Functional Electrical Stimulation Improves Motor Recovery of the Lower Extremity and Walking Ability of Subjects With First Acute Stroke

Yan, Tiebin; Hui-Chan, C.W.Y.; Li, Leonard S.W.

doi:10.1161/01.str.0000149623.24906.63

Cited by 278 publications

(208 citation statements)

References 21 publications

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“…Small trials have shown modest clinical improvement in disabilities after stroke with the use of the following techniques: electrical stimulation over the surface of muscles to contract them for simple movements, such as grasping, or to assist ankle dorsiflexion while walking 49 ; intense practice with electromechanical devices that assist in reaching or stepping 50 ; noninvasive stimulation of the peripheral nerve of the arm 51 or direct stimulation of the motor cortex over the hand representation 52 to augment cortical plasticity and learning during arm therapies; pharmacotherapy with agonists of dopamine, acetylcholine, and serotonin, which may modulate neurotransmission and learning 53 ; and the use of mental imagery of an action, 54 which may enhance training because it activates many of the same cortical neurons that are involved in performing the action. Phase 1 trials are beginning in order to assess the safety of the injection of drugs into the cerebrospinal fluid or of cells into brain tissue to replace neurons and promote dendrite sprouting and axon regeneration, 55 with the goal of possible neural repair.…”

Section: Areas Of Uncertaintymentioning

confidence: 99%

Rehabilitation after Stroke

2005

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A 66-year-old man was suddenly unable to speak, follow directions, or move his right arm and leg. He received tissue plasminogen activator within 90 minutes. Four days later, his speech was limited to effortful answers of yes or no. He could not walk or use his right arm, and self-care tasks required maximal assistance. What advice would you offer him and his family regarding rehabilitation for his disabilities? THE CLINICAL PROBLEMApproximately 400 persons per 100,000 population over the age of 45 years have a first stroke each year in the United States, Europe, and Australia. Stroke is the most frequent cause of adult-onset disability among people in the United States, and the cost of related care is among the fastest-growing expenses for Medicare. 1 The likelihood of improvement after stroke varies with the nature and severity of the initial deficit. Approximately 35 percent of survivors with initial paralysis of the leg do not regain useful function, and 20 to 25 percent of all survivors are unable to walk without full physical assistance. 2 Six months after stroke, about 65 percent of patients cannot incorporate the affected hand into their usual activities. Poor upper-extremity outcomes are probable after a hemispheric infarction when the leg cannot move by two weeks and the hand has no movement or only slight finger flexion with no opening by four weeks, consistent with considerable damage to the corticospinal tract. 3 Patients who survive a stroke almost always have less physical disability by the end of the first three months. Functional scales, such as the Barthel Index and the Functional Independence Measure (which measure the physical assistance or supervision needed for self-care, including using the toilet, dressing, bathing, eating, and mobility), tend to show a plateau of gains by three to four months after stroke, partly owing to insensitivity of the scale to further improvements. Patients who no longer require assistance at that point may still be unable to use the affected hand, walk at speeds and distances that permit activities outside the home, or live alone. Only 25 percent of patients return to the level of everyday participation and physical functioning of community-matched persons who have not had a

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Section: Areas Of Uncertaintymentioning

confidence: 99%

Rehabilitation after Stroke

2005

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“…Improvement of muscle strengthening and prevention of muscle atrophy have been reported for over 30 years. Improvement in motor and walking ability [2], [3], a possibility of improving gait pattern [3], and motor recovery of upper limb [4] have also been reported as the therapeutic effects of FES. Furthermore, FES therapy has been found to reduce disability and improve voluntary grasping beyond the effects of conventional upper extremity therapy [5].…”

Section: Introductionmentioning

confidence: 99%

A Measurement of Lower Limb Angles Using Wireless Inertial Sensors during FES Assisted Foot Drop Correction with and without Voluntary Effort

Watanabe¹,

Endo²,

Murakami³

et al. 2013

IJBBB

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Abstract-An integrated wireless system of lower limb angle measurement and Functional Electrical Stimulation (FES) control was developed in our previous study for application to motor rehabilitation. In the motor rehabilitation, it is also considered that voluntary effort to move their limbs is effective. In this paper, gait movements of a hemiplegic subject were measured with and without voluntary effort of ankle dorsiflexion during FES assisted foot drop correction as a preliminary test for gait rehabilitation with FES. Some characteristics of hemiplegic gait and differences in joint angles between the paralyzed and the non-paralyzed sides were found in the measurement. The foot and the shank inclination angles at the toe off timing showed small change with the voluntary effort of dorsiflexion during FES control. In addition, variations of the inclination angles of some segments of the paralyzed side were larger than those with only FES at the toe off timing, maximum angle point and the foot contact timing in the case of the voluntary effort. These results suggested that voluntary effort could change movement in FES control. However, these changes with voluntary effort were not seen with larger stimulation intensity. Therefore, it was considered that the movement changes with voluntary effort were small because the subject could not produce further voluntary muscle force in excess of the muscle force production by FES. It would be necessary to determine appropriate intensity of electrical stimulation for rehabilitation use.

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“…Other potential benefits of applying FES early after stroke may include an ability to walk earlier, increased functional independence, earlier discharge home and improved motor recovery which may reduce the requirement for long-term use of FES or any orthotic device . (Taylor et al, 1999a;Yan, Hui-Chan and Li, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…This lack of research may be linked to the complexity of applying FES during the early stages after stroke or the difficulty of assessing its impact beyond that of routine recovery [Wade, 2009]. At present; only two studies have investigated the application of FES in acute stroke populations (< 2 weeks post stroke) [Kottink et al, 2004;Yan, Hui-Chan and Li, 2005;NICE 2008;Dunning et al, 2009] with no studies exclusively investigating FES during the subacute phase of stroke (two weeks to six months post stroke) [Kottink et al, 2004]. Yan, Hui-Chan and Li, 2005, undertook a trial with 46 participants, on average 10 days after stroke.…”

Section: Introductionmentioning

confidence: 99%

“…At present; only two studies have investigated the application of FES in acute stroke populations (< 2 weeks post stroke) [Kottink et al, 2004;Yan, Hui-Chan and Li, 2005;NICE 2008;Dunning et al, 2009] with no studies exclusively investigating FES during the subacute phase of stroke (two weeks to six months post stroke) [Kottink et al, 2004]. Yan, Hui-Chan and Li, 2005, undertook a trial with 46 participants, on average 10 days after stroke. Measures included the composite spasticity scale, ankle dorsiflexion torque and the percentage of participants able to walk.…”

Section: Introductionmentioning

confidence: 99%

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