Functional Electrostimulation Research Articles

Functional electrostimulation therapy for vastus medialis decreases the varus thrust during gait.

[Purpose] This study aimed to investigate whether modification of vastus medialis activity can delay the varus thrust. [Participants and Methods] Ten participants (Kellgren-Laurence grades I: n=2, II: n=6, and III: n=2) diagnosed with knee osteoarthritis were enrolled. The intervention involved free walking on a 10-m walkway at any speed after donning a functional electrical stimulation set to contract the vastus medialis before heel contact. Using a Vicon Nexus ground reaction force meter and a wireless electromyograph DELSYS, varus thrust, maximal knee extension angle, maximal knee adduction moment, and vastus medialis onset time were assessed both before and after intervention. [Results] A significant difference in varus thrust was detected from before to after the intervention (2.7 ± 1.1° vs. 2.2 ± 1.3°). Both the vastus medialis activation time (-0.06 ± 0.09 vs. -0.21 ± 0.1) and the knee-joint extension angle (8.7 ± 5.1° vs. 5.5 ± 5.9°) decreased following intervention, whereas the knee adduction moment significantly increased (0.50 ± 0.20° vs 0.56 ± 0.18°). [Conclusion] Wearing the functional electrical stimulation set caused the vastus medialis to act earlier in response to heel strike, thereby improving the knee-joint extension angle and suppressing varus thrust.

Functional Electrostimulation System for a Prototype of a Human Hand Prosthesis Using Electromyography Signal Classification by Machine Learning Techniques

Functional electrical stimulation (FES) has been proven to be a reliable rehabilitation technique that increases muscle strength, reduces spasms, and enhances neuroplasticity in the long term. However, the available electrical stimulation systems on the market produce stimulation signals with no personalized voltage–current amplitudes, which could lead to muscle fatigue or incomplete enforced therapeutic motion. This work proposes an FES system aided by machine learning strategies that could adjust the stimulating signal based on electromyography (EMG) information. The regulation of the stimulated signal according to the patient’s therapeutic requirements is proposed. The EMG signals were classified using Long Short-Term Memory (LSTM) and a least-squares boosting ensemble model with an accuracy of 91.87% and 84.7%, respectively, when a set of 1200 signals from six different patients were used. The classification outcomes were used as input to a second regression machine learning algorithm that produced the adjusted electrostimulation signal required by the user according to their own electrophysiological conditions. The output of the second network served as input to a digitally processed electrostimulator that generated the necessary signal to be injected into the extremity to be treated. The results were evaluated in both simulated and robotized human hand scenarios. These evaluations demonstrated a two percent error when replicating the required movement enforced by the collected EMG information.

Electrochemical Properties of Sputtered Ruthenium Oxide Neural Stimulation and Recording Electrodes

A chronically stable electrode material with a low impedance for recording neural activity, and a high charge-injection capacity for functional electro-stimulation is desirable for the fabrication of implantable microelectrode arrays that aim to restore impaired or lost neurological functions in humans. For this purpose, we have investigated the electrochemical properties of sputtered ruthenium oxide (RuOx) electrode coatings deposited on planar microelectrode arrays, using an inorganic model of interstitial fluid (model-ISF) at 37 °C as the electrolyte. Through a combination of cyclic voltammetry (CV) and an electrochemical impedance spectroscopy (EIS) modelling study, we have established the contribution of the faradaic reaction as the major charge-injection contributor within the safe neural stimulation potential window of ±0.6 V vs. Ag|AgCl. We have also established the reversibility of the charge-injection process for sputtered RuOx film, by applying constant charge-per-phase current stimulations at different pulse widths, and by comparing the magnitudes of the leading and trailing access voltages during voltage transient measurements. Finally, the impedance of the sputtered RuOx film was found to be reasonably comparable in both its oxidized and reduced states, although the electronic contribution from the capacitive double-layer was found to be slightly higher for the completely oxidized film around 0.6 V than for its reduced counterpart around −0.6 V.

Is There a Standard Rehabilitation Procedure in Cervical Dystonia?

Introduction: Idiopathic cervical dystonia, also known as spasmodic torticollis, is the most common form of focal dystonia in adults. Cervical dystonia usually appears between the ages of 30 and 50, twice as often in women, and is characterised by uncontrollable painful contractions of the sternocleidomastoid muscle, which results in misalignment of the head and shoulder. Over time, the disease becomes very burdensome for the patient and reduces his/her independence and quality of life; falls happen.Aim: The aim of the article is to present the current state of knowledge on comprehensive rehabilitation in cervical dystonia. Data on the prevalence, symptoms, diagnosis, clinical assessment, pharmacological treatment (including the most commonly used botulinum toxin), neurosurgical treatment and comprehensive rehabilitation are presented.Methods: The applied methods was a narrative critical review of scientific reports.Results: Out of several hundred publications, works worthy of particular attention were selected. In them, are described of conducting exercises, the main goal of which is to stretch and relax the dystonic muscles while strengthening the antagonistic muscles and correcting the position of the head. The selected authors used manual therapy, exercises at the patient's home, EMG biofeedback, magnetic stimulation of the cerebellum, vibration of the neck muscles, functional electrostimulation (FES) of antagonistic muscles, mobilisation of the cervical spine, postural exercises, isometric exercises, muscle relaxation, the PNF method, relaxation training, balance exercises, coordination, corrective exercises, massage, relaxation exercises, stretching and kinesiotaping.Conclusions: The variety of disease forms (10 head positioning patterns are described) and different severity of symptoms make it impossible to draw up a scheme of rehabilitation. In each case, rehabilitation must be tailored individually, and the physiotherapist taking care of the patient should have extensive experience. Physiotherapy can alleviate the disability caused by dystonia, however, due to the many non-motor symptoms, a holistic approach to the patient should also be kept in mind.

Functional Electrostimulation in Patients Affected by the Most Frequent Central Motor Neuron Disorders—A Scoping Review

Post-stroke sequelae, spinal cord injury and multiple sclerosis are the most common and disabling diseases of upper motor neurons. These diseases cause functional limitations and prevent patients from performing activities of daily living. This review aims to identify the potential of functional electrical stimulation (FES) for locomotor rehabilitation and daily use in upper motor neuron diseases. A systematic search was conducted. For the search strategy, MeSH terms such as “stroke”, “functional electrical stimulus*” and “FES”, “post-stroke”, “multiple sclerosis”, and “spinal cord injury*” were used. Of the 2228 papers from the raw search results, 14 articles were analyzed after inclusion and exclusion criteria were applied. Only four articles were randomized clinical trials, but with low numbers of participants. RehaMove, Microstim and STIWELL were reported in three independent studies, whereas Odstock was used in four articles. The results of the studies were very heterogeneous, although for lower extremity stimulation (11 out of 14 papers), walking speed was reported only in 6. Berg Balance Scale, Timed Up and Go, Functional Ambulation Category, 6-Minute Walk Test, 10-Meter Walk Test, Fugl-Meyer Assessment, Motricity Index and Action Research Arm Test were reported for functional assessment. For clinical assessment, the Modified Barthel Index, the Rivermead Mobility Index and the Stroke Impact Scale were used. Four studies were spread over 6 months, two investigated the effects of FES during one session, and the other eight were conducted for 3 to 8 weeks. Improvements were reported related to gait speed, functional ambulation, hand agility and range of motion. FES can be considered for large-scale use as a neuroprosthesis in upper neuron motor syndromes, especially in patients with impaired gait patterns. Further research should focus on the duration of the studies and the homogeneity of the reported results and assessment scales, but also on improvements to devices, accessibility and quality of life.

Application of exoskeleton with functional electrostimulation for rebalancing of patients in acute and early recovery periods of ischemic stroke

To study impact of robotic mechanotherapy with functional electrostimulation (FES) on rebalancing in patients in acute and early recovery periods of ischemic stroke. The number of patients equal 60, divided into 2 groups, were examined. Study group included 30 patients, who were treated in an exoskeleton with FES; control group consisted of 30 patients, whose walking and balance recovering was carried out with exercise therapy. The study group showed a more pronounced improvement of balance indicators by Tinetti scale compared to the control group (11 [8; 13] against 8 [6; 12]; p=0.0281) at the end of treatment. Patients of study group demonstrated significantly better results both by Tinetti scale and stabilometrical parameters in acute period of stroke compared to the control group. Application of exoskeleton with FES in patients in acute and early periods of ischemic stroke contributes (to a better balance recovery), which may be achieved by long-lasting verticalization and large repetition of the correct walking pattern during rehabilitative trainings.

Stationary rehabilitation robot and functional electrostimulation for the treatment of patients in the initial six months after stroke: a randomized controlled trial

Background: Results from studies investigating the effects of rehabilitation robots, including those using robots combined with functional electrostimulation (FES), on gait quality and postural control post-stroke are conflicting. Therefore, the evidence supporting the use of this approach to rehabilitation remains inconclusive and further research is required into how robotic therapy and FES can improve gait function and postural control at different times after stroke. Aim of the study: To gain knowledge on the effectiveness of stationary robotic exercises, and robotic exercises combined with FES of the lower extremity muscles, on activities of daily living, gait quality, postural control, and quality of life, in people who were between one and six months post-stroke. Material and Methods: A randomized controlled clinical pilot study was conducted. Forty-three post-stroke patients hospitalized at a rehabilitation center were randomly assigned to the following three groups: the GEO Group, for whom stationary robotic exercises were provided, the GEO+FES Group, for whom stationary robotic exercises were provided in combination with FES, and the Control Group, for whom conventional overground gait training was provided. Exercises were undertaken by all groups for 20 minutes a day, six days a week, for three weeks. In addition, all patients were provided with basic post-stroke therapy based on the principles of best clinical practice. All patients were assessed for stroke symptoms before and after therapy using the National Institutes of Health Stroke Scale (NIHSS), for independence in activities of daily living using the Barthel Index, and for quality of life using the Stroke Impact Scale Questionnaire. Static and dynamic postural control and gait performance were assessed using the Berg Balance Scale, the Timed Up and Go Test, the Functional Reach Test, and the 10 Meter Walk Test. Static postural control and gait quality were also assessed using a treadmill with a stabilometric platform. Results. Exercising on a stationary robot, both with and without FES of the lower extremity muscles, contributed to a statistically significant reduction in stroke symptoms (NIHSS, p<0.05). Additionally, exercising on a stationary robot without FES application significantly improved patient quality of life (p<0.05). However, these effects were not significantly different between the experimental and control groups. Conclusions. Stationary robotic exercise, either with or without FES, can be used as a substitute for traditional overground gait training to reduce stroke symptoms and improve quality of life in the first six months post-stroke. They can also be used as exercises to augment standard post-stroke therapy.

Physiatric treatment of hip dysplasia in a puppy: Case report

Hip dysplasia is a highly recurrent orthopedic condition that starts in the puppy with joint laxity and progresses to osteoarthrosis, which can cause severe pain and compromise the animal's quality of life. Its development is multifactorial and there are several described. In adults, there is a consensus that the treatment of the disease is multifactorial and encompasses environmental management, use of nutraceuticals, anti-inflammatories, and physical therapy. When there is no response the treatment, surgical procedures such as acetabular denervation, arthroplastic excision of the femoral head and total hip replacement can be performed. In puppies there are already studies that prove the hormonal, nutritional influence, and the development of muscle mass in the evolution of hip dysplasia. However, there is no previous report of a physiatric protocol for dysplastic puppies. Conservative treatment was performed on a male dog of the Saint Bernard breed with a severe degree of hip subluxation and valgus angular deviation from 4 to 9 months of age. With the application of functional electrostimulation, kinesiotherapy and photobiomodulation during 30 sessions, there was a significant improvement in muscular and cardiovascular resistance, an important reduction in claudication, muscle mass gain in the gluteal region and thigh extensors, reduction of angular deviation of the femorotibial joint and it was easier for it to stand up. It is concluded that physiatric techniques have the potential to control the factors that negatively influence the development of hip dysplasia and can be included in the conservative treatment in puppies, however further studies are needed.

Finite dimensional approximation to muscular response in force-fatigue dynamics using functional electrical stimulation

Recent dynamical models, based on the seminal work of V. Hill, allow to predict the muscular response to functional electrostimulation (FES), in the isometric and non-isometric cases. The physical controls are modeled as Dirac pulses and lead to a sampled-data control system, sampling corresponding to times of the stimulation, where the output is the muscular force response. Such a dynamics is suitable to compute optimized controls aiming to produce a constant force or force strengthening, but is complex for real time applications. The objective of this article is to construct a finite dimensional approximation of this response to provide fast optimizing schemes for the design of a smart electrostimulator for muscular reinforcement or rehabilitation. It is an on-going industrial project based on force-fatigue models, validated by experiments. Moreover it opens the road to application of optimal control to track a reference trajectory in the joint angular variable to produce movement in the non-isometric models.

Combined conventional speech therapy and functional electrical stimulation in acute stroke patients with dyphagia: a randomized controlled trial

BackgroundStroke is the main cause of oropharyngeal neurogenic dysphagia. Electrostimulation has been used as a therapeutic tool in these cases. However, there are few studies that prove its effectiveness. We evaluated the effect of functional electrostimulation as a complement to conventional speech therapy in patients with dysphagia after a stroke in a stroke unit.MethodsWe performed a clinical, randomized, and controlled trial divided into intervention group (IG) (n = 16) and control group (CG) (n = 17). All patients were treated with conventional speech therapy, and the IG also was submitted to the functional electrotherapy. Primary outcomes were Functional Oral Ingestion Scale (FOIS) and Swallowing videoendoscopy (FEES). The degree of dysphagia was scored in functional, mild, moderate and severe dysphagia according to FEES procedure. Dysphagia Risk Evaluation Protocol (DREP) was considered a secondary outcome.ResultsThere was a significant difference regarding FOIS scores after 5 days of intervention in groups. Both groups also showed a tendency to improve dysphagia levels measured by FEES, although not statistically significant. Improvements on oral feeding was seen in both groups. No significant differences between groups before and after the intervention were detected by DREP scores. Electrical stimulation did not show additional benefits beyond conventional therapy when comparing outcomes between groups.ConclusionConventional speech therapy improved oral ingestion even regardless the use of electrostimulation in a stroke unit.Trial registrationThis research was registered in ClinicalTrials.gov (Identifier: NCT03649295) in 28/08/2018 and in the Brazilian Registry of Clinical Trials (ReBEC) (Register Number: RBR-56QK5J), approval date: 18/12/2018. HGF Ethics Committee Approval Number: N. 2.388.931.

P 52 Short-term therapeutic effects of functional electrical stimulation on the somatosensory evoked potentials in the rehabilitation of the patients after the stroke: an interventional study

Objective: The aim was to investigate whether the short-term therapeutic effects of functional electrostimulation (FES) have a role in improving pathological latencies and/or amplitudes of somatosensory evoked potentials (SSEPs) caused by a cortical post-stroke lesion in acute patients with a foot drop. Methods: A randomized clinical sequential two-period crossover-design protocol was constructed and the study followed the PICO Consort criteria. 32 patients were divided in a two separate consecutive treatment periods as part of a four-week inpatient neurological rehabilitation. All patients received conventional rehabilitation therapy. Additionally, group A was treated with FES for two weeks and after this period Group A and Group B were switched. Results: The initial results indicated interaction between functional electrostimulation and the primary somatosensory cortical complex because we observed at this stage of the study that the cortical latency P40 of the intervention group remained invariable. Nevertheless, the control group indicated increase in P40 latency delay. Further data evaluation is necessary to answer the main objective of the study.

Post-Stroke Treatment with Neuromuscular Functional Electrostimulation of Antagonistic Muscles and Kinesiotherapy Evaluated with Electromyography and Clinical Studies in a Two-Month Follow-Up.

The aim of this study was to determine the sustained influence of personalized neuromuscular functional electrical stimulation (NMFES) combined with kinesiotherapy (mainly, proprioceptive neuromuscular facilitation (PNF)) on the activity of muscle motor units acting antagonistically at the wrist and the ankle in a large population of post-stroke patients. Clinical evaluations of spasticity (Ashworth scale), manual muscle testing (Lovett scale), and surface electromyography recordings at rest (rEMG) and during attempts of maximal muscle contraction (mcEMG) were performed three times in 120 post-stroke patients (T0: up to 7 days after the incidence; T1: after 21 days of treatment; T2: after 60 days of treatment). Patients (N = 120) were divided into two subgroups—60 patients received personalized NMFES and PNF treatment (NMFES+K), and the other 60 received only PNF (K). The NMFES+K therapy resulted in a decrease in spasticity and an increase in muscle strength of mainly flexor muscles, in comparison with the K group. A positive correlation between the increase of rEMG amplitudes and high Ashworth scale scores and a positive correlation between low amplitudes of mcEMG and low Lovett scale scores were found in the wrist flexors and calf muscles on the paretic side. Negative correlations were found between the rEMG and mcEMG amplitudes in the recordings. The five-grade alternate activity score of the antagonists’ actions improved in the NMFES+K group. These improvements in the results of controlled NMFES treatment combined with PNF in patients having experienced an ischemic stroke, in comparison to the use of kinesiotherapy alone, might justify the application of conjoined rehabilitation procedures based on neurophysiological approaches. Considering the results of clinical and neurophysiological studies, we suppose that NMFES of the antagonistic muscle groups acting at the wrist and the ankle may evoke its positive effects in post-stroke patients by the modulation of the activity more in the spinal motor centers, including the level of Ia inhibitory neurons, than only at the muscular level.

Use of electrostimulation in outpatients after ischemic stroke

Stroke is considered the 2nd most fatal disease worldwide, this pathology, is responsible for physical and cognitive sequelae for the consequences of its aggressiveness that damages the structures and functions of the brain, where it interferes effectively in the quality of life of those affected. Following a literature review, in the current year 2022, the following electronic databases were used: VHL, SciELO, MEDLINE, PEDro and PubMed between 2012 and 2022. The Boolean operator AND was used to association the following descriptors: Stroke. Electrostimulation. Physiotherapy. Rehabilitation. The main relevant changes due to the obstruction of brain vascular regions provide neural deficit, loss of function of the region to the affected area and irreversible functional conditions of affected individuals who survived this pathology. Physiotherapy through techniques, studies and emphasis on the use of functional electrostimulation has the role of safeguarding the functionalities of affected individuals.

A Feasibility and Efficacy Randomized Controlled Trial of Two Exercise Programs in Severe AECOPD Patients with Resting Hypoxemia.

Resting hypoxemia is the most severe stage of Chronic Obstructive Pulmonary Disease (COPD). Due to their impairments during the exacerbation, these patients are limited to traditional exercise rehabilitation and are excluded from the majority of the studies. The aim of this study was to assess the feasibility and the efficacy of two exercise programs in Acute Exacerbation of COPD (AECOPD) patients with resting hypoxemia. In this randomized clinical trial, patients hospitalized due to an acute exacerbation of COPD with hypoxemia at rest were included. Patients were randomly assigned into three groups. A Control Group (pharmacological treatment), a Global Exercise Group (GEG), and a Functional Electrostimulation Group (FEG). Patients were treated during the hospitalization period. The main outcomes were lower limb strength (assessed by a dynamometer), balance (assessed by the one leg standing balance test), health related quality of life (assessed by the EQ-5D), adverse events and adherence. At the end of the intervention, there were significant differences in all the variables in favour of the experimental groups (p < 0.05). We concluded that conducting an exercise program is feasible and improves lower limb strength, balance, and health related quality of life in AECOPD patients with resting hypoxemia.

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.

Tratamento fisioterapêutico com o uso da eletroestimulação funcional e a facilitação neuromuscular proprioceptiva em pacientes com sequelas de AVC

Objetivo: O objetivo desse estudo é analisar as evidências científicas encontradas sobre o tratamento do AVC através da eletroestimulação funcional (FES) e da facilitação neuromuscular proprioceptiva (FNP). Métodos: A metodologia usada foi uma revisão de literatura integrativa, nas bases de dados, SCIELO, PEDro, artigos publicados nas bases de dados nos últimos 10 anos. Foram avaliados os efeitos da eletroestimulação funcional (FES) e da facilitação neuromuscular proprioceptiva (FNP) nos pacientes com sequelas de AVC. Resultados: A busca resultou no total de 357 artigos que após os critérios de inclusão e exclusão ficaram 10 artigos para o estudo onde foi dividido em duas tabelas ressaltando os tratamentos e sua eficácia onde, ao total foram analisados dez artigos dos quais seis são estudos piloto, 1 ensaio clinico, 2 estudos controle e 1 estudo transversal. Considerações Finais: Com a aplicação dos dois recursos, foi observado que os mesmos removem uma reabilitação mais eficaz, proporcionando maior qualidade de vida aos pacientes. Sugere-se que estudos mais complexos sejam realizados, com amostras maiores e mais homogêneas, na tentativa de análises mais eficientes.

The Effectiveness of Functional Stimulation in Multiple Sclerosis (Literature Review)

Introduction. The restoration of motor functions in patients with multiple sclerosis is a priority task of medical rehabilitation in orderto slow the progression of the orthopedic defect and patients’ quality of life improvement. Despite the usage of disease modifying drugs, patients suffering from significant neurological disorders gain orthopedic complications. A decrease in physical activity leadsto increased body weight, trophic and other disorders, aggravating the course of the main illness and complicating the process of medical rehabilitation. Mobile functional electrical stimulation devices (FES) could became an innovative mean for the improvement of MS patient’s mobility and gait in everyday life. Aim. To provide evidence-based data from clinical studies on the potential of FES devices usage in clinical practice by patients with paresis of the lower extremities. The article deals with general characteristics of modern devices of functional electrostimulation,compares the most popular devices. The results of meta-analyzes and clinical studies on the effectiveness and safety of FES devices forthe rehabilitation of patients with multiple sclerosis are presented. The influence of functional electrical stimulation on gait parameters,ankle joint functional mobility and quality of life are considered. Conclusion. When patients with MS undergo rehabilitation using neuro-orthoses with FES, the pattern of gait is normalized, stability of walking is increased, the number of falls and the need for additional support are reduced. Among the main advantages of FES a significant increase in the mobility and independence of patients, which directly affects the quality of life is noted. FES has a positive effect on the level of physical activity and on muscle strength, cardio-respiratory parameters, as well as on a decrease in the severity of paresis. FES therapy in motion is an excellent rehabilitation tool with proved therapeutic efficacy when used in the rehabilitation of MS patients.

Effects of Gamification in BCI Functional Rehabilitation.

ObjectiveTo evaluate whether introducing gamification in BCI rehabilitation of the upper limbs of post-stroke patients has a positive impact on their experience without altering their efficacy in creating motor mental images (MI).DesignA game was designed purposely adapted to the pace and goals of an established BCI-rehabilitation protocol. Rehabilitation was based on a double feedback: functional electrostimulation and animation of a virtual avatar of the patient’s limbs. The game introduced a narrative on top of this visual feedback with an external goal to achieve (protecting bits of cheese from a rat character). A pilot study was performed with 10 patients and a control group of six volunteers. Two rehabilitation sessions were done, each made up of one stage of calibration and two training stages, some stages with the game and others without. The accuracy of the classification computed was taken as a measure to compare the efficacy of MI. Users’ opinions were gathered through a questionnaire. No potentially identifiable human images or data are presented in this study.ResultsThe gamified rehabilitation presented in the pilot study does not impact on the efficacy of MI, but it improves users experience making it more fun.ConclusionThese preliminary results are encouraging to continue investigating how game narratives can be introduced in BCI rehabilitation to make it more gratifying and engaging.

Intradialytic training in patients with end-stage renal disease: a systematic review and meta-analysis of randomized clinical trials assessing the effects of five different training interventions.

Patients with end-stage renal disease (ESRD) undergoing hemodialysis may have reduced dialysis adequacy (Kt/V), low cardiorespiratory fitness, and worseprognosis. Different types of intradialytic training (IDT) may serve as an adjunct therapy for the management of the ESRD. This systematic review and meta-analysis aimed to assess the impact of different types of IDT on clinical outcomes and functional parameters in ESRD. PubMed, Embase, CINAHL, Cochrane CENTRAL, Scopus, SPORTDiscus, and Google Scholar were searched for randomized clinical trials in adult patients with ESRD which compared IDT with usual care (UC),without language restrictions and published up toJuly 2019; a handsearch of references was also performed. Certainty of evidence was assessed using GRADE, and risk of bias in primary studies with the RoB 1.0 tool. Fifty studies were included (n = 1757).Compared to UC, aerobic IDT improved Kt/V (WMD = 0.08), VO2peak (WMD = 2.07mL/kg/min), 6-minute walk test (6MWT) distance (64.98m), reduced systolic blood pressure (- 10.07mmHg) and C-reactive protein (- 3.28mg/L). Resistance training increased 6MWT distance (68.50m). Combined training increased VO2peak (5.41mL/kg/min) and reduced diastolic blood pressure (- 5.76mmHg). Functional electrostimulation (FES) and inspiratory muscle training (IMT) improved 6MWT distance (54.14m and 117.62m, respectively).There was no impact on total cholesterol, interleukin-6, or hemoglobin levels. There was no difference in incidence of adverse events between the IDT and control groups. The certainty of evidence was variable according to the GRADE scale, with most outcomes rated very low certainty. The risk of bias assessment of primary studies showed unclear risk in most. Aerobic, resistance, and combined training during hemodialysis, as well as FES and IMT, demonstrated to be effective for the treatment of the patient with ESRD. Our data should be interpreted in light of the unclear risk of bias of most evaluated articles and the low to very low certainty of evidence for evaluated outcomes. CRD42017081338. DATA SHARING REPOSITORY: https://osf.io/fpj54/.

Exploring intrinsic triggers for functional facial electrostimulation based on intramuscular electromyography recordings.

Based on univariate intramuscular electromyography (EMG) recordings of facial muscles of patients suffering from chronic idiopathic facial palsy we propose a data-driven feature selection process for the discrimination of different mimic maneuvers. Following fundamental ideas of automatic EMG decompositions based on templates defined by motor unit action potentials, the proposed approach relies on a multiple template matching. Yet, the novel methodology utilizes templates derived from the intramuscular EMG signal itself without any supervisor interaction or a priori information by identifying abundant short signal sections (motifs). Focusing on motifs as individual, characteristical graphoelements of an EMG recording implies a high level of flexibility. In connection with facial palsy such a flexibility is necessary, since unique individual, also pathological, EMG patterns can be expected due to the high spatial variability of intramuscular recordings combined with random patterns of aberrant reinnervation. The proposed methodology is applied to EMG data of frontalis, zygomaticus, and orbicularis oculi muscle without patient- or muscle-specific adaptations.