Neuromuscular electrical stimulation (NMES), specifically functional electrical stimulation (FES) that compensates for voluntary motion, and therapeutic electrical stimulation (TES) aimed at muscle strengthening and recovery from paralysis are widely used in stroke rehabilitation. The electrical stimulation of muscle contraction should be synchronized with intended motion to restore paralysis. Therefore, NMES devices, which monitor electromyogram (EMG) or electroencephalogram (EEG) changes with motor intention and use them as a trigger, have been developed. Devices that modify the current intensity of NMES, based on EMG or EEG, have also been proposed. Given the diversity in devices and stimulation methods of NMES, the aim of the current review was to introduce some commercial FES and TES devices and application methods, which depend on the condition of the patient with stroke, including the degree of paralysis.
We investigated whether untriggered neuromuscular electrical stimulation (NMES) can increase the effectiveness of shoulder and elbow robotic training in patients with hemiparesis. Thirty subacute stroke patients were randomly equally allocated to robot only (RO) and robot and electrical stimulation (RE) groups. During training, shoulder and elbow movements were trained by operating the robotic arm with the paretic arm, and the robotic device helped to move the arm. In the RE group, the anterior deltoid and triceps brachii muscles were electrically stimulated at sub-motor threshold intensity. Training was performed (approximately 1h/day, 5 days/week for 2 weeks) in addition to regular rehabilitation. Active range of motion (ROM) values of shoulder flexion and abduction, and Fugl-Meyer assessment (FMA) scores were measured before and after training. Active shoulder ROM was significantly better after than before training in the RE group; however, no such improvement was noted in the RO group. FMA scores were significantly better in both groups, and there was no significant difference between the groups. Untriggered NMES might increase the effectiveness of shoulder and elbow robotic training in patients with hemiparesis. Additionally, NMES at a sub-motor threshold during robotic training might facilitate activation of paretic muscles, resulting in paralysis improvement.
Objective: This study examined whether subacute stroke patients with hemiplegia who receive gait training using the Gait Exercise Assist Robot (GEAR) show early improvement in gait independence compared to patients who receive orthosis-assisted gait training. Methods: Six patients who satisfied the following criteria were included in the study: patients with hemiplegia caused by primary supratentorial intracerebral hemorrhage or cerebral infarction, within 60 days after onset, aged 20 to 75 years, Functional Independence Measure (FIM) walking score ≤ 3, Stroke Impairment Assessment Set (SIAS) lower extremity total score ≤ 6, and use of a knee-ankle-foot orthosis. Rehabilitation was conducted for a maximum of 3 h a day, including 40 min of gait training using GEAR. A historical control group was selected from among patients admitted to the ward for intensive inpatient rehabilitation at Nanakuri Memorial Hospital. One control patient matching the criteria of each subject was selected, with a total of six in the control group. The primary outcome measure was the improvement in efficiency of FIM-walk, defined as the gain in FIM walking score from the baseline to supervised walking divided by the number of weeks required. Results: The mean improvement in efficiency of FIMwalk was 1.0 in the GEAR group and 0.54 in the control group, and was significantly higher in the GEAR group (p = 0.042).
Conclusion:Gait training using GEAR may facilitate early improvement in gait independence.
settings.Methods: In all, 30 patients (18 men and 12 women) with a mean (standard deviation) age of 57.4 (16.97) years (range, 25 85 years) who were admitted to the "Kaifukuki" rehabilitation ward voluntarily participated in this study. In the reliability study, 2 physiotherapists independently classifi ed the level of static postural control ability by using SIDE. Functional balance control ability was simultaneously evaluated using the Berg Balance Scale (BBS). Cohen's κ statistic was used to determine the inter-rater reliability, and the Spearman rank-correlation coeffi cient between the BBS score and SIDE level was used to determine the criterion-related validity. Results: Inter-rater reliability of SIDE showed excellent reproducibility (Cohen's κ statistic = 0.76). Criterion-related validity was very high between SIDE levels and BBS scores (Spearman rank-correlation coeffi cient = 0.93; p < 0.01). Conclusion: SIDE can be used to effi ciently and accurately classify balance control ability across individuals and has remarkable concurrent validity in balance evaluation compared to BBS.
ME administration is effective for improving muscle CSA and, thus, muscle strengthening in stroke rehabilitation. The CSA increase in the ME group was most prominent in patients with a low initial FIM-M score.
[Purpose] The motor paralysis-improving effect on the hemiplegic lower limb was compared
among mirror therapy, integrated volitional-control electrical stimulation, therapeutic
electrical stimulation, repetitive facilitative exercises, and the standard training
method in post-stroke hemiplegia patients. [Subjects and Methods] Eighty one stroke
patients admitted to a convalescent rehabilitation ward were randomly allocated to the
above 5 treatment groups. Each patient performed functional training of the paralytic
lower limb for 20 minutes a day for 4 weeks, and changes in the lower limb function were
investigated using the Stroke Impairment Assessment Set. [Results] The hip and knee joint
functions did not significantly improve in the standard training control group, but
significant improvements were observed after 4 weeks in the other intervention groups.
Significant improvement was noted in the ankle joint function in all groups. [Conclusion]
Although the results were influenced by spontaneous recovery and the standard training in
the control group, the hip and knee joints were more markedly improved by the
interventions in the other 4 groups of patients with moderate paralysis, compared to the
control group.
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