Electrical stimulation as a means for achieving recovery of function in stroke patients

Abstract

This review presents technologies used in and assesses the main clinical outcomes of electrical therapies designed to speed up and increase functional recovery in stroke patients. The review describes methods which interface peripheral systems (e.g., cyclic neural stimulation, stimulation triggered by electrical activity of muscles, therapeutic functional electrical stimulation) and transcranial brain stimulation with surface and implantable electrodes. Our conclusion from reviewing these data is that integration of electrical therapy into exercise-active movement mediated by electrical activation of peripheral and central sensory-motor mechanisms enhances motor re-learning following damage to the central nervous system. Motor re-learning is considered here as a set of processes associated with practice or experience that leads to long-term changes in the capability for movement. An important suggestion is that therapeutic effects are likely to be much more effective when treatment is applied in the acute, rather than in the chronic, phase of stroke.

Surface‐distributed low‐frequency asynchronous stimulation delays fatigue of stimulated muscles

“…activity training (e.g., grasping), augmented by functional electrical stimulation (FES), leads to positive long-term functional changes in stroke patients. 1 One reason why FES has not gained widespread clinical use is the limitation imposed by rapid muscle fatigue. 2 Unlike voluntary contractions, smaller and more fatigue-resistant motor units are not always recruited prior to larger and more fatigable units during electrically elicited contractions.…”

Plasticity and modular control of locomotor patterns in neurological disorders with motor deficits

“…FES has been shown to be an effective tool for muscle strength augmentation, increase in the range of motion in joints and improvements in walking in neurological patients (Popovic et al, 2009). FES is delivered in reference to the timing of natural muscle excitation during movement and it provides additional sensory reinforcement which ultimately improves learning.…”

“…FES is delivered in reference to the timing of natural muscle excitation during movement and it provides additional sensory reinforcement which ultimately improves learning. As a result, the locomotor centers or networks are excited or released from inhibition in phase with their expected activity and thus may be accessible for correction or stimulating effects (Yan et al, 2005; Tong et al, 2006; Popovic et al, 2009; Solopova et al, 2011). Thus, this approach takes advantage of the spatiotemporal architecture of the locomotor program and increases the patient's functional abilities and the effectiveness of rehabilitation.…”

The effects of wide pulse neuromuscular electrical stimulation on elbow flexion torque in individuals with chronic hemiparetic stroke

“…Neuromuscular electrical stimulation (NMES) has been applied to muscles affected by stroke to assist with muscle strengthening and activities of daily living (Chae, 2003; de Kroon et al, 2005; Popovic et al, 2009; Stein et al, 2006). Traditionally, parameters used to stimulate muscles affected by stroke include pulse widths of 200–300 μs and frequencies of 20–50 Hz (de Kroon et al, 2005).…”