Neuromuscular electrical stimulation restores upper limb sensory-motor functions and body representations in chronic stroke survivors

Med ◽  
2022 ◽  
Author(s):  
Andrea Crema ◽  
Michela Bassolino ◽  
Eleonora Guanziroli ◽  
Maria Colombo ◽  
Olaf Blanke ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Upper Limb ◽  
Neuromuscular Electrical Stimulation ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Motor Functions ◽  
Body Representations ◽  
Sensory Motor

scholarly journals Bilateral Contralaterally Controlled Functional Electrical Stimulation Reveals New Insights Into the Interhemispheric Competition Model in Chronic Stroke

2019 ◽  
Vol 33 (9) ◽  
pp. 707-717 ◽  
Author(s):  
David A. Cunningham ◽  
Jayme S. Knutson ◽  
Vishwanath Sankarasubramanian ◽  
Kelsey A. Potter-Baker ◽  
Andre G. Machado ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Upper Limb ◽  
Functional Electrical Stimulation ◽  
Repeated Measures ◽  
Neuromuscular Electrical Stimulation ◽  
Chronic Stroke ◽  
Motor Impairments ◽  
Repeated Measures Design ◽  
Interhemispheric Competition ◽  
Wide Range

Background. Upper-limb chronic stroke hemiplegia was once thought to persist because of disproportionate amounts of inhibition imposed from the contralesional on the ipsilesional hemisphere. Thus, one rehabilitation strategy involves discouraging engagement of the contralesional hemisphere by only engaging the impaired upper limb with intensive unilateral activities. However, this premise has recently been debated and has been shown to be task specific and/or apply only to a subset of the stroke population. Bilateral rehabilitation, conversely, engages both hemispheres and has been shown to benefit motor recovery. To determine what neurophysiological strategies bilateral therapies may engage, we compared the effects of a bilateral and unilateral based therapy using transcranial magnetic stimulation. Methods. We adopted a peripheral electrical stimulation paradigm where participants received 1 session of bilateral contralaterally controlled functional electrical stimulation (CCFES) and 1 session of unilateral cyclic neuromuscular electrical stimulation (cNMES) in a repeated-measures design. In all, 15 chronic stroke participants with a wide range of motor impairments (upper extremity Fugl-Meyer score: 15 [severe] to 63 [mild]) underwent single 1-hour sessions of CCFES and cNMES. We measured whether CCFES and cNMES produced different effects on interhemispheric inhibition (IHI) to the ipsilesional hemisphere, ipsilesional corticospinal output, and ipsilateral corticospinal output originating from the contralesional hemisphere. Results. CCFES reduced IHI and maintained ipsilesional output when compared with cNMES. We found no effect on ipsilateral output for either condition. Finally, the less-impaired participants demonstrated a greater increase in ipsilesional output following CCFES. Conclusions. Our results suggest that bilateral therapies are capable of alleviating inhibition on the ipsilesional hemisphere and enhancing output to the paretic limb.

scholarly journals Pathway-specific modulatory effects of neuromuscular electrical stimulation during pedaling in chronic stroke survivors

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Shi-Chun Bao ◽  
Wing-Cheong Leung ◽  
Vincent C. K. Cheung ◽  
Ping Zhou ◽  
Kai-Yu Tong
Keyword(s):  
Electrical Stimulation ◽  
Healthy Subjects ◽  
Neuromuscular Electrical Stimulation ◽  
Neuromuscular Control ◽  
Chronic Stroke ◽  
Sensory Level ◽  
Stroke Survivors ◽  
Potential Contribution ◽  
Descending Pathways ◽  
Post Stroke

Abstract Background Neuromuscular electrical stimulation (NMES) is extensively used in stroke motor rehabilitation. How it promotes motor recovery remains only partially understood. NMES could change muscular properties, produce altered sensory inputs, and modulate fluctuations of cortical activities; but the potential contribution from cortico-muscular couplings during NMES synchronized with dynamic movement has rarely been discussed. Method We investigated cortico-muscular interactions during passive, active, and NMES rhythmic pedaling in healthy subjects and chronic stroke survivors. EEG (128 channels), EMG (4 unilateral lower limb muscles) and movement parameters were measured during 3 sessions of constant-speed pedaling. Sensory-level NMES (20 mA) was applied to the muscles, and cyclic stimulation patterns were synchronized with the EMG during pedaling cycles. Adaptive mixture independent component analysis was utilized to determine the movement-related electro-cortical sources and the source dipole clusters. A directed cortico-muscular coupling analysis was conducted between representative source clusters and the EMGs using generalized partial directed coherence (GPDC). The bidirectional GPDC was compared across muscles and pedaling sessions for post-stroke and healthy subjects. Results Directed cortico-muscular coupling of NMES cycling was more similar to that of active pedaling than to that of passive pedaling for the tested muscles. For healthy subjects, sensory-level NMES could modulate GPDC of both ascending and descending pathways. Whereas for stroke survivors, NMES could modulate GPDC of only the ascending pathways. Conclusions By clarifying how NMES influences neuromuscular control during pedaling in healthy and post-stroke subjects, our results indicate the potential limitation of sensory-level NMES in promoting sensorimotor recovery in chronic stroke survivors.

scholarly journals Effect of Functional Electrical Stimulation on Upper Limb Motor Functions in Patient with Chronic Stroke - A Case Report

2021 ◽  
pp. 199-203
Author(s):  
Rupa Zanwar ◽  
Pooja Motar ◽  
Minal Holani
Keyword(s):  
Electrical Stimulation ◽  
Ischemic Stroke ◽  
Case Report ◽  
Upper Limb ◽  
Functional Electrical Stimulation ◽  
Chronic Stroke ◽  
Post Intervention ◽  
Motor Functions ◽  
Chronic Stage ◽  
Hand Muscles

Background: Literature shows that intensive Functional Electrical Stimulation facilitates upper limb motor recovery after Stroke. Aim: To assess the effects of 4 weeks of FES therapy on right upper limb motor functions in patient with Chronic Stroke. Materials and Methods: The participant was thirty year old male Right Hemiparesis who had experienced Chronic Ischemic Stroke. FES therapy was given for forty five minutes per session, three sessions a week for complete four weeks. The pre and post intervention score were measured with Fugl Meyer Assessment, Voluntary Control Grading and MAS. Results: The Fugl Meyer Assessment score for right upper limb showed improvement with progression in stage of VCG for right upper limb and hand. Also improved MAS score was noted for right shoulder, elbow and hand muscles. Conclusion: The current study confirms that application of FES therapy improves upper limb motor functions in Chronic stage of Stroke after 4 weeks.

scholarly journals Regional Cerebral Blood Perfusion Changes in Chronic Stroke Survivors as Potential Brain Correlates of The Functional Outcome Following Gamified Home-Based Rehabilitation (IntelliRehab)

2021 ◽  
Author(s):  
Younis Firwana ◽  
Mohd Khairul Izamil Zolkefley ◽  
Hasnetty Zuria Mohamed Hatta ◽  
Christina Rowbin ◽  
Che Mohd Nasril Che Mohd Nassir ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Blood Perfusion ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Motor Functions ◽  
Staffing Ratios ◽  
Recovery Potential ◽  
Home Based ◽  
Brain Correlates

Abstract Background: Hospital-based stroke rehabilitation for stroke survivors in developing countries may be limited by staffing ratios and length of stay that could hamper recovery potential. Thus, a home-based, gamified rehabilitation system (i.e. IntelliRehab) was tested for its ability to increase cerebral blood flow (CBF), and the secondary impact of changes on the upper limb motor function and functional outcomes. Objective: To explore the effect of IntelliRehab on CBF in chronic stroke patients and its correlation with the upper limb motor function. Methods: Two-dimensional pulsed Arterial Spin Labelling (2D-pASL) was used to obtain CBF images of stable, chronic stroke subjects (n=8) over 3-months intervention period. CBF alterations were mapped and the detected differences were marked as regions of interest. Motor functions represented by Fugl-Meyer Upper Extremity Assessment (FMA) and Stroke Impact Scale (SIS) were used to assess the primary and secondary outcomes, respectively. Results: Regional CBF were significantly increased in right inferior temporal gyrus and left superior temporal white matter after 1-month (p=0.044) and 3-months (p=0.01) of rehabilitation, respectively. However, regional CBF in left middle fronto-orbital gyrus significantly declined after 1-month of rehabilitation (p=0.012). Moreover, SIS-Q7 and FMA scores significantly increased after 1-month and 3-months of rehabilitation. There were no significant correlations, however, between CBF changes and upper limb motor function. Conclusions: Participants demonstrated improved motor functions, supporting the benefit of using IntelliRehab as a tool for home-based rehabilitation. However, the chronic nature of the stroke in recruited subjects may have limited potential for within-participant improvements.

scholarly journals The effects of anxiety and dual-task on upper limb motor control of chronic stroke survivors

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mahnaz Hejazi-Shirmard ◽  
Laleh Lajevardi ◽  
Mehdi Rassafiani ◽  
Ghorban Taghizadeh
Keyword(s):  
Motor Control ◽  
Upper Limb ◽  
Dual Task ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
High Anxiety ◽  
Reach And Grasp ◽  
Stroke Group ◽  
Task Conditions ◽  
Hand Opening

Abstract This study was designed to investigate the effects of anxiety and dual-task on reach and grasp motor control in chronic stroke survivors compared with age- and sex-matched healthy subjects (HC). Reach and grasp kinematic data of 68 participants (high-anxiety stroke (HA-stroke), n = 17; low-anxiety stroke (LA-stroke), n = 17; low-anxiety HC, n = 17; and high-anxiety HC, n = 17) were recorded under single- and dual-task conditions. Inefficient reach and grasp of stroke participants, especially HA-stroke were found compared with the control groups under single- and dual-task conditions as evidenced by longer movement time (MT), lower and earlier peak velocity (PV) as well as delayed and smaller hand opening. The effects of dual-task on reach and grasp kinematic measures were similar between HCs and stroke participants (i.e., increased MT, decreased PV that occurred earlier, and delayed and decreased hand opening), with greater effect in stroke groups than HCs, and in HA-stroke group than LA-stroke group. The results indicate that performing a well-learned upper limb movement with concurrent cognitive task leads to decreased efficiency of motor control in chronic stroke survivors compared with HCs. HA-stroke participants were more adversely affected by challenging dual-task conditions, underlying importance of assessing anxiety and designing effective interventions for it in chronic stroke survivors.

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