Effectiveness of neuromuscular electrical stimulation for wrist rehabilitation after acute ischemic stroke

Guo, Xiaoxian; Fan, Bai-ya; Mao, Yan-yang

doi:10.1097/md.0000000000012299

Cited by 7 publications

(4 citation statements)

References 26 publications

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“…Most of the studies on an NMFES application in post-stroke patients are applied to a single muscle; moreover, the results are usually evaluated with clinical, often subjective tests [ 11 , 12 ], and not with objective neurophysiology methods such as rEMG and mcEMG. However, they similarly described the effectiveness of NMFES up to 8 weeks following its application, in terms of decreased spasticity and increased motor performance, when the frequency of the applied stimulation ranged, as in our study, from 35 to 50 Hz [ 17 , 19 , 20 , 42 , 43 ].…”

Section: Discussionsupporting

confidence: 74%

Post-Stroke Treatment with Neuromuscular Functional Electrostimulation of Antagonistic Muscles and Kinesiotherapy Evaluated with Electromyography and Clinical Studies in a Two-Month Follow-Up

Huber

Leszczyńska²,

Leszczyńska

et al. 2022

IJERPH

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The aim of this study was to determine the sustained influence of personalized neuromuscular functional electrical stimulation (NMFES) combined with kinesiotherapy (mainly, proprioceptive neuromuscular facilitation (PNF)) on the activity of muscle motor units acting antagonistically at the wrist and the ankle in a large population of post-stroke patients. Clinical evaluations of spasticity (Ashworth scale), manual muscle testing (Lovett scale), and surface electromyography recordings at rest (rEMG) and during attempts of maximal muscle contraction (mcEMG) were performed three times in 120 post-stroke patients (T0: up to 7 days after the incidence; T1: after 21 days of treatment; T2: after 60 days of treatment). Patients (N = 120) were divided into two subgroups—60 patients received personalized NMFES and PNF treatment (NMFES+K), and the other 60 received only PNF (K). The NMFES+K therapy resulted in a decrease in spasticity and an increase in muscle strength of mainly flexor muscles, in comparison with the K group. A positive correlation between the increase of rEMG amplitudes and high Ashworth scale scores and a positive correlation between low amplitudes of mcEMG and low Lovett scale scores were found in the wrist flexors and calf muscles on the paretic side. Negative correlations were found between the rEMG and mcEMG amplitudes in the recordings. The five-grade alternate activity score of the antagonists’ actions improved in the NMFES+K group. These improvements in the results of controlled NMFES treatment combined with PNF in patients having experienced an ischemic stroke, in comparison to the use of kinesiotherapy alone, might justify the application of conjoined rehabilitation procedures based on neurophysiological approaches. Considering the results of clinical and neurophysiological studies, we suppose that NMFES of the antagonistic muscle groups acting at the wrist and the ankle may evoke its positive effects in post-stroke patients by the modulation of the activity more in the spinal motor centers, including the level of Ia inhibitory neurons, than only at the muscular level.

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Section: Discussionsupporting

confidence: 74%

Post-Stroke Treatment with Neuromuscular Functional Electrostimulation of Antagonistic Muscles and Kinesiotherapy Evaluated with Electromyography and Clinical Studies in a Two-Month Follow-Up

Huber

Leszczyńska²,

Leszczyńska

et al. 2022

IJERPH

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“…The convincing conclusion of Sahin et al [ 18 ] and Guo et al [ 19 ] about the effectiveness of NMFES applied together with PNF stretching on the wrist extensor muscle activity in post-stroke patients, similarly to our study, may be explained by the facilitation of two sources of afferent stimulations on the reflex motor recovery at the spinal or even the supraspinal levels, e.g., provided from NMFES electrotherapy and PNF stretching exercises. This explanation holds true, taking into account that the activity of the antagonistic muscle acting at the wrist and the ankle is regulated by the spinal Ia inhibitory interneuron reflex on a biofeedback way.…”

Section: Discussionsupporting

confidence: 89%

Electroneurographic Evaluation of Neural Impulse Transmission in Patients after Ischemic Stroke Following Functional Electrical Stimulation of Antagonistic Muscles at Wrist and Ankle in Two-Month Follow-Up

Leszczyńska¹,

Huber

Leszczyńska

et al. 2022

IJERPH

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The available data from electroneurography (ENG) studies on the transmission of neural impulses in the motor fibers of upper and lower extremity nerves following neuromuscular functional electrical stimulation (NMFES) combined with kinesiotherapy in post-stroke patients during sixty-day observation do not provide convincing results. This study aims to compare the effectiveness of an NMFES of antagonistic muscle groups at the wrist and ankle and kinesiotherapy based mainly on proprioceptive neuromuscular facilitation (PNF). An ENG was performed once in a group of 60 healthy volunteers and three times in 120 patients after stroke (T0, up to 7 days after the incident; T1, after 21 days of treatment; and T2, after 60 days of treatment); 60 subjects received personalized NMFES and PNF treatment (NMFES+K), while the other 60 received only PNF (K). An ENG studied peripheral (M-wave recordings), C8 and L5 ventral root (F-wave recordings) neural impulse transmission in the peroneal and the ulnar nerves on the hemiparetic side. Both groups statistically differed in their amplitudes of M-wave recording parameters after peroneal nerve stimulation performed at T0 and T2 compared with the control group. After 60 days of treatment, only the patients from the NMFES+K group showed significant improvement in M-wave recordings. The application of the proposed NMFES electrostimulation algorithm combined with PNF improved the peripheral neural transmission in peroneal but not ulnar motor nerve fibers in patients after ischemic stroke. Combined kinesiotherapy and safe, personalized, controlled electrotherapy after stroke give better results than kinesiotherapy alone.

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“…It is performed by applying an electric current to the muscle or peripheral nerve. In general, NMES has been applied alone or in combination with other rehabilitation measures for rehabilitation after stroke [1,2], chronic obstructive pulmonary disease [3], muscle weakness, and musculoskeletal diseases (low back pain, hip and knee arthroplasty, anterior cruciate ligament) [4]. In essence, the mechanism of NMES is that electrical current delivery to neuromuscular tissue causes the depolarization of the motor axons to indirectly activate fiber contraction, When the intensity of NMES exceeds the motor threshold (MT), an upward afferent signal is generated, and then the muscle contraction induced by the electrical stimulation causes a re-afferent.…”

Section: Introductionmentioning

confidence: 99%

Modulatory Effect of Peripheral Magnetic and Neuromuscular Electrical Stimulation on Cortical Excitability: A Functional Near-Infrared Spectroscopy Study

Wang

Liang

et al. 2021

Preprint

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Background: The present study was designed to investigate the effects of neuromuscular electrical stimulation (NMES) and peripheral magnetic stimulation (PMS) applied to the wrist extensor muscle on the cortical activity of healthy adults by using fNIRS. Methods: Fifteen healthy adult subjects (7 males, mean age: 27.13 ± 4.52 years) all received two different conditions of peripheral muscle stimulation in random order: (1) NMES and (2) PMS. The sessions were separated by at least 48 h as a washout period. During muscle stimulation, the motor evoked potential (MEP) of the left primary motor cortex (M1) was measured by transcranial magnetic stimulation (TMS) and the concentration of oxygenated (HbO) and deoxygenated (HbR) hemoglobin detected by fNIRS were used to evaluate the excitability and the activity of the cortex. Results: After the stimulation of the wrist extensor, the MEP amplitude in the left M1 area did not change in both conditions, and there was no difference between NMES and PMS condition. NMES reduced HbO values of several channels in the Prefrontal cortex (PFC), Somatosensory motor cortex (SMC) and Occipital cortex (OC), and HbR valus of several channels in the PFC and SMC. During the PMS stimulation period, the HbO value of all brain areas did not change significantly, while the HbR value of the SMC area decreased. The HbO and HbR value of the channels in the SMC did not differ between NMES and PMS. Inter-region of interest and inter-channel analysis between NMES and PMS showed no difference in functional connectivity. Conclusions: In the case of wrist extensor muscle stimulation, both NMES and PMS can induce cortical activation. PMS targeted to increases the activity of the contralateral SMC, while NMES increased contralateral SMC activity and negatively activated the PFC and OC.

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Effectiveness of neuromuscular electrical stimulation for wrist rehabilitation after acute ischemic stroke

Cited by 7 publications

References 26 publications

Post-Stroke Treatment with Neuromuscular Functional Electrostimulation of Antagonistic Muscles and Kinesiotherapy Evaluated with Electromyography and Clinical Studies in a Two-Month Follow-Up

Post-Stroke Treatment with Neuromuscular Functional Electrostimulation of Antagonistic Muscles and Kinesiotherapy Evaluated with Electromyography and Clinical Studies in a Two-Month Follow-Up

Electroneurographic Evaluation of Neural Impulse Transmission in Patients after Ischemic Stroke Following Functional Electrical Stimulation of Antagonistic Muscles at Wrist and Ankle in Two-Month Follow-Up

Modulatory Effect of Peripheral Magnetic and Neuromuscular Electrical Stimulation on Cortical Excitability: A Functional Near-Infrared Spectroscopy Study

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