integration of this technology with a BCI‐based control could improve neurorehabilitation processes.