Activity-Based Electrical Stimulation Training in a Stroke Patient With Minimal Movement in the Paretic Upper Extremity

Page, Stephen J.; Maslyn, Samantha; Hermann, Valerie; Wu, Andy; Dunning, Kari; Levine, Peter

doi:10.1177/1545968308329922

Cited by 20 publications

(9 citation statements)

References 21 publications

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“…Furthermore, proprioceptive sensory feedback might play an important role in this kind of therapy. The results of the single-case study from Page et al (2009) supports these promising results. Moreover, another recent single-case study supports the benefit of a combination of FES and BCI (Daly et al, 2009).…”

Section: Motor Substitutionmentioning

confidence: 60%

Combining brain-computer interfaces and assistive technologies: state-of-the-art and challenges

et al. 2010

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In recent years, new research has brought the field of electroencephalogram (EEG)-based brain–computer interfacing (BCI) out of its infancy and into a phase of relative maturity through many demonstrated prototypes such as brain-controlled wheelchairs, keyboards, and computer games. With this proof-of-concept phase in the past, the time is now ripe to focus on the development of practical BCI technologies that can be brought out of the lab and into real-world applications. In particular, we focus on the prospect of improving the lives of countless disabled individuals through a combination of BCI technology with existing assistive technologies (AT). In pursuit of more practical BCIs for use outside of the lab, in this paper, we identify four application areas where disabled individuals could greatly benefit from advancements in BCI technology, namely, “Communication and Control”, “Motor Substitution”, “Entertainment”, and “Motor Recovery”. We review the current state of the art and possible future developments, while discussing the main research issues in these four areas. In particular, we expect the most progress in the development of technologies such as hybrid BCI architectures, user–machine adaptation algorithms, the exploitation of users’ mental states for BCI reliability and confidence measures, the incorporation of principles in human–computer interaction (HCI) to improve BCI usability, and the development of novel BCI technology including better EEG devices.

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Section: Motor Substitutionmentioning

confidence: 60%

Combining brain-computer interfaces and assistive technologies: state-of-the-art and challenges

et al. 2010

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“…Thus, we examined whether the addition of FES improved the quality and recovery of hand function during training. The Bioness H200 device was selected for this study, because it is designed for easy donning and doffing, making it suitable for participants to take home and use reliably on a daily basis 25-26. The rationale for combining FES, OnabotulinumtoxinA, and task practice was that boosting muscle contractile force with FES and relaxing spasticity with OnabotulinumtoxinA would improve motor performance during task practice training.…”

Section: Discussionmentioning

confidence: 99%

Cyclic Functional Electrical Stimulation Does Not Enhance Gains in Hand Grasp Function When Used as an Adjunct to OnabotulinumtoxinA and Task Practice Therapy: A Single-Blind, Randomized Controlled Pilot Study

Weber

Skidmore

Niyonkuru

et al. 2010

Archives of Physical Medicine and Rehabilitation

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Objective-To determine if OnabotulinumtoxinA injections and task practice training with or without functional electrical stimulation (FES) improves upper limb motor function in chronic spastic hemiparesis. Design-Randomized controlled trial. Setting-Outpatient spasticity clinic.Participants-Participants (N=23) had chronic spastic hemiparesis with moderate-severe hand impairment based on Chedoke-McMaster Assessment ≥ 2.Interventions-OnabotulinumtoxinA injections followed by 12-weeks of post-injection task practice. Participants randomly assigned to FES group were also fitted with an orthosis that provided functional electrical stimulation.Main Outcome Measures-Motor Activity Log (MAL)-Observation was the primary outcome. Secondary outcomes were Action Research Arm Test (ARAT) and MAL-Self-Report.Results-For the entire cohort, MAL-Observation mean item scores improved significantly from baseline to week-6 (p = 0.005), but did not remain significant at week-12. MAL-Self-Report mean item scores improved significantly (p = 0.009) from baseline to week-6 and remained significantly higher (p = 0.014) at week-12. ARAT total scores also improved significantly from baseline to week-6 (p = 0.018) and were sustained at week-12 (p = 0.032). However, there were no significant differences between the FES and No-FES groups for any outcome variable over time. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on ay organization with which the authors are associated. Conclusions-RehabilitationPublisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Stroke is the leading cause of disability in the United States, with an estimated 795,000 new or recurrent cases of stroke each year 1 . About 55% to 75% of stroke survivors sustain impaired upper extremity function, although with routine interventions, only about 12% of survivors recover fully within 6 months of injury 2, 3 . Unfortunately, the vast majority continue to experience upper extremity impairment 6 months post-stroke and beyond, with little or no prospect for additional motor improvement after that. NIH Public AccessTask-oriented practice is effective for promoting motor recovery after chronic stroke and traumatic brain injury 4,5 . In clinical practice, task-practice protocols involve the development of home exercise programs using 4 to 5 activities chosen by the therapist to match the patient's interests. However, the level and quality of participation in task practice activities may be limited for individuals with moderate to s...

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“…38 Based on these findings the authors suggest that the H200 could be used as a 'gateway' or 'bridge' to participation in therapy regimes that demand greater volitional activity than is available to the stroke survivor with severe paresis, in particular constraint induced movement therapy. 33,38,39 This indicates that neuroprostheses can be used to not only replace, but also retrain UL function.…”

Section: Neuroprosthesesmentioning

confidence: 96%

“…17,45 When considering stroke survivors with little or no volitional activity, a controlled study reported improvements in both impairment (spasticity, active ROM) and hand activity (BBT, JTHFT). 29 Similarly, in a number of single case studies of stroke survivors with no active extension of the wrist or fingers, reduced impairment (FMA), increased activity (ARAT, Arm Motor Ability Test) 31,39 and participation (Stroke Impact Scale and Motor Activity Log) 31 was demonstrated. More recently, it has been found that repetitive taskspecific training for 20 hours over 8 weeks can lead to an increase in cortical activation, which the authors believe was associated with an increased use of the arm.…”

Section: Neuroprosthesesmentioning

confidence: 96%

Advances in neuromuscular electrical stimulation for the upper limb post-stroke

Hayward

Barker

Brauer

2010

Physical Therapy Reviews

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Objectives: To review current and explore future applications of neuromuscular electrical stimulation (NMES) to restore or retrain upper limb (UL) recovery after stroke. Methods: Short summaries of NMES applications that have been investigated and a discussion of future research directions are presented. Results: Neuromuscular electrical stimulation applications that have been developed and investigated to restore or retrain UL recovery after stroke include: cyclic NMES; triggered NMES which includes electromyogram-triggered NMES (EMG-NMES), positional feedback NMES, contralateral-triggered NMES, outcome-triggered NMES and accelerometer-triggered NMES; iterative learning control mediated NMES; and neuroprostheses such as the Bioness H200. Overall, published studies of these applications indicate that NMES can improve UL function after stroke, with improvements at the impairment level more common than improvements at the activity level. While EMG-NMES has been researched most widely and has the highest level of evidence to support its use, newer applications (e.g. outcome-triggered NMES, accelerometer-triggered NMES) appear promising, on the basis that key requirements for motor learning are employed. Discussion: There are several areas for further research of NMES to achieve greater functional gains at the activity level than are currently achieved post-stroke. These include the use of NMES to retrain multijoint movements; and exploration of single-versus multichannel stimulation, cortical changes that occur after NMES, and NMES with other technologies. Use of NMES to restore or retrain UL function after stroke has come a long way and presents exciting challenges for research and clinicians in the future.

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Activity-Based Electrical Stimulation Training in a Stroke Patient With Minimal Movement in the Paretic Upper Extremity

Abstract: Although conventional paretic upper extremity training strategies are ineffective in patients at this level, electrical stimulation training incorporating a neuroprosthesis appears promising.

Cited by 20 publications

References 21 publications

Combining brain-computer interfaces and assistive technologies: state-of-the-art and challenges

Combining brain-computer interfaces and assistive technologies: state-of-the-art and challenges

Cyclic Functional Electrical Stimulation Does Not Enhance Gains in Hand Grasp Function When Used as an Adjunct to OnabotulinumtoxinA and Task Practice Therapy: A Single-Blind, Randomized Controlled Pilot Study

Advances in neuromuscular electrical stimulation for the upper limb post-stroke

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