scholarly journals Muscle Electrical Impedance Properties and Activation Alteration After Functional Electrical Stimulation-Assisted Cycling Training for Chronic Stroke Survivors: A Longitudinal Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Chengpeng Hu ◽  
Tong Wang ◽  
Kenry W. C. Leung ◽  
Le Li ◽  
Raymond Kai-Yu Tong
Keyword(s):  
Electrical Stimulation ◽  
Lower Extremity ◽  
Functional Electrical Stimulation ◽  
Electrical Impedance ◽  
Muscle Activation ◽  
Chronic Stroke ◽  
Anisotropy Ratio ◽  
Stroke Survivors ◽  
Clinical Scales ◽  
Cycling Training

Electrical impedance myography (EIM) is a sensitive assessment for neuromuscular diseases to detect muscle inherent properties, whereas surface electromyography (sEMG) is a common technique for monitoring muscle activation. However, the application of EIM in detecting training effects on stroke survivors is relatively few. This study aimed to evaluate the muscle inherent properties and muscle activation alteration after functional electrical stimulation (FES)-assisted cycling training to chronic stroke survivors. Fifteen people with chronic stroke were recruited for 20 sessions of FES-assisted cycling training (40 min/session, 3–5 sessions/week). The periodically stimulated and assessed muscle groups were quadriceps (QC), tibialis anterior (TA), hamstrings (HS), and medial head of gastrocnemius (MG) on the paretic lower extremity. EIM parameters [resistance (R), reactance (X), phase angle (θ), and anisotropy ratio (AR)], clinical scales (Fugl-Meyer Lower Extremity (FMA-LE), Berg Balance Scale (BBS), and 6-min walking test (6MWT)] and sEMG parameters [including root-mean square (RMS) and co-contraction index (CI) value] were collected and computed before and after the training. Linear correlation analysis was conducted between EIM and clinical scales as well as between sEMG and clinical scales. The results showed that motor function of the lower extremity, balance, and walking performance of subjects improved after the training. After training, θ value of TA (P = 0.014) and MG (P = 0.017) significantly increased, and AR of X (P = 0.004) value and AR of θ value (P = 0.041) significantly increased on TA. The RMS value of TA decreased (P = 0.022) and a significant reduction of CI was revealed on TA/MG muscle pair (P < 0.001). Significant correlation was found between EIM and clinical assessments (AR of X value of TA and FMA-LE: r = 0.54, P = 0.046; X value of TA and BBS score: 0.628, P = 0.016), and between sEMG and clinical scores (RMS of TA and BBS score: r = −0.582, P = 0.029). This study demonstrated that FES-assisted cycling training improved lower limb function by developing coordinated muscle activation and facilitating an orderly myofiber arrangement. The current study also indicated that EIM can jointly evaluate lower extremity function alteration with sEMG after rehabilitation training.Clinical Trail Registration: The study was registered on the Clinical Trial Registry (trial registration number: NCT 03208439, https://clinicaltrials.gov/ct2/show/NCT03208439).

CLINICAL USE OF FUNCTIONAL ELECTRICAL STIMULATION FOR CORRECTION OF FOOT DROP: A COMPARISON BETWEEN SUBACUTE AND CHRONIC STROKE PATIENTS

2011 ◽  
Vol 11 (05) ◽  
pp. 1165-1177 ◽  
Author(s):  
SUKANTA K. SABUT ◽  
CHHANDA SIKDAR ◽  
RATNESH KUMAR ◽  
MANJUNATHA MAHADEVAPPA
Keyword(s):  
Electrical Stimulation ◽  
Lower Extremity ◽  
Functional Electrical Stimulation ◽  
Rehabilitation Program ◽  
Chronic Stroke ◽  
Motor Recovery ◽  
Calf Muscle ◽  
Foot Drop ◽  
Stroke Patients ◽  
Muscle Spasticity

Functional electrical stimulation (FES) allows active exercises for correction of foot drop in stroke patients. Our objective is to evaluate and compare the effects of FES therapy in walking ability, calf muscle spasticity, and lower-extremity motor recovery between subacute and chronic stroke patients. Twenty consecutive hemiplegic patients having foot drop were assigned either to subacute or chronic group. Both group subjects were treated with conventional rehabilitation program combined with FES therapy for 12 weeks. All subjects received the electrical stimulation to the peroneal nerve of paretic limb for 15–30 min while walking.After being treated with FES-based rehabilitation program, subacute subjects showed a mean increase in walking speed of 31.3% and chronic subjects of 19.1% and the physiological cost index (PCI), with a reduction of 66.7% in subacute subjects and 46.4% in chronic subjects between the beginning and end of the trial. Improvement was also measured in gait parameters such as cadence, step and stride lengths, ankle joint range of motion (ROM), calf muscle spasticity, and lower-extremity motor recovery assessed by Fugl-Meyer score in both group subjects, but subacute subjects improved better compared with chronic subjects. In conclusion, early and intensive interventions of FES therapy combine with conventional rehabilitation program could significantly improve the waking ability and recovery of lower-extremity motor functions in stroke survivors.

scholarly journals Volitional cycling augmented by functional electrical stimulation in hemiparetic adolescents: A case series study

2013 ◽  
Vol 21 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Elisabetta Peri ◽  
Emilia Ambrosini ◽  
Alessandra Pedrocchi ◽  
Emanuela Pagliano ◽  
Daria Riva ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Case Series ◽  
Control Group ◽  
P Value ◽  
Walking Ability ◽  
Clinical Scales ◽  
Case Series Study ◽  
Series Study ◽  
Cycling Training

The aim of this work was to assess the feasibility of a treatment based on volitional cycling augmented by Functional Electrical Stimulation (FES) on hemiparetic adolescents. Six chronic hemiparetic adolescents were included in a case series study. Patients underwent FES-cycling training combined with voluntary pedaling. The intervention consisted of 21 sessions lasting 30 minutes each. Patients were evaluated before, after training, and at a 3-month follow-up visit through clinical scales (Winter scale, observational gait scale, gross motor function measurement, Boyd test and Ashworth scale), a standard gait analysis and a voluntary pedaling test. Results were compared with an age-matched healthy control group (N=6). Two subjects withdrew the study before the completion of the intervention. Concerning the four remaining subjects, the clinical scales showed a slight level of disability already at baseline and no changes were observed after the intervention. In terms of walking ability, some significant improvements (Kruskal-Wallis test, p-value<0.05) were obtained after training in two out of four subjects: an increase of about 16% and 41% of the ankle range of motion and of about 18% and 33% of the ankle propelling power were achieved for two subjects, respectively. During pedaling, the work produced by the paretic leg while pulling the pedal significantly increased in 3 out of 4 subjects. In one subject a more symmetrical cycling movement was observed, whilst for another subject a significant improvement in terms of co-contraction between rectus femoris and biceps femoris was achieved. In conclusion, this study assessed the feasibility of FES-cycling training on hemiparetic adolescents, but did not provide evidences about the effectiveness of this intervention in improving motor recovery and walking ability. However, since only a small group of patients with a low level of disability was involved in the study, further investigations are needed to provide conclusive results.

scholarly journals Does cycling induced by functional electrical stimulation enhance motor recovery in the subacute phase after stroke? A systematic review and meta-analysis

2020 ◽  
Vol 34 (11) ◽  
pp. 1341-1354
Author(s):  
Emilia Ambrosini ◽  
Monica Parati ◽  
Giorgio Ferriero ◽  
Alessandra Pedrocchi ◽  
Simona Ferrante
Keyword(s):  
Electrical Stimulation ◽  
Activities Of Daily Living ◽  
Usual Care ◽  
Functional Electrical Stimulation ◽  
Daily Living ◽  
Mean Difference ◽  
Control Group ◽  
Stroke Survivors ◽  
Subacute Stroke ◽  
Cycling Training

Objective: To investigate the effects of cycling with functional electrical stimulation on walking, muscle power and tone, balance and activities of daily living in subacute stroke survivors. Data Sources: Ten electronic databases were searched from inception to February 2020. Review methods: Inclusion criteria were: subacute stroke survivors (<6 months since stroke), an experimental group performing any type of cycling training with electrical stimulation, alone or in addition to usual care, and a control group performing usual care alone. Two reviewers assessed eligibility, extracted data and analyzed the risks of bias. Standardized Mean Difference (SMD) or Mean Difference (MD) with 95% Confidence Intervals (CI) were estimated using fixed- or random-effects models to evaluate the training effect. Results: Seven randomized controlled trials recruiting a total of 273 stroke survivors were included in the meta-analyses. There was a statistically significant, but not clinically relevant, effect of cycling with electrical stimulation compared to usual care on walking (six studies, SMD [95% CI] = 0.40 [0.13, 0.67]; P = 0.004), capability to maintain a sitting position (three studies, MD [95% CI] = 7.92 [1.01, 14.82]; P = 0.02) and work produced by the paretic leg during pedaling (2 studies, MD [95% CI] = 8.13 [1.03, 15.25]; P = 0.02). No significant between-group differences were found for muscular power, tone, standing balance, and activities of daily living. Conclusions: Cycling training with functional electrical stimulation cannot be recommended in terms of being better than usual care in subacute stroke survivors. Further investigations are required to confirm these results, to determine the optimal training parameters and to evaluate long-term effects.

Effects of Mirror Therapy Combined With EMG-triggered Functional Electrical Stimulation to Improve on Upper Extremity Function in Patient with Chronic Stroke

2020 ◽  
Author(s):  
Joo Yeol Jung ◽  
Pong Sub Youn ◽  
Dong Hoon Kim
Keyword(s):  
Electrical Stimulation ◽  
Physical Therapy ◽  
Muscle Strength ◽  
Range Of Motion ◽  
Upper Extremity ◽  
Functional Electrical Stimulation ◽  
Chronic Stroke ◽  
Mirror Therapy ◽  
Extremity Function ◽  
Upper Extremity Function

AbstractThis study was performed to evaluate the effects of Mirror therapy combined with EMG-triggered Functional Electrical Stimulation on upper extremity function in patient with Chronic Stroke. A total of 24 chronic stroke patients were divided into 3 groups. Group I (n=8) was given with traditional physical therapy (TPT), group II (n=7) was given with traditional physical therapy and mirror therapy (MT), and group III (n=9) was given with traditional physical therapy and mirror therapy in conjunction with EMG-triggered Functional Electrical Stimulation (EMGFES-MT). Each group performed one hour a day 5 times a week for 6 weeks.We obtained the following result between before and after treatments about changes of elbow flexion muscle strength (EFMS), elbow extension muscle strength (EEMS), wrist flexion muscle strength (WFMS), wrist extension muscle strength (WEMS), elbow flexion range of motion (EFROM), elbow extension range of motion (EEROM), wrist flexion range of motion (WFROM), wrist extension range of motion (WEROM), grip strength (GS) and upper extremity function.Each group showed a significant difference in EFMS, EEMS, WFMS, WEMS, EFROM, EEROM, WFROM, WEROM, GS and upper extremity function (p<0.05) EMFES-MT group revealed significant differences in EEMS, WEROM, grip strength and upper extremity function as compared to the other groups (p<0.05). No difference was found in the change of spasticity among the 3 groups.Our results showed that EMFES-MT was more effective on elbow, WFMS, WEMS, AROM, grip strength and upper extremity function in patients with chronic stroke. We suggest that this study will be able to be used as an intervention data for recovering upper extremity function in chronic stroke patients

scholarly journals Investigation of different stimulation patterns with doublet pulses to reduce muscle fatigue

2019 ◽  
Vol 6 ◽  
pp. 205566831982580 ◽  
Author(s):  
Ruslinda Ruslee ◽  
Jennifer Miller ◽  
Henrik Gollee
Keyword(s):  
Electrical Stimulation ◽  
Muscle Fatigue ◽  
Functional Electrical Stimulation ◽  
Muscle Activation ◽  
Motor Units ◽  
Pulse Interval ◽  
Time Interval ◽  
Fatigue Index ◽  
Significant Difference ◽  
Cord Injury

Introduction: Functional electrical stimulation is a common technique used in the rehabilitation of individuals with a spinal cord injury to produce functional movement of paralysed muscles. However, it is often associated with rapid muscle fatigue which limits its applications. Methods: The objective of this study is to investigate the effects on the onset of fatigue of different multi-electrode patterns of stimulation via multiple pairs of electrodes using doublet pulses: Synchronous stimulation is compared to asynchronous stimulation patterns which are activated sequentially (AsynS) or randomly (AsynR), mimicking voluntary muscle activation by targeting different motor units. We investigated these three different approaches by applying stimulation to the gastrocnemius muscle repeatedly for 10 min (300 ms stimulation followed by 700 ms of no-stimulation) with 40 Hz effective frequency for all protocols and doublet pulses with an inter-pulse-interval of 6 ms. Eleven able-bodied volunteers (28 ± 3 years old) participated in this study. Ultrasound videos were recorded during stimulation to allow evaluation of changes in muscle morphology. The main fatigue indicators we focused on were the normalised fatigue index, fatigue time interval and pre-post twitch–tetanus ratio. Results: The results demonstrate that asynchronous stimulation with doublet pulses gives a higher normalised fatigue index (0.80 ± 0.08 and 0.87 ± 0.08) for AsynS and AsynR, respectively, than synchronous stimulation (0.62 ± 0.06). Furthermore, a longer fatigue time interval for AsynS (302.2 ± 230.9 s) and AsynR (384.4 ± 279.0 s) compared to synchronous stimulation (68.0 ± 30.5 s) indicates that fatigue occurs later during asynchronous stimulation; however, this was only found to be statistically significant for one of two methods used to calculate the group mean. Although no significant difference was found in pre-post twitch–tetanus ratio, there was a trend towards these effects. Conclusion: In this study, we proposed an asynchronous stimulation pattern for the application of functional electrical stimulation and investigated its suitability for reducing muscle fatigue compared to previous methods. The results show that asynchronous multi-electrode stimulation patterns with doublet pulses may improve fatigue resistance in functional electrical stimulation applications in some conditions.

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