Effect of electrical stimulation therapy on upper extremity functional recovery and cerebral cortical changes in patients with chronic hemiplegia

Abstract

Hemiplegia is a common sequel of stroke and assisted living care is needed in many cases. The purpose of this study was to evaluate the effect of using surface electrode stimulation device in rehabilitation, in terms of functional improvement in upper limb and the changes in brain activation related to central nervous system reconstruction. Five patients with chronic hemiplegia received electrical stimulation therapy using the orthosis-type surface electrode stimulation device for 12 weeks. Training time was 30 min/day for the first weeks, and increased 30 min/day in every 4 weeks. Upper limb outcome measures included Brunnstrom stage, range of motion, Fugl-Meyer assessment and manual function test. Brain activation was measured using functional MRI. After therapy with therapeutic electrical stimulation (TES) for 12 weeks upper limb function improved in all cases. The results of brain activation showed two patterns. In the first, the stimulation produced an activity in the bilateral somatosensory cortices (SMC), which was seen to continue over time. The second, activation was bilateral and extensive before stimulation, but localized to the SMC after intervention. Treatment with TES using an orthosis-type electrode stimulation device improves upper limb function in chronic hemiplegia patients. The present findings suggest that there are not only efferent but also afferent effects that may promote central nervous system remodeling.Stroke is the main cause of disability in industrialized countries, with a significant impact on individual, family, and societal healthcare. Although many hemiplegic survivors after stroke achieve independent ambulatory functions with orthotic devices, half of them are unable to use their upper extremity in their activities of daily living (ADL) after months of standard stroke rehabilitation (31). A common approach in rehabilitation for upper limb hemiplegia in chronic stage has been training the healthy side, especially if it contains the nondominant hand, and learning to perform tasks with only one arm. In recent years, it has been recognized that the phenomenon of "learned non-use" (30, 33), which results from use of the healthy side only, invites a state of further inability to use the affected side. Because this can lead to exacerbation of secondary disorders such as edema, pain, decreased range of motion, and shoulder subluxation, attention has focused on approaches for rehabilitating the affected upper limb based on the plasticity of the central nervous system. Reports that rehabilitation for the affected upper limb produces reconstruction of the central nervous system as upper limb function improves (27) have also attracted attention. One of the most promising alternate interventions to help hemiplegic survivors recover upper limb function is functional electrical stimulation (FES). FES is a method of restoring functionality to upper or lower extremities by electrically stimulating the lower motor neurons of hemiplegic survivors after stroke (26). FES training involves t...

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

“…On the one hand, some studies found either an increase of fMRI BOLD signal in the contralesional postcentral gyrus [9,34] as a correlate of enhanced cortical activation or a decrease of activation in the ipsilesional hemisphere correlated to reduced cortical activation [31]. On the other hand, other research groups propose that FES, accompanied by improvement of motor function, leads to less diffuse activity in the sensorimotor cortex (SMC), shifting to focused activity in the ipsilesional SMC [32,33]. Likewise, a recent study investigating changes of cortical brain perfusion using near-infrared spectroscopy (NIRS) during and after therapeutic FES intervention found a redistribution towards the ipsilesional SMC in patients with improved functional motor control following FES [30].…”

Electromyogram-controlled assistive exercise for the motor recovery of shoulder in chronic hemiplegia: A pilot study

“…In fact, this kind of study design (focusing on chronic patients with stabilized hemiplegia and without control subjects) is often taken in the pilot studies where the effect of new rehabilitation therapy for the hemiplegia was investigated, e.g., to evaluate the effects of electrical stimulation on the upper limb function and pain [42][43][44][45] and the effects of robotic therapy on the upper extremity functions [46,47]. Negligible effects of the natural recovery or the conventional therapy on the improvement of the shoulder motor function is also supported by the fact that the functional (FMA score) improvement is exclusively demonstrated for the shoulder-related items (Figure 3).…”

Developing and Evaluating a Flexible Wireless Microcoil Array Based Integrated Interface for Epidural Cortical Stimulation

“…Neural plasticity, which is presumed to play a major role in motor recovery, can be modulated by various exogenous methods, including electrical stimulation [5,6]. Epidural cortical stimulation (ECS), a therapeutic that exposes dura mater by craniotomy for electrical stimulation of the cortex, has demonstrated significant improvements in motor function in animal models of stroke and as an adjunctive treatment in limb motor function rehabilitation of stroke patients with hemiparesis by modulating neuronal plasticity [4,7,8,9,10,11,12]. In addition, approximately one-third of stroke patients present with the devastating consequences of aphasia, the inability to speak [13].…”