Rehabilitation with Functional Electrical Stimulation in Stroke Patients

In recent years, our understanding of motor learning, neuroplasticity and functional recovery after the occurrence of brain lesion has grown significantly. New findings in basic neuroscience have provided an impetus for research in motor rehabilitation. Several prospective studies have shown that repeated motor practice and motor activity in a real world environment have a favorable effect on motor recovery in stroke patients. Electrical stimulation can be applied in a variety of ways to the hemiparetic upper extremity following a stroke. In particular, electromyography (EMG)- triggered electrical muscle stimulation improves the motor function of the hemiparetic arm and hand. Triggered electrical stimulation is reported to be more effective than non-triggered electrical stimulation in facilitating upper extremity motor recovery after stroke. EMG-controlled functional electrical stimulation (FES) induces greater muscle contraction by electrical stimulation that is in proportion to voluntary integrated EMG signals. EMG-controlled FES and motor point block for antagonist muscles have been applied as a new hybrid FES therapy in an outpatient rehabilitation clinic for patients with stroke with good result. Daily EMG-controlled FES home-program therapy with novel equipment has been shown to effectively improve wrist, finger extension, and shoulder flexion. Combined modulation of voluntary movement, proprioceptive sensory feedback, and electrical stimulation might play an important role in improving impaired sensory-motor integration by EMG-controlled FES therapy. A multi-channel near-infrared spectroscopy (NIRS) studies in which the hemoglobin levels in the brain were non-invasively and dynamically measured during functional activity found that the cerebral blood flow in the injured sensory-motor cortex area is greater during a EMG-controlled FES session than during simple active movement or simple electrical stimulation. Nevertheless, evidence-based strategies for FES rehabilitation are more and more available, particularly for patients suffering from hemiparesis.

[1]  A. Prochazka,et al.  A functional electric stimulation-assisted exercise therapy system for hemiplegic hand function. , 2004, Archives of physical medicine and rehabilitation.

[2]  Agnès Roby-Brami,et al.  Reaching and Grasping Strategies in Hemiparetic Patients , 1997 .

[3]  Mary Y. Harley,et al.  Improving hand function in stroke survivors: a pilot study of contralaterally controlled functional electric stimulation in chronic hemiplegia. , 2007, Archives of physical medicine and rehabilitation.

[4]  L. Martins,et al.  Analysis of the results of functional electrical stimulation on hemiplegic patients' upper extremities using the Minnesota manual dexterity test , 2005, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[5]  M. Dimitrijevic,et al.  Modification of motor control of wrist extension by mesh-glove electrical afferent stimulation in stroke patients. , 1996, Archives of physical medicine and rehabilitation.

[6]  A Smith,et al.  Hybrid functional electrical stimulation orthosis system for the upper limb: effects on spasticity in chronic stable hemiplegia. , 1998, American journal of physical medicine & rehabilitation.

[7]  T. Chalmers,et al.  Functional electrostimulation in poststroke rehabilitation: a meta-analysis of the randomized controlled trials. , 1996, Archives of physical medicine and rehabilitation.

[8]  Mark Schram Christensen,et al.  Modulation of proprioceptive feedback during functional electrical stimulation: an fMRI study , 2013, The European journal of neuroscience.

[9]  D. Stein.  Brain Injury and Theories of Recovery , 2000 .

[10]  Mary Y. Harley,et al.  Contralaterally Controlled Functional Electrical Stimulation for Upper Extremity Hemiplegia , 2012, Neurorehabilitation and neural repair.

[11]  S. Page,et al.  Home-based electromyography-triggered stimulation in chronic stroke , 2005, Clinical rehabilitation.

[12]  K. Ottenbacher.  Cerebral vascular accident: some characteristics of occupational therapy evaluation forms. , 1980, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[13]  Yoshihiro Muraoka,et al.  A home-based rehabilitation program for the hemiplegic upper extremity by power-assisted functional electrical stimulation , 2008, Disability and rehabilitation.

[14]  D. Wade,et al.  Loss of arm function after stroke: measurement, frequency, and recovery. , 1986, International rehabilitation medicine.

[15]  L. Cohen,et al.  Influence of electric somatosensory stimulation on paretic-hand function in chronic stroke. , 2006, Archives of physical medicine and rehabilitation.

[16]  Richard S. J. Frackowiak,et al.  Neural correlates of motor recovery after stroke: a longitudinal fMRI study. , 2003, Brain : a journal of neurology.

[17]  A. Behrman,et al.  Chronic motor dysfunction after stroke: recovering wrist and finger extension by electromyography-triggered neuromuscular stimulation. , 2000, Stroke.

[18]  M. Wong,et al.  Brain lesion size and location: effects on motor recovery and functional outcome in stroke patients. , 2000, Archives of physical medicine and rehabilitation.

[19]  Yoshihiro Muraoka,et al.  Development of an EMG recording device from stimulation electrodes for functional electrical stimulation. , 2002, Frontiers of medical and biological engineering : the international journal of the Japan Society of Medical Electronics and Biological Engineering.

[20]  C. Calautti,et al.  Functional Neuroimaging Studies of Motor Recovery After Stroke in Adults: A Review , 2003, Stroke.

[21]  P. Duncan.  Synthesis of Intervention Trials To Improve Motor Recovery following Stroke. , 1997, Topics in stroke rehabilitation.

[22]  Allen and Rosenbloom Paul S. Newell,et al.  Mechanisms of Skill Acquisition and the Law of Practice , 1993 .

[23]  R. Hart,et al.  Intramuscular Hand Neuroprosthesis for Chronic Stroke Survivors , 2003, Neurorehabilitation and neural repair.

[24]  Thomas Sinkjær,et al.  Interaction of electrical stimulation and voluntary hand movement in SII and the cerebellum during simulated therapeutic functional electrical stimulation in healthy adults , 2012, Human brain mapping.

[25]  Yoshihiro Muraoka,et al.  Hybrid Power-Assisted Functional Electrical Stimulation to Improve Hemiparetic Upper-Extremity Function , 2006, American journal of physical medicine & rehabilitation.

[26]  J. Chae,et al.  Intramuscular electromyographically controlled neuromuscular electrical stimulation for upper limb recovery in chronic hemiplegia. , 2001, American journal of physical medicine & rehabilitation.

[27]  Maarten J. IJzerman,et al.  Relation between stimulation characteristics and clinical outcome in studies using electrical stimulation to improve motor control of the upper extremity in stroke. , 2005, Journal of rehabilitation medicine.

[28]  S. Page,et al.  A Four-Week, Task-Specific Neuroprosthesis Program for a Person With No Active Wrist or Finger Movement Because of Chronic Stroke , 2008, Physical Therapy.

[29]  CinziaCalautti,et al.  Functional Neuroimaging Studies of Motor Recovery After Stroke in Adults , 2003 .

[30]  V. Alfieri.  Electrical treatment of spasticity. Reflex tonic activity in hemiplegic patients and selected specific electrostimulation. , 1982, Scandinavian journal of rehabilitation medicine.

[31]  C. Calautti,et al.  Dynamics of Motor Network Overactivation After Striatocapsular Stroke: A Longitudinal PET Study Using a Fixed-Performance Paradigm , 2001, Stroke.

[32]  S. Page,et al.  Paretic upper extremity movement gains are retained 3 months after training with an electrical stimulation neuroprosthesis. , 2012, Archives of physical medicine and rehabilitation.

[33]  R. Nudo,et al.  Neural Substrates for the Effects of Rehabilitative Training on Motor Recovery After Ischemic Infarct , 1996, Science.

[34]  S. Obayashi,et al.  The effects of electromyography-controlled functional electrical stimulation on upper extremity function and cortical perfusion in stroke patients , 2013, Clinical Neurophysiology.

[35]  E. Taub,et al.  Constraint Induced Movement Techniques To Facilitate Upper Extremity Use in Stroke Patients. , 1997, Topics in stroke rehabilitation.

[36]  H. Ring,et al.  Improving selected hand functions using a noninvasive neuroprosthesis in persons with chronic stroke. , 2002, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[37]  Maarten J. IJzerman,et al.  Functional electrical stimulation by means of the ‘Ness Handmaster Orthosis’ in chronic stroke patients: an exploratory study , 2001, Clinical rehabilitation.

[38]  L. Cohen,et al.  Increase in hand muscle strength of stroke patients after somatosensory stimulation , 2002, Annals of neurology.

[39]  G. Kraft,et al.  Techniques to improve function of the arm and hand in chronic hemiplegia. , 1992, Archives of physical medicine and rehabilitation.

[40]  J. Burridge,et al.  Poststroke upper-limb rehabilitation using 5 to 7 inserted microstimulators: implant procedure, safety, and efficacy for restoration of function. , 2008, Archives of physical medicine and rehabilitation.

[41]  Steven R. Roys,et al.  Functional MRI determination of a dose-response relationship to lower extremity neuromuscular electrical stimulation in healthy subjects , 2003, Experimental Brain Research.

[42]  F. Müller,et al.  Effect of levodopa in combination with physiotherapy on functional motor recovery after stroke: a prospective, randomised, double-blind study , 2001, The Lancet.

[43]  R. Waters,et al.  Electrical stimulation of wrist and fingers for hemiplegic patients. , 1979, Physical therapy.

[44]  S. Page,et al.  Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke. , 2012, Archives of physical medicine and rehabilitation.