Physical Therapists' Use of Functional Electrical Stimulation for Clients With Stroke: Frequency, Barriers, and Facilitators

Auchstaetter, Nolan; Luc, Juliana; Lukye, Stacey; Lynd, Kaylea; Schemenauer, Shelby; Whittaker, Maura; Musselman, Kristin E.

doi:10.2522/ptj.20150464

Cited by 51 publications

(80 citation statements)

References 29 publications

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“…The clinical uptake of these technologies into SCI rehabilitation has received little study to-date; however, previous work in stroke rehabilitation would suggest the likelihood is not high. FES, robotics and Wii or Kinect systems are infrequently used by clinicians working with individuals who have experienced a stroke [ 5 – 7 ]. Numerous barriers to the clinical implementation of rehabilitative technology exist.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous barriers to the clinical implementation of rehabilitative technology exist. For example, a lack of knowledge about the technology combined with little or no allocated time to learn [ 6 , 7 ]. The technology may be perceived too time-consuming to set-up and/or administer, detracting from a patient’s allocated therapy time [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…To facilitate the intensive training process, therapeutic technologies have been developed, such as exoskeletons, functional electrical stimulation (FES), and robotic rehabilitation devices. While clinicians have an interest in incorporating technology that may augment neurorecovery into practice, the actual uptake of technology in neurorehabilitation has been low [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends

Musselman

Shah

Zariffa

2018

J NeuroEngineering Rehabil

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In the past, neurorehabilitation for individuals with neurological damage, such as spinal cord injury (SCI), was focused on learning compensatory movements to regain function. Presently, the focus of neurorehabilitation has shifted to functional neurorecovery, or the restoration of function through repetitive movement training of the affected limbs. Technologies, such as robotic devices and electrical stimulation, are being developed to facilitate repetitive motor training; however, their implementation into mainstream clinical practice has not been realized. In this commentary, we examined how current SCI rehabilitation research aligns with the potential for clinical implementation. We completed an environmental scan of studies in progress that investigate a physical intervention promoting functional neurorecovery. We identified emerging interventions among the SCI population, and evaluated the strengths and gaps of the current direction of SCI rehabilitation research. Seventy-three study postings were retrieved through website and database searching. Study objectives, outcome measures, participant characteristics and the mode(s) of intervention being studied were extracted from the postings. The FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) Framework was used to evaluate the strengths and gaps of the research with respect to likelihood of clinical implementation. Strengths included aspects of Feasibility, as the research was practical, aspects of Appropriateness as the research aligned with current scientific literature on motor learning, and Effectiveness, as all trials aimed to evaluate the effect of an intervention on a clinical outcome. Aspects of Feasibility were also identified as a gap; with two thirds of the studies examining emerging technologies, the likelihood of successful clinical implementation was questionable. As the interventions being studied may not align with the preferences of clinicians and priorities of patients, the Appropriateness of these interventions for the current health care environment was questioned. Meaningfulness and Economic Evidence were also identified as gaps since few studies included measures reflecting the perceptions of the participants or economic factors, respectively. The identified gaps will likely impede the clinical uptake of many of the interventions currently being studied. Future research may lessen these gaps through a staged approach to the consideration of the FAME elements as novel interventions and technologies are developed, evaluated and implemented.Electronic supplementary materialThe online version of this article (10.1186/s12984-018-0386-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends

Musselman

Shah

Zariffa

2018

J NeuroEngineering Rehabil

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“…For this reason, researchers and clinicians have explored a variety of neurorehabilitation approaches in search of an effective means to restore post-stroke walking function. These approaches include functional electrical stimulation (FES) (Popovic et al, 1999 ; Kesar et al, 2009 , 2010 ; Sabut et al, 2013 ; Chung et al, 2014 ; O’Dell et al, 2014 ; Pilkar et al, 2014 ; Auchstaetter et al, 2015 ; Chantraine et al, 2016 ), ankle–foot orthoses (AFOs) (Ferreira et al, 2013 ; Tyson et al, 2013 ; Kobayashi et al, 2016 ), exoskeletons (Nilsson et al, 2014 ; Bortole et al, 2015 ; Buesing et al, 2015 ), partial body weight support (Ng et al, 2008 ; Lee et al, 2013 ) and split-belt treadmill training systems (Reisman et al, 2007 ; Malone and Bastian, 2014 ), and robotic gait trainers (Pennycott et al, 2012 ; Mehrholz et al, 2013 ; Bae et al, 2014 ; Hussain, 2014 ; Dundar et al, 2015 ). Each of these approaches has shown varying levels of promise for improving post-stroke walking function.…”

Section: Introductionmentioning

confidence: 99%

Muscle Synergies Facilitate Computational Prediction of Subject-Specific Walking Motions

Meyer

Eskinazi

Jackson

et al. 2016

Front. Bioeng. Biotechnol.

131

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Researchers have explored a variety of neurorehabilitation approaches to restore normal walking function following a stroke. However, there is currently no objective means for prescribing and implementing treatments that are likely to maximize recovery of walking function for any particular patient. As a first step toward optimizing neurorehabilitation effectiveness, this study develops and evaluates a patient-specific synergy-controlled neuromusculoskeletal simulation framework that can predict walking motions for an individual post-stroke. The main question we addressed was whether driving a subject-specific neuromusculoskeletal model with muscle synergy controls (5 per leg) facilitates generation of accurate walking predictions compared to a model driven by muscle activation controls (35 per leg) or joint torque controls (5 per leg). To explore this question, we developed a subject-specific neuromusculoskeletal model of a single high-functioning hemiparetic subject using instrumented treadmill walking data collected at the subject’s self-selected speed of 0.5 m/s. The model included subject-specific representations of lower-body kinematic structure, foot–ground contact behavior, electromyography-driven muscle force generation, and neural control limitations and remaining capabilities. Using direct collocation optimal control and the subject-specific model, we evaluated the ability of the three control approaches to predict the subject’s walking kinematics and kinetics at two speeds (0.5 and 0.8 m/s) for which experimental data were available from the subject. We also evaluated whether synergy controls could predict a physically realistic gait period at one speed (1.1 m/s) for which no experimental data were available. All three control approaches predicted the subject’s walking kinematics and kinetics (including ground reaction forces) well for the model calibration speed of 0.5 m/s. However, only activation and synergy controls could predict the subject’s walking kinematics and kinetics well for the faster non-calibration speed of 0.8 m/s, with synergy controls predicting the new gait period the most accurately. When used to predict how the subject would walk at 1.1 m/s, synergy controls predicted a gait period close to that estimated from the linear relationship between gait speed and stride length. These findings suggest that our neuromusculoskeletal simulation framework may be able to bridge the gap between patient-specific muscle synergy information and resulting functional capabilities and limitations.

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“…These damages are not considered in this perspective nor is the uncounted number of patients who for various reasons are not candidates for FES intervention. In a recent paper, Auchstaetter and colleagues identi ied a number of barriers to the utilization of FES by physical therapists in clinical practice [34]. These barriers as well as practical issues including patients' tolerance, or reimbursement challenges are likewise not the focus of this paper.…”

Section: Fes As a Clinical Training Toolmentioning

confidence: 99%

Functional Electrical Stimulation (FES): Clinical successes and failures to date

Alon¹

2018

J Nov Physiother Rehabil

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Non-invasive electrical stimulation in the form of neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES) has been documented as an optional assessment and treatment technology for decades. In contrast, translation of the robust clinical evidence supporting the effectiveness of FES' enhancement of muscle force generation and adding to the recovery of motor control following damage to the brain appears limited. Furthermore, enabling many patients to regain locomotion ability though utilization of FES as a standard care option in rehabilitation medicine remains unmet. This perspective evolved over years of collaborative experience in clinical research, teaching, and patient care having a common goal of advancing patients' rehabilitation outcomes. The clinical successes are supported by repeated evidence of FES utilization across the life span, from toddlers to elders, from hospitals' critical care units to the home environment. The utilization include managing multiple defi cits associated with the musculo-skeletal, neurological, cardio-pulmonary, or peripheral vascular systems. These successes were achieved in no small part because of the technological advancement leading to today's wearable wireless FES systems that are being used throughout the continuum of rehabilitation care. However, failures to benefi t from FES utilization are likewise numerous, collectively depriving most patients from using the technology to maximize their rehabilitation gains. The most critical failures are both clinical and technological. Whereas numerous barriers to NMES and FES utilization have been published, the focus of this perspective is on barriers not considered to date.

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Physical Therapists' Use of Functional Electrical Stimulation for Clients With Stroke: Frequency, Barriers, and Facilitators

Abstract: Functional electrical stimulation is not widely used by physical therapists in stroke rehabilitation. Improving access to resources-in particular, continuing education-may facilitate the implementation of FES into clinical practice.

Cited by 51 publications

References 29 publications

Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends

Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends

Muscle Synergies Facilitate Computational Prediction of Subject-Specific Walking Motions

Functional Electrical Stimulation (FES): Clinical successes and failures to date

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