Use Of Functional Electrical Stimulation Research Articles

The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries.

Background: People with spinal cord injuries (SCIs) often have trouble remaining active because of paralysis. In the past, exercise recommendations focused on the non-paralyzed muscles in the arms, which provides limited benefits. However, recent studies show that electrical stimulation can help engage the paralyzed extremities, expanding the available muscle mass for exercise. Methods: The authors provide an evidence-based approach using expertise from diverse fields, supplemented by evidence from key studies toward the management of electrical stimulation therapies in individuals with SCIs. Literature searches were performed separately using the PubMed, Medline, and Google Scholar search engines. The keywords used for the searches included functional electrical stimulation cycling, hybrid cycling, neuromuscular electrical stimulation exercise, spinal cord injury, cardiovascular health, metabolic health, muscle strength, muscle mass, bone mass, upper limb treatment, diagnostic and prognostic use of functional electrical stimulation, tetraplegic hands, and hand deformities after SCI. The authors recently presented this information in a workshop at a major rehabilitation conference. Additional information beyond what was presented at the workshop was added for the writing of this paper. Results: Functional electrical stimulation (FES) cycling can improve aerobic fitness and reduce the risk of cardiovascular and metabolic diseases. The evidence indicates that while both FES leg cycling and neuromuscular electrical stimulation (NMES) resistance training can increase muscle strength and mass, NMES resistance training has been shown to be more effective for producing muscle hypertrophy in individual muscle groups. The response to the electrical stimulation of muscles can also help in the diagnosis and prognosis of hand dysfunction after tetraplegia. Conclusions: Electrical stimulation activities are safe and effective methods for exercise and testing for motor neuron lesions in individuals with SCIs and other paralytic or paretic conditions. They should be considered part of a comprehensive rehabilitation program in diagnosing, prognosing, and treating individuals with SCIs to improve function, physical activity, and overall health.

Methodology for Selecting the Appropriate Electric Motor for Robotic Modular Systems for Lower Extremities.

Torque calculation is essential for selecting the appropriate motor to achieve the required torque at each joint of a hybrid exoskeleton. In recent years, the combined use of functional electrical stimulation (FES) and robotic devices, called hybrid robotic rehabilitation systems, has emerged as a promising approach for the rehabilitating of lower limb motor functions. Specifically, the implementation strategy of functional electrical stimulation walking aid combined with the design of the exoskeleton part is the main focus of our research team. This work copes with issues of the design process of a robotic exoskeleton. The importance of robotic exoskeletons for providing walking aid to people with mobility disorders or the elderly is discussed. Furthermore, the approaches to calculating the joint torques are investigated, and the mathematical models and parameters of interest are identified. This further includes the comparative data for servo motors: robotic exoskeleton characteristics and actuator analysis in the robotic exoskeleton. The aforementioned is used to propose a mathematical model based on previous models (Zatsiorsky BSP and Dempster BSP body segment parameters models, forward kinematics models), which was extended to include added adjustable parameters such as length, area, volume, mass, density, the centre of mass, human body characteristics, and considering both static and dynamic parameter extraction. Then, an analytic method is presented, exploiting the results from the mathematical model to select the appropriate motor for each joint of the lower extremities. The detailed description of the method is followed by examples, experimental measurements, and statistical analysis of qualitative and quantitative characteristics. The results showed deviations from typical calculation methods, offering a better understanding of the motor requirements for each joint of the exoskeleton and avoiding selections of marginal functionality features of the motors. In addition, researchers are offered a tool for replicating the results of this work, allowing them to configure the parameters associated with the servo motor features. The researcher can either use the embedded library developed for this work or enter new data into it, affecting the calculated torques of the model joints. The extracted results assist the researcher in choosing the appropriate motor among commercially available brushed and brushless motors based on the torques applied at each joint in robotic articulated systems.

Position and cadence tracking of a motorized FES-cycle with an unknown time-varying input delay using saturated FES control

Neurological conditions (NCs) can have debilitating effects on an individual and can impede a person’s ability to perform activities of daily living. A common rehabilitation for individuals with NCs is the use of functional electrical stimulation (FES) to induce muscle contractions to perform a functional task, such as cycling. In this paper, we develop a closed-loop FES cycling controller that yields exponential cadence tracking. Contributions of the work result from the design and analysis innovations to compensate for switching between the different muscles and motor control inputs, compensating for the inherent uncertain nonlinear dynamics, compensating for the time-varying unknown input delay resulting from the complex electrochemical FES muscle torque production process, and compensating for saturation in the evoked torque due to fatigue, available muscle mass, or stimulation sensitivity. The performance of the developed control system was examined through a series of experiments on nine participants (five able-bodied and four with NCs). The experiments resulted in a cadence tracking error of −0.03 ± 1.69 RPM for non-informed passive able-bodied participants and −0.04 ± 1.98 RPM for the participants with NCs, for a desired cadence of 50 RPM.

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

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

A nation-wide survey exploring the views of current and future use of functional electrical stimulation in spinal cord injury

Purpose Functional electrical stimulation (FES) can be effective in assisting physical and psychosocial difficulties experienced by people with spinal cord injury. Perceived benefits and barriers of the current and future use of FES within the wider spinal cord injury community is currently unknown. The main objective of this research was to explore the spinal cord injury community’s views of the use of FES to decrease disability in rehabilitation programmes. Materials and methods An online and paper questionnaire was distributed to people with spinal cord injury, health care professionals and researchers working in spinal cord injury settings in the United Kingdom. Results A total of 299 participants completed the survey (152 people with spinal cord injury, 141 health care professionals and 6 researchers). Common views between groups identified were: (1) FES can be beneficial in improving physical and psychosocial aspects and that (2) adequate support and training for FES application was provided to users. Barriers to FES use included a lack of staff time and training, financial cost and availability of the equipment. Sixty three percent of non-users felt they would use FES in the future if they had the opportunity. Conclusions Users’ views were important in identifying that FES application can be beneficial for people with spinal cord injury but also has some resourceful barriers. In order to increase use, future research should focus on reducing the cost of FES clinical service and also address implementation of awareness and training programmes within spinal units and community rehabilitation settings. IMPLICATIONS FOR REHABILITATION Users of functional electrical stimulation think that it is beneficial for improving physical and psychosocial limitations after spinal cord injury Barriers to FES use include a lack of staff time and training, financial cost and availability of the equipment have been suggested by people with spinal cord injury and health care professionals Education and implementation programs for health care professionals and people with spinal cord injury are now necessary to increase the awareness about functional electrical stimulation application Reduction of FES cost could also increase its uptake in spinal cord injury clinical services

Physiotherapeutic resources in vaginismus

Vaginismus consists of involuntary spasms in the external musculature of the vagina, the etiology of which is still unknown, but there are cases of biopsychosocial factors such as sexual abuse, strict sex, education, emotional trauma, religious beliefs, low-quality sexual relations, fear of sex, or even changes of ostemioarticular origin, can lead to this condition, making vaginal penetration impossible during sexual intercourse, gynecological exams or use of tampons. Objective: To highlight as physical therapy practices, their validation for the treatment of vaginismus and to verify the effectiveness of the analyzed practices. Methods: Systematic literature review carried out through digital bibliographic research on scientific articles published in electronic and electronic journals, randomized clinical trials, with no period between the years 2010 to 2020, in the electronic databases PubMed, Bireme and PEDro. Results: There was no great variability in the resources used and the studies showed positive and similar results. Conclusion: Physical therapy proved to be beneficial for cases of vaginismus, with the use of functional electrical stimulation (FES) in an analogue way, pelvic floor muscle relaxation exercises, local desensitization performed with vaginal dilator and massage. However, more research is needed, considering the moderate methodological scores found in the studies analyzed.Keywords: vaginismus, physical therapy, rehabilitation.

Neuroprosthetic Technology «Bioness» (Exorobot) in the Process of Restoring Motor and Vegetative-Trophic Disorders in Central Paresis of the Upper Limb

Disability after a stroke or brain injury is most often associated with impaired movement, speech, swallowing, and reduced cognitive abilities. By the end of the acute period of stroke, paresis in the arm and leg of varying degrees is observed in 80-90 % of survivors.In case of severe paresis, it is advisable to support the function of the limb at the early stages of recovery using modern specialized modifiable devices and methods that provide functional and multimodal stimulation and partial prosthetics. Aim of the study: evaluation of the efficacy of functional electrical stimulation (FES) in a complex of multimodal effects in restoring movement in Stroke patients with upper limb paresis (palcy).Methods. Stimulation and neuroprosthetic methods (FES - “Bioness H200”, RTMs) were used as the main therapeutic program of rehabilitation treatment for patients with motor disorders of the upper limb after an ischemic stroke (n=140). The median period of stroke was 25 [13; 56] days, median age 52 [48; 69] years. The standard methods of diagnosis and treatment of patients with stroke in accordance to the protocol of the Ministry of health of the Russian Federation No. 928 n and 1705 n (2012) were used, as well as scales and questionnaires for assessing the loss of strength and volume of motor disorders, assessing depression and motivation for treatment (Motricity Index), Fugl-Meyer AR, Medical Research Council Weakness Scale, Modified Ashworth Scale (MAS), Beck Depression Inventory; Beck At, Recovery Locus of Control, Patridge C., Johnstone M. Results. The effectiveness of personalized therapy with the use of a neuroprosthesis (“Bioness H200”) in patients in the acute period of ischemic stroke was shown, with the Motrisight index, Fugle-Meier scale being the most sensitive scales. the results depend on thebasic disease characteristics, the most relevant of which were - focus, degree of neurological deficit, personal motivation. The addition using of botulinum toxin allowed eliminating the inhibitory effect of spasticity, which prepared patients for intensive methods of physical rehabilitation. During the follow-up period, no complications were revealed. In 90% of cases, an increase in daily activity was noted. Functional electrical stimulation has significantly increased their level of self-care. The disability complex was initially equally pronounced in all patients, but positive reinforcement in the form of movement of the paretic hand against the background of FES led to a decrease in the severity of depression. In 100%, there was a high motivation to continue the treatment program with neuroprosthetics. Conclusion. The use of a complex of stimulating personalized techniques in the acute period of stroke is justified and safe. The useof FES significantly increases the range of motion in the hand, helps to overcome power paresis, coordination disorders, increases the general level of physical activity of patients after a stroke, motivation for the recovery process and improves the quality of life.

Functional electrical stimulation for restoration of gait and motor recovery after a stroke. Review of scientific literature

The article presents an analysis of studies on the use of functional electrical stimulation (FES) technology in the rehabilitation of patients after stroke. We reviewed the influence of FES on improving walking speed, kinematics, gait symmetry, the ability to overcome obstacles, the range of motion of the ankle and foot clearance during walking. In the review it is considered FES influence on reducing energy costs for walking, the frequency of falls and spasticity of muscles of the lower limbs. It is also discussed FES influence on increasing confidence and comfort while walking, the speed of adaptation and patient tolerance of functional electrical stimulation devices. A comparison is made of functional electrical stimulation with using ankle orthoses (AFO).

Functional electrical stimulation reduces pain and shoulder subluxation in chronic post-stroke patients?

Background: Shoulder subluxation is a common complication of cerebral vascular accident (stroke) and the use of Functional Electrical Stimulation (FES) within the rehabilitation process is extremely important. Objective: To analyze the therapeutic effects of FES in the treatment of chronic shoulder subluxation in post-stroke patients. Method: This is a case study of patients with radiologically subluxation confirmed, who were randomly divided into two groups: Control Group (CG) and Treatment Group (TG). Patients were assessed before and after treatment and at the 2-month follow-up. The assessment consisted of the modified Ashworth scale; passive goniometry; Fugl-Meyer scale; McGill pain questionnaire and evaluation of shoulder subluxation by radiography. The CG did not receive physiotherapeutic intervention; and TG underwent 20 sessions of motor kinesiotherapy and FES associated with functional exercises with a total duration of 1 hour, three times a week, for 7 weeks. The data were analyzed descriptively. Results: The mean age of CG participants was 82.5 ± 1.5 years and of the TG was 70.5 ± 13.5 years. All of them were retired, sedentary, non-smokers/alcoholics and had hemiparesis on the left side. There was an approximate increase of 10o for most joint movements of the shoulder, improvement in McGill scale scores and reduction of shoulder subluxation in TG patients. Conclusion: FES associated with functional movements was effective in reducing the degree of subluxation of the shoulder joint and decreased pain in subjectsin the chronic phase of the post-stroke.

Evaluation of the effectiveness of the use of functional electrical stimulation after VII-XII anastomosis in patients with facial nerve damage of various etiologies

Surgical treatment of lesions of the facial nerve by an hypoglossal-facial anastomosis takes a long time to re-sprout of the nerve fibers to the facial muscles. The recovery time of facial function after surgical treatment of patients with paralysis of the facial nerve is long enough and can start from 6-8 months after surgery and last up to 2 years. Thus, all this time the mimic muscles are in a state of denervation. The purpose of this work was to determine the effect of electrical stimulation of facial muscles in patients with lesions of the facial nerve of different etiology after hypoglossal -facial anastomosis. Materials and methods: To evaluate the results of the use of early postoperative transcutaneus electrical stimulation, a low frequency FES was used, starting from the 2nd month after performing a XII-VII anastomosis. Assessment of the recovery of facial nerve function was performed 1 year after surgery. The study included 88 patients who underwent surgery to restore facial nerve function - hypoglossal -facial anastomosis. The survey was divided into 2 groups. The first (main) group consisted of 28 patients who underwent FES of facial muscles in the postoperative period, and the second group (comparison) consisted of 60 patients who underwent XII-VII anastomosis according to the following by the same method, but no further pharmacological or physiotherapeutic agents were used that could affect facial nerve regeneration. Results and discussion: According to this scale, the surveyed control group after 12 months. After the operation of XII-VII anastomosis according to the classical method, the following distribution was observed: The 1st degree of recovery of facial nerve function was not present in any of the patients, the 2nd degree had 2 (3.33%) patients, the thirds - 28 (46, 66%), IV - 20 (33,33%), V - 6 (10%) and VI - 4 (6,66%). In patients in the main group (where FES was used), distribution by degrees of recovery of facial nerve function on the House-Brackman scale after 12 months. after surgery it had the following character: II degree had 2 (6.45%) examined, III - 17 (54.83%), IV - 5 (22.58%), V - 2 (7.4%) and VI - 2 (7.4%). Conclusions: A statistically significant difference was observed in the postoperative period when comparing the mean M-responses of mimic muscles registered at different times after surgery in control subjects compared with patients in the main group in which FES was used. In addition, in the main group, a significantly larger number of patients reported a recovery of FN function to grade III-IV on the House-Brackman scale. Therefore, based on the results of the evaluation of the function of FN on the House-Brackman scale and electromyographic examination data in patients who underwent XII-VII anastomosis, it can be argued that with the use of FES in the postoperative period of recovery of facial nerve function is significantly faster and more complete in compared to the control group.

A portable assist-as-need upper-extremity hybrid exoskeleton for FES-induced muscle fatigue reduction in stroke rehabilitation

BackgroundHybrid exoskeletons are a recent development which combine Functional Electrical Stimulation with actuators to improve both the mental and physical rehabilitation of stroke patients. Hybrid exoskeletons have been shown capable of reducing the weight of the actuator and improving movement precision compared to Functional Electrical Stimulation alone. However little attention has been given towards the ability of hybrid exoskeletons to reduce and manage Functional Electrical Stimulation induced fatigue or towards adapting to user ability. This work details the construction and testing of a novel assist-as-need upper-extremity hybrid exoskeleton which uses model-based Functional Electrical Stimulation control to delay Functional Electrical Stimulation induced muscle fatigue. The hybrid control is compared with Functional Electrical Stimulation only control on a healthy subject.ResultsThe hybrid system produced 24° less average angle error and 13.2° less Root Mean Square Error, than Functional Electrical Stimulation on its own and showed a reduction in Functional Electrical Stimulation induced fatigue.ConclusionAs far as the authors are aware, this is the study which provides evidence of the advantages of hybrid exoskeletons compared to use of Functional Electrical Stimulation on its own with regards to the delay of Functional Electrical Stimulation induced muscle fatigue.

Utilizing Functional Electrical Stimulation and Exoskeletons in Pediatrics: a Closer Look at Their Roles in Gait and Functional Changes in Cerebral Palsy

A primary focus for many children with cerebral palsy (CP) is functional independence. However, due to neurologic insults that occur early in life, typical gait pattern development is impaired. Research has shown the importance of task-oriented movements in reorganizing the central nervous system in a functionally meaningful way. Advancements in technology, when used in conjunction with conventional strategies, have made it possible for therapists to utilize devices that provide repetitive patterning and feedback for gait retraining. This enables patients the opportunity to develop normal gait patterns and improve functional independence. Interventions such as functional electrical stimulation and exoskeletons can be utilized to assist patients with sequencing motor contractions of different muscles in more physiologic patterning. Children who suffer from neurologic insults may not only benefit from the restorative properties of these interventions, but also from the active engagement that is provided through the use of this technology. Therapists, utilizing these interventions, are able to encourage their patient’s interest and motivation while providing them with a repetitive goal-oriented task to assist with cortical reorganization. This review focuses on current literature addressing the use of functional electrical stimulation and exoskeletons in pediatric rehabilitation. The results of these studies demonstrate the effectiveness of these devices when compared to conventional therapeutic interventions. This review shows that continued research is needed on specific dosage in order to determine optimal outcomes.

A cohort study of functional electrical stimulation in people with multiple sclerosis demonstrating improvements in quality of life and cost-effectiveness

Objective: The objective of this study was to determine the impact on health-related quality of life of functional electrical stimulation used to improve walking in people with multiple sclerosis and to explore cost-effectiveness. Design: A retrospective analysis of patient records was conducted. Setting: This study used outpatient therapy service as the study setting. Subjects: Data from 82 consecutive patients with multiple sclerosis attending for set up with functional electrical stimulation were analysed. Interventions: Patients were seen at baseline, three and six months for support in use of functional electrical stimulation, and data were collected at baseline and six months. Main measures: The EQ-5D-5L and walking speed were collected at baseline and six months after using functional electrical stimulation. The Psychosocial Impact of Assistive Device Scale was collected at six months. EQ-5D-3L utilities were derived and cost-effectiveness analysis was completed utilizing a five-year time horizon and methodology published by National Institute for Health and Care Excellence. Results: Significant differences (P < 0.001) were seen in walking speed (baseline 0.670 m/s; with stimulation 0.768 m/s) and maintained over six months (0.772 m/s with stimulation). EQ-5D data significantly improved over six months (baseline 0.486, six months 0.596, P < 0.001) and meaningful mean scores were seen in all aspects of the Psychosocial Impact of Assistive Device Scale. However, there were no correlations between measures. In the cost utility analysis, compared to standard care, functional electrical stimulation was more expensive and more effective with an incremental cost-effectiveness ratio of £6137. Conclusion: Functional electrical stimulation is a cost-effective treatment to improve walking speed and health-related quality of life in people with multiple sclerosis.

Garments for functional electrical stimulation: Design and proofs of concept.

IntroductionRepeated use of functional electrical stimulation can promote functional recovery in individuals with neurological paralysis. We designed garments able to deliver functional electrical stimulation.MethodsShirts and pants containing electrodes knitted with a conductive yarn were produced. Electrodes were moistened with water before use. Stimulation intensity at four thresholds levels (sensory, movement, full range of motion, and maximal), stimulation comfort, and electrical properties of the interface were tested in one able-bodied subject with garment electrodes and size-matched conventional gel electrodes. The pants and shirt were then used to explore usability and design limitations.ResultsCompared to gel electrodes, fabric electrodes had a lower sensory threshold (on forearm muscles) but they had a higher maximal stimulation threshold (for all tested muscles). The stimulation delivery was comfortable when the garment electrodes were recently moistened; however, as the electrodes dried (within 9 to 18 min) stimulation became unpleasant. Inconsistent water content in the fabric electrodes caused inconsistent intensity thresholds and inconsistent voltage necessary to apply a desired stimulation current. Garments’ tightness and impracticality of electrode lead necessitate further design improvement.ConclusionsFabric electrodes offer a promising alternative to gel electrodes. Further work involving people with paralysis is required to overcome the identified challenges.

An exploration of the experiences and utility of functional electrical stimulation for foot drop in people with multiple sclerosis

Purpose: Functional electrical stimulation (FES) is effective in improving walking in people with multiple sclerosis (MS) with foot drop. There is limited research exploring people’s experiences of using this device. This study aims to explore the utility, efficacy, acceptability, and impact on daily life of the device in people with MS.Methods: An interpretative phenomenological approach was employed. Ten participants who had used FES for 12 months were interviewed. Transcripts were analysed, and emergent themes identified.Results: Nine participants continued to use the device. Three relevant super-ordinate themes were identified; impact of functional electrical stimulation, sticking with functional electrical stimulation, and autonomy and control. Participants reported challenges using the device; however, all reported positive physical and psychological benefits. Intrinsic and external influences such as; access to professional help, the influence of others, an individual’s ability to adapt, and experiences using the device, influenced their decisions to continue with the device. A thematic model of these factors was developed.Conclusions: This study has contributed to our understanding of people with MS experiences of using the device and will help inform prescribing decisions and support the continued, appropriate use of FES over the longer term.Implications for RehabilitationPeople with multiple sclerosis using functional electrical stimulation report benefits in many aspects of walking, improved psychological well-being and increased engagement in valued activities.A number of challenges impact on functional electrical stimulation use. Factors such as; a positive experience using the device, access to professional help, the influence of others, a strong sense of personal autonomy and an individual’s ability to adapt, influence an individual’s decision to continue using functional electrical stimulation.Clinicians prescribing functional electrical stimulation should be aware of these factors so that the right support and guidance can be provided to people with multiple sclerosis, thus improving outcomes and compliance over the long term.

Hybrid robotic system combining passive exoskeleton and functional electrical stimulation for upper limb stroke rehabilitation: Preliminary results of the retrainer multi-center randomized controlled trial

Stroke is the main cause of acquired adult disability with major impact on arm function. The combined use of Functional Electrical Stimulation (FES) and robotic technologies is strongly advocated to improve rehabilitation outcomes after stroke. We present the preliminary data of a multi-center Randomized Controlled Trial aimed at evaluating the effectiveness of this system with respect to conventional therapy for sub-acute stroke upper limb rehabilitation. The RETRAINER system consists of a lightweight and non-cumbersome passive arm exoskeleton for weight relief, a current-controlled stimulator with 2 channels of stimulation and 2 channels of EMG recordings. In this work we are presenting the preliminary results of 39 sub-acute stroke patients with a distance from the acute event between two weeks and nine months. The inclusion criteria was: age between 18 and 85 years, Motricity Index (MI) < 80%, muscular activity for arm and shoulder at least 1 Medical Research Council (MRC) with a visible contraction, no joint limitation, pain or spasticity. They were randomized in two group: 1 conventional rehabilitation methods, 2 experimental group using Retrainer System. Each participant performed 9 weeks of treatment 3 times for week. We measured MI, Action Research Arm Test (ARAT) and Motor Activity Log (MAL) at beginning (T0) and at the end of treatment (T1). Results are showed in the next Table 1 . Both groups showed statistical improvement in outcome measures. Experimental group showed a statistical better improvement regarding time and group effect.

Improvement in overactive bladder symptoms in patients using functional electrical stimulation of the common peroneal nerve for walking

Objective: Functional electrical stimulation is used to improve walking speed and reduces falls in people with upper motor neurone foot-drop. Following anecdotal observations of changes in bladder symptoms, an observational study was performed to explore this association further. Design: A total of 47 consecutive patients attending for setup with functional electrical stimulation during a six-month period were asked to complete a questionnaire assessing bladder symptoms (ICIQ-OAB (International Consultation on Incontinence Questionnaire Overactive Bladder)) at baseline and three months during routine appointments. Subjects: In all, 35 (75%) had multiple sclerosis and the other 12 subjects had a total of 9 diagnoses including 3 with stroke. Other conditions included cerebral palsy, motor neurone disease, hereditary spastic paraparesis, meningioma and spinocerebellar ataxias. Results: Improvement in overactive bladder symptoms was not significant in the whole cohort, however, was significant in patients with multiple sclerosis (n = 35; mean change in ICIQ-OAB score 1.0, P = 0.043). Specifically, significant improvements were seen in urgency and urge incontinence in multiple sclerosis patients. There was a significant negative correlation of moderate strength within the multiple sclerosis cohort between baseline walking speed and subsequent change in ICIQ-OAB score (correlation coefficient of r = −0.40, P = 0.046). Thus, greater changes in bladder symptoms were seen with lower baseline walking speeds. Conclusion: The results of this exploratory study suggest that functional electrical stimulation use does improve overactive bladder symptoms in people with multiple sclerosis. Further exploration is needed to study this association and explore whether the mechanism is similar to that of percutaneous tibial nerve stimulation, a recognized treatment for the overactive bladder.

The use of functional electrical stimulation to improve upper limb function in children with hemiplegic cerebral palsy: A feasibility study.

BackgroundGrasping and manipulating objects are common problems for children with hemiplegic cerebral palsy. Multichannel-functional electrical stimulation may help facilitate upper limb movements and improve function.ObjectiveTo evaluate the feasibility of multichannel-functional electrical stimulation to improve grasp and upper limb function in children with hemiplegic cerebral palsy to inform the development of a clinical trial.MethodsA prospective pre-/post-test/follow-up (six months) design with three children, aged 6–13 years, was used. Multichannel-functional electrical stimulation (mFES) was applied to the hemiplegic upper limb for up to 48 sessions over 16 weeks. Feasibility indicators included recruitment of participants and adherence rates, safety, and discomfort/pain. Effectiveness was assessed using the grasp domain of the Quality of Upper Extremity Skills Test, and other secondary clinical outcome measures with “success” criteria set a priori.ResultsParticipant recruitment target was not met but adherence was high, and multichannel-functional electrical stimulation was found to be safe and comfortable. Of the three participants, two improved in grasp at post-test, whereas one child’s ability deteriorated. Only one child met success criteria on most outcomes at post-test.ConclusionsFeasibility indicators met success criteria, except for participant recruitment. Treatment effectiveness was mixed. A future case comparison investigation with a larger but more selected sample is suggested.

Functional electrical stimulation reduces pain and shoulder subluxation in chronic post-stroke patients?

Background: Shoulder subluxation is a common complication of cerebral vascular accident (stroke) and the use of Functional Electrical Stimulation (FES) within the rehabilitation process is extremely important. Objective: To analyze the therapeutic effects of FES in the treatment of chronic shoulder subluxation in post-stroke patients. Method: This is a case study of patients with radiologically subluxation confirmed, who were randomly divided into two groups: Control Group (CG) and Treatment Group (TG). Patients were assessed before and after treatment and at the 2-month follow-up. The assessment consisted of the modified Ashworth scale; passive goniometry; Fugl-Meyer scale; McGill pain questionnaire and evaluation of shoulder subluxation by radiography. The CG did not receive physiotherapeutic intervention; and TG underwent 20 sessions of motor kinesiotherapy and FES associated with functional exercises with a total duration of 1 hour, three times a week, for 7 weeks. The data were analyzed descriptively. Results: The mean age of CG participants was 82.5 ± 1.5 years and of the TG was 70.5 ± 13.5 years. All of them were retired, sedentary, non-smokers/alcoholics and had hemiparesis on the left side. There was an approximate increase of 10o for most joint movements of the shoulder, improvement in McGill scale scores and reduction of shoulder subluxation in TG patients. Conclusion: FES associated with functional movements was effective in reducing the degree of subluxation of the shoulder joint and decreased pain in subjectsin the chronic phase of the post-stroke.

Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study

BackgroundBrain injury survivors often present upper-limb motor impairment affecting the execution of functional activities such as reaching. A currently active research line seeking to maximize upper-limb motor recovery after a brain injury, deals with the combined use of functional electrical stimulation (FES) and mechanical supporting devices, in what has been previously termed hybrid robotic systems. This study evaluates from the technical and clinical perspectives the usability of an integrated hybrid robotic system for the rehabilitation of upper-limb reaching movements after a brain lesion affecting the motor function.MethodsThe presented system is comprised of four main components. The hybrid assistance is given by a passive exoskeleton to support the arm weight against gravity and a functional electrical stimulation device to assist the execution of the reaching task. The feedback error learning (FEL) controller was implemented to adjust the intensity of the electrical stimuli delivered on target muscles according to the performance of the users. This control strategy is based on a proportional-integral-derivative feedback controller and an artificial neural network as the feedforward controller. Two experiments were carried out in this evaluation. First, the technical viability and the performance of the implemented FEL controller was evaluated in healthy subjects (N = 12). Second, a small cohort of patients with a brain injury (N = 4) participated in two experimental session to evaluate the system performance. Also, the overall satisfaction and emotional response of the users after they used the system was assessed.ResultsIn the experiment with healthy subjects, a significant reduction of the tracking error was found during the execution of reaching movements. In the experiment with patients, a decreasing trend of the error trajectory was found together with an increasing trend in the task performance as the movement was repeated. Brain injury patients expressed a great acceptance in using the system as a rehabilitation tool.ConclusionsThe study demonstrates the technical feasibility of using the hybrid robotic system for reaching rehabilitation. Patients’ reports on the received intervention reveal a great satisfaction and acceptance of the hybrid robotic system.Trial registrationRetrospective trial registration in ISRCTN Register with study ID ISRCTN12843006.