The influence of functional electrical stimulation on hand motor recovery in stroke patients: a review

Neuromuscular stimulation has been used as one potential rehabilitative treatment option to restore motor function and improve recovery in patients with paresis. Especially stroke patients who often regain only limited hand function would greatly benefit from a therapy that enhances recovery and restores movement. Multiple studies investigated the effect of functional electrical stimulation on hand paresis, the results however are inconsistent. Here we review the current literature on functional electrical stimulation on hand motor recovery in stroke patients. We discuss the impact of different parameters such as stage after stoke, degree of impairment, spasticity and treatment protocols on the functional outcome. Importantly, we outline the results from recent studies investigating the cortical effects elicited by functional electrical stimulation giving insights into the underlying mechanisms responsible for long-term treatment effects. Bringing together the findings from present research it becomes clear that both, treatment outcomes as well as the neurophysiologic mechanisms causing functional recovery, vary depending on patient characteristics. In order to develop unified treatment guidelines it is essential to conduct homogenous studies assessing the impact of different parameters on rehabilitative success

The influence of functional electrical stimulation on hand motor recovery in stroke patients: a review

Neuromuscular stimulation has been used as one potential rehabilitative treatment option to restore motor function and improve recovery in patients with paresis. Especially stroke patients who often regain only limited hand function would greatly benefit from a therapy that enhances recovery and restores movement. Multiple studies investigated the effect of functional electrical stimulation on hand paresis, the results however are inconsistent. Here we review the current literature on functional electrical stimulation on hand motor recovery in stroke patients. We discuss the impact of different parameters such as stage after stoke, degree of impairment, spasticity and treatment protocols on the functional outcome. Importantly, we outline the results from recent studies investigating the cortical effects elicited by functional electrical stimulation giving insights into the underlying mechanisms responsible for long-term treatment effects. Bringing together the findings from present research it becomes clear that both, treatment outcomes as well as the neurophysiologic mechanisms causing functional recovery, vary depending on patient characteristics. In order to develop unified treatment guidelines it is essential to conduct homogenous studies assessing the impact of different parameters on rehabilitative success

Association of the time of day of EVT with clinical outcomes and benefit from successful recanalization after stroke

Experimental and neuroimaging studies suggest an influence of the time of day on acute infarct growth, but whether this could inform patient selection for acute treatments is uncertain. In a multicenter cohort of 9357 stroke patients undergoing endovascular treatment, morning treatment (05:00–10:59) was associated with lowest 90-day mRS scores (adjusted odds ratio, 1.27 [95% CI, 1.08–1.47]; p = 0.004). The association between successful recanalization and outcome was stronger in morning compared to evening-treated patients (pia = 0.046) with treatment benefit persisting until 24 h for morning-treated compared to 11.5 h for evening-treated patients suggesting that the time of day might inform patient selection for EVT

Smart control for functional electrical stimulation with optimal pulse intensity

Transcutaneous electrical stimulation is a common treatment option for patients suffering from spinal cord injury or stroke. Two major difficulties arise when employing electrical stimulation in patients: Accurate stimulation electrode placement and configuration of optimal stimulation parameters. Optimizing the stimulation parameters has the advantage to reduce muscle fatigue after repetitive stimulation. Here we present a newly developed system which is able to automatically find the optimal individual stimulation intensity by varying the pulse length. The effectiveness is measured with flex sensors. By adapting the stimulation parameters, the effect of muscle fatigue can be compensated, allowing for a more stable movement upon stimulation over time

Smart control for functional electrical stimulation with optimal pulse intensity

Transcutaneous electrical stimulation is a common treatment option for patients suffering from spinal cord injury or stroke. Two major difficulties arise when employing electrical stimulation in patients: Accurate stimulation electrode placement and configuration of optimal stimulation parameters. Optimizing the stimulation parameters has the advantage to reduce muscle fatigue after repetitive stimulation. Here we present a newly developed system which is able to automatically find the optimal individual stimulation intensity by varying the pulse length. The effectiveness is measured with flex sensors. By adapting the stimulation parameters, the effect of muscle fatigue can be compensated, allowing for a more stable movement upon stimulation over time

A flexible standalone system with integrated sensor feedback for multi-pad electrode FES of the hand

Functional electrical stimulation aims to help patients suffering from stroke or spinal cord injury to supplement lost motor function. Effective functional electrical stimulation requires precise placement of the stimulation electrode. Finding the correct placement, however, can be difficult and time consuming. Another common problem with functional electrical stimulation is early occurrence of muscle fatigue upon repetitive stimulation, limiting treatment efficiency. Both, precise electrode placement as well as the reduction of muscle fatigue can be achieved using multi-pad electrodes. Here we present a new standalone device for multi-pad functional electrical stimulation. The device is easy to use and designed to help patients recovering from stroke to train and perform opening of the hand

A flexible standalone system with integrated sensor feedback for multi-pad electrode FES of the hand

Functional electrical stimulation aims to help patients suffering from stroke or spinal cord injury to supplement lost motor function. Effective functional electrical stimulation requires precise placement of the stimulation electrode. Finding the correct placement, however, can be difficult and time consuming. Another common problem with functional electrical stimulation is early occurrence of muscle fatigue upon repetitive stimulation, limiting treatment efficiency. Both, precise electrode placement as well as the reduction of muscle fatigue can be achieved using multi-pad electrodes. Here we present a new standalone device for multi-pad functional electrical stimulation. The device is easy to use and designed to help patients recovering from stroke to train and perform opening of the hand

Spectral Variability in the Aged Brain during Fine Motor Control

Physiological aging is paralleled by a decline of fine motor skills accompanied by structural and functional alterations of the underlying brain network. Here, we aim to investigate age-related changes in the spectral distribution of neuronal oscillations during fine skilled motor function. We employ the concept of spectral entropy in order to describe the flatness and peaked-ness of a frequency spectrum to quantify changes in the spectral distribution of the oscillatory motor response in the aged brain. Electroencephalogram was recorded in elderly (n = 32) and young (n = 34) participants who performed either a cued finger movement or a pinch or a whole hand grip task with their dominant right hand. Whereas young participant showed distinct, well-defined movement-related power decreases in the alpha and upper beta band, elderly participants exhibited a flat broadband, frequency-unspecific power desynchronization. This broadband response was reflected by an increase of spectral entropy over sensorimotor and frontal areas in the aged brain. Neuronal activation patterns differed between motor tasks in the young brain, while the aged brain showed a similar activation pattern in all tasks. Moreover, we found a wider recruitment of the cortical motor network in the aged brain. The present study adds to the understanding of age-related changes of neural coding during skilled motor behavior, revealing a less predictable signal with great variability across frequencies in a wide cortical motor network in the aged brain. The increase in entropy in the aged brain could be a reflection of random noise-like activity or could represent a compensatory mechanism that serves a functional role