Usability of Functional Electrical Stimulation in Upper Limb Rehabilitation in Post-Stroke Patients: A Narrative Review

Abstract

Stroke leads to significant impairment in upper limb (UL) function. The goal of rehabilitation is the reestablishment of pre-stroke motor stroke skills by stimulating neuroplasticity. Among several rehabilitation approaches, functional electrical stimulation (FES) is highlighted in stroke rehabilitation guidelines as a supplementary therapy alongside the standard care modalities. The aim of this study is to present a comprehensive review regarding the usability of FES in post-stroke UL rehabilitation. Specifically, the factors related to UL rehabilitation that should be considered in FES usability, as well a critical review of the outcomes used to assess FES usability, are presented. This review reinforces the FES as a promising tool to induce neuroplastic modifications in post-stroke rehabilitation by enabling the possibility of delivering intensive periods of treatment with comparatively less demand on human resources. However, the lack of studies evaluating FES usability through motor control outcomes, specifically movement quality indicators, combined with user satisfaction limits the definition of FES optimal therapeutical window for different UL functional tasks. FES systems capable of integrating postural control muscles involving other anatomic regions, such as the trunk, during reaching tasks are required to improve UL function in post-stroke patients.

Electrical Stimulation of Acute Fractures: A Narrative Review of Stimulation Protocols and Device Specifications

“…Outside of the indication for augmentation of acute fracture healing, there is a robust body of literature to demonstrate that ES can be used to improve peripheral nerve regeneration, neuroplasticity, and soft tissue wound healing ( Zuo et al, 2020 ; Luo et al, 2021 ; Sousa et al, 2022 ). One key component of the literature for these fields is that the dose-response curve and optimal duration of therapy is well described.…”

Encoder-Controlled Functional Electrical Stimulator for Bilateral Wrist Activities—Design and Evaluation

“…Evidence suggests that the stroke-affected brain is highly adaptable and, if given the correct motor strategies, can be reshaped in a constructive way [ 13 ]. Electrical stimulation is one of the modalities that encourages this type of plasticity in neurons of the stroke-affected brain [ 15 , 16 , 17 , 18 ]. Electrical stimulation in arm rehabilitation has been used widely to retrain functional properties of the musculoskeletal units and replace function.…”

“…When electrical stimulation is applied through the electrodes, the current causes the muscles to contract, resulting in movement. Electrical stimulation that uses the correct stimulation parameters on appropriate muscle synergy during the optimal therapeutic window has proven to impart positive re-learning benefits [ 15 ]. The superiority of functional electrical stimulation (FES) over conventional therapy is yet to be proved, but pairing electrical stimulation with conventional therapies is ongoing and has a promising future [ 19 ].…”

Development of a Wearable Haptic Glove Presenting Haptic Sensation by Electrical Stimulation

“…To address this issue, many studies developed new approaches for generating haptic sensations via vibration [ 7 ], ultrasonic wave [ 8 ], air pressure [ 9 ], laser [ 10 ], magnetic field [ 11 ], etc., but these devices lack force generation.…”

“…Electrical stimulation, which applies the electrical stimulus signals to the electrodes attached to the human body, is widely used in the treatment and rehabilitation of physical paralysis [ 9 ]. When implementing electrical stimulation, electrotactile stimulation current can elicit nerve firing at the subdermal receptors, giving users the sensation of “touching.” Many studies developed haptic interfaces using electrical stimulation.…”