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

Abstract

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.

Dose and Content of Training Provided to Stroke Survivors with Severe Upper Limb Disability Undertaking Inpatient Rehabilitation: An Observational Study

“…Thus, there is a need to improve access to strategies that make activity-related practice possible for people with severe upper limb therapy. Currently such strategies may include robotic therapy, e.g., MIT-Manus, and non-robotic therapy, e.g., SMART Arm (Hayward et al, 2010b) and triggered methods of neuromuscular electrical stimulation (NMES), e.g., electromyogram-triggered, accelerometer-triggered (Hayward, Barker, & Brauer, 2010a).…”

Dose of arm activity training during acute and subacute rehabilitation post stroke: a systematic review of the literature

“…Modalities, such as functional electrical stimulation and robotic therapy, are gaining use in clinical practice as they make such training possible. 40,41…”

Neuromuscular electrical stimulation on upper limb function post-stroke

“…1 This could provide more information for clinicians regarding which stroke patients will benefit from NMES intervention or is suitable for which types of NMES. Some studies supported the treatment effect of NMES in the acute phase; however, few studies have applied NMES in patients with severe paresis.…”

“…Hayward et al's review paper 1 summarizes the current applications of neuromuscular electrical stimulation (NMES) and the treatment effects of different types of NMES in the impairment, activity, and participation domains of International Classification of Functioning, Disability and Health model for stroke patients. In addition, they suggested future research directions for NMES research.…”