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Advanced Sensors/Devices for Functional Electrical Stimulation Systems

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A special issue of Sensors (ISSN 1424-8220). This special issue belongs to the section "Wearables".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 37210

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Special Issue Editors

Prof. Dr. Milos Popovic

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Guest Editor

Toronto Rehabilitation Institute, Toronto, ON, Canada
Interests: functional electrical stimulation; neuroprostheses; neuro-rehabilitation; neuromodulation; brain–machine interfaces; physiological control systems; assistive technology; modeling and control of linear and non-linear dynamic systems; robotics; signal processing

Prof. Dr. Samuel C.K. Lee

E-Mail Website
Guest Editor

Department of Physical Therapy, University of Delaware, Newark, DE, USA
Interests: pediatric mobility; cerebral palsy; FES; exoskeletons

Prof. Dr. Kei Masani

E-Mail Website
Guest Editor

Toronto Rehabilitation Institute, Toronto, ON, Canada
Interests: postural control; functional electrical stimulation; spinal cord injury

Special Issue Information

Dear Colleagues,

In 1961, Dr. Wladimir Theodore Liberson first defined the term “functional electrotherapy” to describe the application of electrical stimulation to skeletal muscle to activate the ankle dorsiflexors during hemiplegic gait. The unique feature of this application was the use of a heel-switch to stimulate the peroneal nerve such that the activation of the dorsiflexors occurred during the swing-phase of gait to prevent foot-drop in lieu of using an ankle-foot orthosis. To distinguish from other forms of electrotherapy, in which multiple treatments are used to produce a lasting therapeutic effect, Dr. Liberson distinguished functional electrical stimulation (FES) as having the objective to “provide the muscles with electric stimulation in cases of the central nervous system lesion so that at the very time of the stimulation the muscle contraction has a functional purpose either in locomotion or in prehension or in other muscle activity”. In more general terms, FES “is a form of replacement therapy when the impulses coming from the central nervous system are lacking”.

Since Liberson’s novel application, FES has been used for myriad patient populations and for various applications, ranging from gait and breathing assistance to bladder control. Likewise, FES devices have advanced with miniaturization, sophisticated control systems, multiple channels, implantable devices, electrode development, and the use of sensors with control systems to regulate stimulation delivery. For this Special Issue, we invite manuscripts that advance sensor and device development for FES systems and clinical studies demonstrating the efficacy of FES systems using wearable devices in clinical populations.

Prof. Dr. Milos Popovic
Prof. Dr. Samuel C.K. Lee
Prof. Dr. Kei Masani
Guest Editors

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Keywords

functional electrical stimulation (FES)
wearable sensors
functional orthosis
implantable devices
electrode design
brain-computer interface
rehabilitation
neuroplasticity

Published Papers (12 papers)

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11 pages, 1541 KiB

Open AccessArticle

Development of a Coaching System for Functional Electrical Stimulation Rowing: A Feasibility Study in Able-Bodied Individuals

by Shirin Tajali, Kai Lon Fok, Pirashanth Theventhiran, Gongkai Ye, Hikaru Yokoyama, Kento Nakagawa and Kei Masani

Sensors 2022, 22(5), 1813; https://doi.org/10.3390/s22051813 - 25 Feb 2022

Cited by 1 | Viewed by 2284

Abstract

Background: Functional electrical stimulation (FES) during rowing has substantial effects on cardiovascular health in individuals with spinal cord injuries. Currently, manual stimulation control where stimulation is operated by rowers is mostly utilized. However, it takes time to obtain the skill to initiate FES at the optimal timing. The purpose of this study was to develop a coaching system that helps rowers to initiate FES at the optimal timing. Methods: The optimal range for FES application was identified based on the electromyography of the left quadriceps in 10 able-bodied individuals (AB). Then, the effects of the coaching system on the timing of button-pressing, power, and work were investigated in 7 AB. Results: Vastus lateralis (VL) activation began consistently before the seat reached the anterior-most position. Therefore, seat position at the onset of VL was used as the variable to control the switch timing in the coaching system. The results revealed significantly higher power and work outputs in the coaching than the no-coaching condition (median power coaching: 19.10 W, power no-coaching: 16.48 W, p = 0.031; median work coaching: 109.74 J, work no-coaching: 65.25 J, p = 0.047). Conclusions: The coaching system can provide the optimal timing for FES, resulting in improved performance. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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16 pages, 4389 KiB

Open AccessArticle

Development of a High-Power Capacity Open Source Electrical Stimulation System to Enhance Research into FES-Assisted Devices: Validation of FES Cycling

by Tiago Coelho-Magalhães, Emerson Fachin-Martins, Andressa Silva, Christine Azevedo Coste and Henrique Resende-Martins

Sensors 2022, 22(2), 531; https://doi.org/10.3390/s22020531 - 11 Jan 2022

Cited by 3 | Viewed by 2794

Abstract

Since the first Cybathlon 2016, when twelve teams competed in the FES bike race, we have witnessed a global effort towards the development of stimulation and control strategies to improve FES-assisted devices, particularly for cycling, as a means to practice a recreational physical activity. As a result, a set of technical notes and research paved the way for many other studies and the potential behind FES-assisted cycling has been consolidated. However, engineering research needs instrumented devices to support novel developments and enable precise assessment. Therefore, some researchers struggle to develop their own FES-assisted devices or find it challenging to implement their instrumentation using commercial devices, which often limits the implementation of advanced control strategies and the possibility to connect different types of sensor. In this regard, we hypothesize that it would be advantageous for some researchers in our community to enjoy access to an entire open-source FES platform that allows different control strategies to be implemented, offers greater adaptability and power capacity than commercial devices, and can be used to assist different functional activities in addition to cycling. Hence, it appears to be of interest to make our proprietary electrical stimulation system an open-source device and to prove its capabilities by addressing all the aspects necessary to implement a FES cycling system. The high-power capacity stimulation device is based on a constant current topology that allows the creation of biphasic electrical pulses with amplitude, width, and frequency up to 150 mA, 1000 µs, and 100 Hz, respectively. A mobile application (Android) was developed to set and modify the stimulation parameters of up to eight stimulation channels. A proportional-integral controller was implemented for cadence tracking with the aim to improve the overall cycling performance. A volunteer with complete paraplegia participated in the functional testing of the system. He was able to cycle indoors for 45 min, accomplish distances of more than 5 km using a passive cycling trainer, and pedal 2400 m overground in 32 min. The results evidenced the capacity of our FES cycling system to be employed as a cycling tool for individuals with spinal cord injury. The methodological strategies used to improve FES efficiency suggest the possibility of maximizing pedaling duration through more advanced control techniques. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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18 pages, 5323 KiB

Open AccessArticle

Ultrasound Echogenicity as an Indicator of Muscle Fatigue during Functional Electrical Stimulation

by Qiang Zhang, Ashwin Iyer, Krysten Lambeth, Kang Kim and Nitin Sharma

Sensors 2022, 22(1), 335; https://doi.org/10.3390/s22010335 - 03 Jan 2022

Cited by 11 | Viewed by 3109

Abstract

Functional electrical stimulation (FES) is a potential neurorehabilitative intervention to enable functional movements in persons with neurological conditions that cause mobility impairments. However, the quick onset of muscle fatigue during FES is a significant challenge for sustaining the desired functional movements for more extended periods. Therefore, a considerable interest still exists in the development of sensing techniques that reliably measure FES-induced muscle fatigue. This study proposes to use ultrasound (US) imaging-derived echogenicity signal as an indicator of FES-induced muscle fatigue. We hypothesized that the US-derived echogenicity signal is sensitive to FES-induced muscle fatigue under isometric and dynamic muscle contraction conditions. Eight non-disabled participants participated in the experiments, where FES electrodes were applied on their tibialis anterior (TA) muscles. During a fatigue protocol under either isometric and dynamic ankle dorsiflexion conditions, we synchronously collected the isometric dorsiflexion torque or dynamic dorsiflexion angle on the ankle joint, US echogenicity signals from TA muscle, and the applied stimulation intensity. The experimental results showed an exponential reduction in the US echogenicity relative change (ERC) as the fatigue progressed under the isometric (

R^{2} = 0.891 \pm 0.081

) and dynamic (

R^{2} = 0.858 \pm 0.065

) conditions. The experimental results also implied a strong linear relationship between US ERC and TA muscle fatigue benchmark (dorsiflexion torque or angle amplitude), with

R^{2}

values of

0.840 \pm 0.054

and

0.794 \pm 0.065

under isometric and dynamic conditions, respectively. The findings in this study indicate that the US echogenicity signal is a computationally efficient signal that strongly represents FES-induced muscle fatigue. Its potential real-time implementation to detect fatigue can facilitate an FES closed-loop controller design that considers the FES-induced muscle fatigue. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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11 pages, 766 KiB

Open AccessArticle

Aerobic Responses to FES-Assisted and Volitional Cycling in Children with Cerebral Palsy

by Ashwini Sansare, Ann Tokay Harrington, Henry Wright, James Alesi, Ahad Behboodi, Khushboo Verma and Samuel C. K. Lee

Sensors 2021, 21(22), 7590; https://doi.org/10.3390/s21227590 - 15 Nov 2021

Cited by 4 | Viewed by 2734

Abstract

Recumbent stationary cycling is a potential exercise modality for individuals with cerebral palsy (CP) that lack the postural control needed for upright exercises. Functional electrical stimulation (FES) of lower extremity muscles can help such individuals reach the cycling intensities that are required for aerobic benefits. The aim of this study was to examine the effect of cycling with and without FES assistance to that of a no-intervention control group on the cardiorespiratory fitness of children with CP. Thirty-nine participants were randomized to a FES group that underwent an 8-week FES-assisted cycling program, the volitional group (VOL), who cycled without FES, or a no-intervention control group (CON) (15 FES, 11 VOL, 13 CON). Cadence, peak VO₂, and net rise in heart rate were assessed at baseline, end of training, and washout (8-weeks after cessation of training). Latent growth curve modeling was used for analysis. The FES group showed significantly higher cycling cadences than the VOL and CON groups at POST and WO. There were no differences in improvements in the peak VO₂ and peak net HR between groups. FES-assisted cycling may help children with CP attain higher cycling cadences and to retain these gains after training cessation. Higher training intensities may be necessary to obtain improvements in peak VO₂ and heart rate. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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9 pages, 1368 KiB

Open AccessCommunication

A Generic Sequential Stimulation Adapter for Reducing Muscle Fatigue during Functional Electrical Stimulation

by Gongkai Ye, Saima S. Ali, Austin J. Bergquist, Milos R. Popovic and Kei Masani

Sensors 2021, 21(21), 7248; https://doi.org/10.3390/s21217248 - 30 Oct 2021

Cited by 2 | Viewed by 2403

Abstract

Background: Clinical applications of conventional functional electrical stimulation (FES) administered via a single electrode are limited by rapid onset neuromuscular fatigue. “Sequential” (SEQ) stimulation, involving the rotation of pulses between multiple active electrodes, has been shown to reduce fatigue compared to conventional FES. However, there has been limited adoption of SEQ in research and clinical settings. Methods: The SEQ adapter is a small, battery-powered device that transforms the output of any commercially available electrical stimulator into SEQ stimulation. We examined the output of the adaptor across a range of clinically relevant stimulation pulse parameters to verify the signal integrity preservation ability of the SEQ adapter. Pulse frequency, amplitude, and duration were varied across discrete states between 4 and 200 Hz, 10 and100 mA, and 50 and 2000 μs, respectively. Results: A total of 420 trials were conducted, with 80 stimulation pulses per trial. The SEQ adapter demonstrated excellent preservation of signal integrity, matching the pulse characteristics of the originating stimulator within 1% error. The SEQ adapter operates as expected at pulse frequencies up to 160 Hz, failing at a frequency of 200 Hz. Conclusion: The SEQ adapter represents an effective and low-cost solution to increase the utilization of SEQ in existing rehabilitation paradigms. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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17 pages, 4984 KiB

Open AccessArticle

New Stimulation Device to Drive Multiple Transverse Intrafascicular Electrodes and Achieve Highly Selective and Rich Neural Responses

by Thomas Guiho, Victor Manuel López-Álvarez, Paul Čvančara, Arthur Hiairrassary, David Andreu, Thomas Stieglitz, Xavier Navarro and David Guiraud

Sensors 2021, 21(21), 7219; https://doi.org/10.3390/s21217219 - 29 Oct 2021

Cited by 5 | Viewed by 2096

Abstract

Peripheral Nerve Stimulation (PNS) is a promising approach in functional restoration following neural impairments. Although it proves to be advantageous in the number of implantation sites provided compared with intramuscular or epimysial stimulation and the fact that it does not require daily placement, as is the case with surface electrodes, the further advancement of PNS paradigms is hampered by the limitation of spatial selectivity due to the current spread and variations of nerve physiology. New electrode designs such as the Transverse Intrafascicular Multichannel Electrode (TIME) were proposed to resolve this issue, but their use was limited by a lack of innovative multichannel stimulation devices. In this study, we introduce a new portable multichannel stimulator—called STIMEP—and implement different stimulation protocols in rats to test its versatility and unveil the potential of its combined use with TIME electrodes in rehabilitation protocols. We developed and tested various stimulation paradigms in a single fascicle and thereafter implanted two TIMEs. We also tested its stimulation using two different waveforms. The results highlighted the versatility of this new stimulation device and advocated for the parameterizing of a hyperpolarizing phase before depolarization as well as the use of small pulse widths when stimulating with multiple electrodes. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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17 pages, 1561 KiB

Open AccessArticle

Reactive Exercises with Interactive Objects: Interim Analysis of a Randomized Trial on Task-Driven NMES Grasp Rehabilitation for Subacute and Early Chronic Stroke Patients

by Andrea Crema, Ivan Furfaro, Flavio Raschellà, Mauro Rossini, Johannes Zajc, Constantin Wiesener, Walter Baccinelli, Davide Proserpio, Andreas Augsten, Nancy Immick, Sebastian Becker, Matthias Weber, Thomas Schauer, Karsten Krakow, Giulio Gasperini, Franco Molteni, Michael Friedrich Russold, Maria Bulgheroni and Silvestro Micera

Sensors 2021, 21(20), 6739; https://doi.org/10.3390/s21206739 - 11 Oct 2021

Cited by 1 | Viewed by 3176

Abstract

Enriched environments and tools are believed to promote grasp rehabilitation after stroke. We designed S2, an interactive grasp rehabilitation system consisting of smart objects, custom orthoses for selective grasp constraining, and an electrode array system for forearm NMES. Motor improvements and perceived usability of a new enriched upper limb training system for sub-acute stroke patients was assessed in this interim analysis. Inclusion criteria: sub-acute stroke patients with

M M S E > 20

, ipsilesional

M I > 80 %

, and contralesional

M I < 80 %

. Effects of 30-min therapy supplements, conventional vs. S2 prototype, are compared through a parallel two-arms dose-matched open-label trial, lasting 27 sessions. Clinical centres: Asklepios Neurologische Klinik Falkenstein, Königstein im Taunus, Germany, and Clinica Villa Beretta, Costa Masnaga, Italy. Assessment scales: ARAT, System Usability, and Technology Acceptance. Methodology: 26 participants were block randomized, allocated to the study (control

N = 12

, experimental

N = 14

) and underwent the training protocol. Among them, 11 participants with ARAT score at inclusion below 35, n = 6 in the experimental group, and n = 5 in the control group were analysed. Results: participants in the enriched treatment group displayed a larger improvement in the ARAT scale (+14.9 pts,

p_{v a l} = 0.0494

). Perceived usability differed between clinics. No adverse effect was observed in relation to the treatments. Trial status: closed. Conclusions: The S2 system, developed according to shared clinical directives, was tested in a clinical proof of concept. Variations of ARAT scores confirm the feasibility of clinical investigation for hand rehabilitation after stroke. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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13 pages, 2727 KiB

Open AccessArticle

A Novel Framework for Quantifying Accuracy and Precision of Event Detection Algorithms in FES-Cycling

by Ronan Le Guillou, Martin Schmoll, Benoît Sijobert, David Lobato Borges, Emerson Fachin-Martins, Henrique Resende, Roger Pissard-Gibollet, Charles Fattal and Christine Azevedo Coste

Sensors 2021, 21(13), 4571; https://doi.org/10.3390/s21134571 - 03 Jul 2021

Cited by 3 | Viewed by 2474

Abstract

Functional electrical stimulation (FES) is a technique used in rehabilitation, allowing the recreation or facilitation of a movement or function, by electrically inducing the activation of targeted muscles. FES during cycling often uses activation patterns which are based on the crank angle of the pedals. Dynamic changes in their underlying predefined geometrical models (e.g., change in seating position) can lead to desynchronised contractions. Adaptive algorithms with a real-time interpretation of anatomical segments can avoid this and open new possibilities for the automatic design of stimulation patterns. However, their ability to accurately and precisely detect stimulation triggering events has to be evaluated in order to ensure their adaptability to real-case applications in various conditions. In this study, three algorithms (Hilbert, BSgonio, and Gait Cycle Index (GCI) Observer) were evaluated on passive cycling inertial data of six participants with spinal cord injury (SCI). For standardised comparison, a linear phase reference baseline was used to define target events (i.e., 10%, 40%, 60%, and 90% of the cycle’s progress). Limits of agreement (LoA) of ±10% of the cycle’s duration and Lin’s concordance correlation coefficient (CCC) were used to evaluate the accuracy and precision of the algorithm’s event detections. The delays in the detection were determined for each algorithm over 780 events. Analysis showed that the Hilbert and BSgonio algorithms validated the selected criteria (LoA: +5.17/−6.34% and +2.25/−2.51%, respectively), while the GCI Observer did not (LoA: +8.59/−27.89%). When evaluating control algorithms, it is paramount to define appropriate criteria in the context of the targeted practical application. To this end, normalising delays in event detection to the cycle’s duration enables the use of a criterion that stays invariable to changes in cadence. Lin’s CCC, comparing both linear correlation and strength of agreement between methods, also provides a reliable way of confirming comparisons between new control methods and an existing reference. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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16 pages, 14502 KiB

Open AccessArticle

A Reversible Low Frequency Alternating Current Nerve Conduction Block Applied to Mammalian Autonomic Nerves

by M. Ivette Muzquiz, Landan Mintch, M. Ryne Horn, Awadh Alhawwash, Rizwan Bashirullah, Michael Carr, John H. Schild and Ken Yoshida

Sensors 2021, 21(13), 4521; https://doi.org/10.3390/s21134521 - 01 Jul 2021

Cited by 5 | Viewed by 3533

Abstract

Electrical stimulation can be used to modulate activity within the nervous system in one of two modes: (1) Activation, where activity is added to the neural signalling pathways, or (2) Block, where activity in the nerve is reduced or eliminated. In principle, electrical nerve conduction block has many attractive properties compared to pharmaceutical or surgical interventions. These include reversibility, localization, and tunability for nerve caliber and type. However, methods to effect electrical nerve block are relatively new. Some methods can have associated drawbacks, such as the need for large currents, the production of irreversible chemical byproducts, and onset responses. These can lead to irreversible nerve damage or undesirable neural responses. In the present study we describe a novel low frequency alternating current blocking waveform (LFACb) and measure its efficacy to reversibly block the bradycardic effect elicited by vagal stimulation in anaesthetised rat model. The waveform is a sinusoidal, zero mean(charge balanced), current waveform presented at 1 Hz to bipolar electrodes. Standard pulse stimulation was delivered through Pt-Black coated PtIr bipolar hook electrodes to evoke bradycardia. The conditioning LFAC waveform was presented either through a set of CorTec^® bipolar cuff electrodes with Amplicoat^® coated Pt contacts, or a second set of Pt Black coated PtIr hook electrodes. The conditioning electrodes were placed caudal to the pulse stimulation hook electrodes. Block of bradycardic effect was assessed by quantifying changes in heart rate during the stimulation stages of LFAC alone, LFAC-and-vagal, and vagal alone. The LFAC achieved

86.2 \pm 11.1 %

and

84.3 \pm 4.6 %

block using hook (N = 7) and cuff (N = 5) electrodes, respectively, at current levels less than 110 µA_p (current to peak). The potential across the LFAC delivering electrodes were continuously monitored to verify that the blocking effect was immediately reversed upon discontinuing the LFAC. Thus, LFACb produced a high degree of nerve block at current levels comparable to pulse stimulation amplitudes to activate nerves, resulting in a measurable functional change of a biomarker in the mammalian nervous system. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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15 pages, 785 KiB

Open AccessArticle

Evaluation of Individualized Functional Electrical Stimulation-Induced Acute Changes during Walking: A Case Series in Children with Cerebral Palsy

by Nicole Zahradka, Ahad Behboodi, Ashwini Sansare and Samuel C. K. Lee

Sensors 2021, 21(13), 4452; https://doi.org/10.3390/s21134452 - 29 Jun 2021

Cited by 5 | Viewed by 2636

Abstract

Functional electrical stimulation (FES) walking interventions have demonstrated improvements to gait parameters; however, studies were often confined to stimulation of one or two muscle groups. Increased options such as number of muscle groups targeted, timing of stimulation delivery, and level of stimulation are needed to address subject-specific gait deviations. We aimed to demonstrate the feasibility of using a FES system with increased stimulation options during walking in children with cerebral palsy (CP). Three physical therapists designed individualized stimulation programs for six children with CP to target participant-specific gait deviations. Stimulation settings (pulse duration and current) were tuned to each participant. Participants donned our custom FES system that utilized gait phase detection to control stimulation to lower extremity muscle groups and walked on a treadmill at a self-selected speed. Motion capture data were collected during walking with and without the individualized stimulation program. Eight gait metrics and associated timing were compared between walking conditions. The prescribed participant-specific stimulation programs induced significant change towards typical gait in at least one metric for each participant with one iteration of FES-walking. FES systems with increased stimulation options have the potential to allow the physical therapist to better target the individual’s gait deviations than a one size fits all device. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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Review

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13 pages, 2264 KiB

Open AccessReview

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

by Andreia S. P. Sousa, Juliana Moreira, Cláudia Silva, Inês Mesquita, Rui Macedo, Augusta Silva and Rubim Santos

Sensors 2022, 22(4), 1409; https://doi.org/10.3390/s22041409 - 12 Feb 2022

Cited by 15 | Viewed by 6224

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. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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Other

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9 pages, 1670 KiB

Open AccessCase Report

Neuromuscular Electrical Stimulation to Immobilized Lower Extremities Directly Following Orthopaedic Surgery in Three Children with Cerebral Palsy: A Case Series

by Kelly Greve and Caroline Colvin

Sensors 2021, 21(22), 7661; https://doi.org/10.3390/s21227661 - 18 Nov 2021

Cited by 1 | Viewed by 1785

Abstract

Cerebral palsy (CP) is a non-progressive, neurological disorder often resulting in secondary musculoskeletal impairments affecting alignment and function which can result in orthopaedic surgery. Neuromuscular electrical stimulation (NMES) is a modality that can be used for rehabilitation; however, NMES immediately following orthopaedic surgery in children with CP using surface electrodes has not been previously reported. The purpose of this case series is to describe the novel use of NMES in the acute rehabilitation phase directly after orthopaedic surgery. This case series included three children with spastic diplegia CP, Gross Motor Function Classification System level II who underwent Single Event Multi-Level orthopaedic Surgery. Each long leg cast contained window cast cut-outs to allow for surface electrode placement for daily NMES intervention to the quadriceps muscles while immobilized. Children were assessed pre- and post-operatively using the Functional Mobility Scale (FMS), Gross Motor Function Measure (GMFM-66), and 6-Minute Walk Test (6MWT). All children demonstrated no adverse effects using NMES intervention and had improvements in the 6MWT. Most children demonstrated gains in the FMS and GMFM-66. Use of NMES through window cast-cuts in a long leg cast is a novel practice approach for delivery of early rehabilitation following lower extremity orthopaedic surgery. Full article

(This article belongs to the Special Issue Advanced Sensors/Devices for Functional Electrical Stimulation Systems)

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