Combined use of functional electrical stimulation and unexpected perturbations for balance training in a person with stroke: A case study

Estudio de caso[Resumen] Antecedentes. El accidente cerebrovascular (ACV) es una patología frecuente que conlleva diferentes secuelas, entre las que se encuentran la afectación de la movilidad del tobillo y las alteraciones del equilibrio. Existen diversas opciones terapéuticas para tratar estos déficits, entre ellas la estimulación eléctrica funcional (FES) y el entrenamiento de la marcha con perturbaciones. Objetivo. Analizar los resultados de una intervención combinada de FES y entrenamiento de la marcha con perturbaciones, así como comprobar las repercusiones en la ejecución de actividades de la vida diaria y la participación de la persona. Metodología. Se estudió el caso de un varón con hemiparesia izquierda a consecuencia de un ACV. El protocolo de rehabilitación constó de 20 sesiones de 50 min (2 sesiones/semana) donde se combinó el entrenamiento del equilibrio y la marcha con Balance Tutor™ y FES con Fesia Walk. Se evaluaron los resultados con las escalas: 10 Meter Walk Test, Five Times Sit to Stand Test, Timed Up and Go, Balance Evaluation Systems Test (BESTest) y Activities-Specific Balance Confidence (ABC). Resultados. Se observaron mejoras clínicas en las escalas valoradas, especialmente en el BESTest y el ABC. Conclusiones. Se trata de una prueba de concepto satisfactoria de la combinación de dos técnicas, y es necesaria más investigación sobre ello en personas con ACV y otras patologías neurológicas.[Abstract] Introduction. Stroke is a frequent disease that entails different sequelae, among which are the affectation of ankle motion and balance disorders. Various therapeutic can be used to treat these deficits, including functional electrical stimulation (FES) and disturbance gait training. Objective. To analyse the results of a combined intervention of FES and gait training with disturbances, as well as to verify the repercussions on the execution of activities of daily living and the person's participation. Methods. The case of a man with left hemiparesis because of a stroke was studied. The rehabilitation protocol consisted of 20 sessions of 50 min (2 sessions/week) where balance and gait training were combined with Balance Tutor™ and FES with Fesia Walk. The results were evaluated with the scales: 10 Meter Walk Test, Five Times Sit to Stand Test, Timed Up and Go, Balance Evaluation Systems Test (BESTest) and Activities-Specific Balance Confidence (ABC). Results. Clinical improvements were observed in the assessed scales, especially in the BESTest and the ABC. Conclusions. This is a satisfactory proof of concept of the combination of two techniques, and more research is needed on it in people with stroke and other neurological diseases

Decoupling the heat loss coefficient of an in-use office building into its transmission and infiltration heat loss coefficients

[EN]The actual building energy performance essentially depends on the building occupant's behaviour, the real performance of the installed energy systems and the in-use performance of the building envelope. The thermal performance characterization of in-use building envelopes, based on monitored data, represents a crucial step towards bridging the gap between the designed and as-built energy performance of buildings. The main indicator to analyse the performance gap of building envelopes is the Heat Loss Coefficient (HLC); when measured, it commonly shows considerable differences when compared with the design value. This research goes further and proposes a method, based on monitored data from in-use buildings, for the decoupling of the HLC of in-use buildings into its transmission (UA) and infiltration (C-v) heat loss coefficients, in order to identify the origin of the heat losses. The identification of this origin will facilitate the reduction of the performance gap. Therefore, a multi-storey occupied office building of the University of the Basque Country has been monitored and analysed, where the in-use HLC for each floor and for the whole building have already been estimated using an average method. Then, based on the ASTM D6245-18 Standard, the decay method of the metabolic CO2 of the building's occupants has been successfully applied in this paper to obtain the Air Change per Hour (ACH) rates due to infiltrations. These ACH values have been used to decouple the estimated HLC values into their transmission and infiltration parts.This work was supported by the Spanish Ministry of Science, Inno-vation and Universities and the European Regional Development Fund (grant number RTI2018-096296-B-C22) through the MONITHERM project 'Investigation of monitoring techniques of occupied buildings for their thermal characterization and methodology to identify their key performance indicators', project reference: RTI2018-096296-B-C22 (MCIU/AEI/FEDER, UE) . The corresponding author also acknowledges the support provided by the Education Department of the Basque Gov-ernment through a scholarship granted to her to complete her PhD degree

Effect of Gel Type and Anode Selection in Ankle Movements Elicited by a Multi-field FES Device

Publisher Copyright: © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.Functional electrical stimulation (FES) is an evidence-based technique for treating foot drop, the inability to lift the foot due to weak or absent ankle dorsiflexors. Surface multi-field electrodes have brought some advantages such as improved selectivity or possibility of performing automatic motor-search configurations. In fact, they provide new stimulation paradigms that should be tested. This pilot study analyses the movements created using different anode combinations and gel types with the Fesia Walk system, a commercial multi-field technology-based FES device for foot drop compensation. 8 different anode combinations and 2 gel types were tested in 4 healthy subjects. Results show that the most lateral anodes located on the shank produce predominantly ankle plantarflexion and eversion, while the ones located most medially produce more dorsiflexion and inversion. No significant effect was observed between both gel types. This study suggests that anode selection has an influence on the elicited ankle movements and therefore it should be taken into account in the configuration process.This work has been supported in part by FIK.Peer reviewe

Analysis of the movements generated by a multi‐field functional electrical stimulation device for upper extremity rehabilitation

Background: The most common chronic sequela after stroke is the loss of arm function, and functional electrical stimulation (FES) applied to the forearm muscles is one of the options to treat it. Surface multi-field electrodes have emerged, showing a great potential to improve the selectivity of the stimulation, delay muscle fatigue, and provide easier donning and doffing. The muscular selectivity takes on special relevance in the rehabilitation of the upper extremity as hand dexterity requires a wide diversity of specific muscle actions. Methods: This pilot study analyses the movements generated in the wrist and fingers using a commercial multi-field technology-based FES device (Fesia Grasp). The study included five patients with hemiplegic subacute stroke, in which scanning of all cathodes of the electrode was carried out daily for 5 days, in two different forearm positions, with the resulting movements being labeled by experienced therapists. Results: The aim of this pilot study was to determine if there were differences between subjects and between forearm positions in terms of produced movements. Movements of the wrist (two movements) and the fingers (six movements) could be achieved in two different forearm positions. Conclusions: The multi-field electrode of Fesia Grasp enables to generate a wide range of movements of the hand in different positions. This fact could allow to produce more physiological movement patterns during the rehabilitation process with FES, which could have a beneficial effect on the recovery of patients with neurological diseases.The authors disclosed receipt of the following financial support for the research, authorship, and/or publications of this article: A part of this study was supported by grants of the Basque Government (Hazitek Program), project FESKU ZL‐2018/00326