Why Is Functional Electrical Stimulation Therapy Capable of Restoring Motor Function Following Severe Injury to the Central Nervous System?

Nagai, Mary K.; Márquez-Chin, César; Popović, Miloš R.

doi:10.1007/978-1-4899-7654-3_25

Cited by 21 publications

(19 citation statements)

References 94 publications

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“…FES therapy) may help individuals with paralysis regain certain voluntary movement and function. 8 Another possible use for the FES-pants could be to replace compression stockings: while being much less tight (thus easier to don and doff), they might be able to ensure a regular venous blood return to the heart, with the advantage of using muscles instead of relying on high passive compression. Indeed, NMES, by activating muscles, create a ''call'' for blood flow, which increases microcirculation in the lower-limbs.…”

Section: Discussionmentioning

confidence: 99%

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Garments for functional electrical stimulation: Design and proofs of concept

Moineau

Márquez-Chin

Alizadeh-Meghrazi

et al. 2019

Journal of Rehabilitation and Assistive Technologies Engineerin

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Introduction Repeated use of functional electrical stimulation can promote functional recovery in individuals with neurological paralysis. We designed garments able to deliver functional electrical stimulation. Methods Shirts and pants containing electrodes knitted with a conductive yarn were produced. Electrodes were moistened with water before use. Stimulation intensity at four thresholds levels (sensory, movement, full range of motion, and maximal), stimulation comfort, and electrical properties of the interface were tested in one able-bodied subject with garment electrodes and size-matched conventional gel electrodes. The pants and shirt were then used to explore usability and design limitations. Results Compared to gel electrodes, fabric electrodes had a lower sensory threshold (on forearm muscles) but they had a higher maximal stimulation threshold (for all tested muscles). The stimulation delivery was comfortable when the garment electrodes were recently moistened; however, as the electrodes dried (within 9 to 18 min) stimulation became unpleasant. Inconsistent water content in the fabric electrodes caused inconsistent intensity thresholds and inconsistent voltage necessary to apply a desired stimulation current. Garments’ tightness and impracticality of electrode lead necessitate further design improvement. Conclusions Fabric electrodes offer a promising alternative to gel electrodes. Further work involving people with paralysis is required to overcome the identified challenges.

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Section: Discussionmentioning

confidence: 99%

“…chronic respiratory disease, chronic heart failure, thoracic cancer), 5 critically ill patients confined to bed, 6,7 and neurorehabilitation after spinal cord injury (SCI) or stroke. 8 Functional electrical stimulation (FES) is the use of NMES to execute a functional movement (e.g. grasping, reaching, standing, and walking).…”

Section: Introductionmentioning

confidence: 99%

Garments for functional electrical stimulation: Design and proofs of concept

Moineau

Márquez-Chin

Alizadeh-Meghrazi

et al. 2019

Journal of Rehabilitation and Assistive Technologies Engineerin

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“…Therefore, due to its physiological advantages, FES is an added benefit during telerehabilitation of persons with partial or complete loss of limb function [15]. Moreover, FES has neuroplastic effects as it helps to retrain active motor units and rebuild the weak connections between the brain and the motor neurons [13, 14]. …”

Section: Discussionmentioning

confidence: 99%

“…The reason why FES is helpful is because it can strengthen muscle, prevent muscle atrophy, and increase bone density. Moreover, FES has neuroplastic effects as it helps to retrain active motor units and rebuild the weak connections between the brain and the motor neurons [13, 14]. The current rehabilitation systems that simply stretch muscles or move limbs through a range of motion provide only part of the needed therapy and hence, may not be as beneficial as FES.…”

Section: Introductionmentioning

confidence: 99%

Bilateral control of functional electrical stimulation and robotics-based telerehabilitation

Alibeji

Dicianno

Sharma

2017

Int J Intell Robot Appl

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Currently a telerehabilitation system includes a therapist and a patient where the therapist interacts with the patient, typically via a verbal and visual communication, for assessment and supervision of rehabilitation interventions. This mechanism often fails to provide physical assistance, which is a modus operandi during physical therapy or occupational therapy. Incorporating an actuation modality such as functional electrical stimulation (FES) or a robot at the patient’s end that can be controlled by a therapist remotely, to provide therapy or to assess and measure rehabilitation outcomes can significantly transform current telerehabilitation technology. In this paper, a position-synchronization controller is derived for FES-based telerehabilitation to provide physical assistance that can be controlled remotely. The newly derived controller synchronizes an FES-driven human limb with a remote physical therapist’s robotic manipulator despite constant bilateral communication delays. The control design overcomes a major stability analysis challenge: the unknown and unstructured nonlinearities in the FES-driven musculoskeletal dynamics. To address this challenge, the nonlinear muscle model was estimated through two neural networks functions that approximated unstructured nonlinearities and an adaptive control law for structured nonlinearities with online update laws. A Lyapunov-based stability analysis was used to prove the globally uniformly ultimately bounded tracking performance. The performance of the state synchronization controller was validated through experiments on an able-bodied subject. Specifically, we demonstrated bilateral control of FES-elicited leg extension and a human operated robotic manipulator. The controller was shown to effectively synchronize the system despite unknown and different delays in the forward and backward channels.

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“…The “neurological” mechanisms are (i) cortical reorganization, (ii) neuroplastic changes in the central nervous system, (iii) strengthening of the synaptic connection via Hebb’s rule, and (iv) functional reorganization and retraining of unaffected, but functionally related, areas of the central nervous system, allowing them to take control over the damaged parts of the central nervous system. Presently, the FEST experts are inclined to explain the improvements using the above listed and few additional neurological mechanisms ( 36 ).…”

Section: Introductionmentioning

confidence: 99%

Restoration of Upper Limb Function in an Individual with Cervical Spondylotic Myelopathy using Functional Electrical Stimulation Therapy: A Case Study

2016

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Non-traumatic spinal cord pathology is responsible for 25–52% of all spinal cord lesions. Studies have revealed that spinal stenosis accounts for 16–21% of spinal cord injury (SCI) admissions. Impaired grips as well as slow unskilled hand and finger movements are the most common complaints in patients with spinal cord disorders, such as myelopathy secondary to cervical spondylosis. In the past, our team carried out couple of successful clinical trials, including two randomized control trials, showing that functional electrical stimulation therapy (FEST) can restore voluntary reaching and/or grasping function, in people with stroke and traumatic SCI. Motivated by this success, we decided to examine changes in the upper limb function following FEST in a patient who suffered loss of hand function due to myelopathy secondary to cervical spondylosis. The participant was a 61-year-old male who had C3–C7 posterior laminectomy and instrumented fusion for cervical myelopathy. The participant presented with progressive right hand weakness that resulted in his inability to voluntarily open and close the hand and to manipulate objects unilaterally with his right hand. The participant was enrolled in the study ~22 months following initial surgical intervention. Participant was assessed using Toronto Rehabilitation Institute’s Hand Function Test (TRI-HFT), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Spinal Cord Independence Measure (SCIM). The pre–post differences in scores on all measures clearly demonstrated improvement in voluntary hand function following 15 1-h FEST sessions. The changes observed were meaningful and have resulted in substantial improvement in performance of activities of daily living. These results provide preliminary evidence that FEST has a potential to improve upper limb function in patients with non-traumatic SCI, such as myelopathy secondary to cervical spondylosis.

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Why Is Functional Electrical Stimulation Therapy Capable of Restoring Motor Function Following Severe Injury to the Central Nervous System?

Cited by 21 publications

References 94 publications

Garments for functional electrical stimulation: Design and proofs of concept

Garments for functional electrical stimulation: Design and proofs of concept

Bilateral control of functional electrical stimulation and robotics-based telerehabilitation

Restoration of Upper Limb Function in an Individual with Cervical Spondylotic Myelopathy using Functional Electrical Stimulation Therapy: A Case Study

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