Feasibility of Functional Electrical Stimulation-Assisted Neurorehabilitation following Stroke in India: A Case Series

Khattar, Bhawna; Banerjee, Alakananda; Dutta, Anirban

doi:10.1155/2012/830873

Cited by 11 publications

(7 citation statements)

References 37 publications

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“…Stroke is a leading cause of long-term disability. 1 Because improving walking ability has been found to be the best way to reduce dependency after stroke, [2][3][4] restoring gait function has become a critical goal of poststroke rehabilitation. 5 A common measure of gait function is walking speed, which has been shown to be correlated with community walking ability and quality of life.…”

Section: Introductionmentioning

confidence: 99%

Contribution of Paretic and Nonparetic Limb Peak Propulsive Forces to Changes in Walking Speed in Individuals Poststroke

Hsiao

Awad

Palmer

et al. 2016

Neurorehabil Neural Repair

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Background Recent rehabilitation efforts after stroke often focus on increasing walking speed because it is associated with quality of life. For individuals poststroke, propulsive force generated from the paretic limb has been shown to be correlated to walking speed. However, little is known about the relative contribution of the paretic versus the non-paretic propulsive forces to changes in walking speed. Objective The primary purpose of this study was to determine the contribution of propulsive force generated from each limb to changes in walking speed during speed modulation within a session and as a result of a 12-week training program. Methods Gait analysis was performed as participants (N=38) with chronic poststroke hemiparesis walked at their self-selected and faster walking speeds on a treadmill before and after a 12-week gait retraining program. Results Prior to training, stroke survivors increased non-paretic propulsive forces as the primary mechanism to change walking speed during speed modulation within a session. Following gait training, the paretic limb played a larger role during speed modulation within a session. In addition, the increases in paretic propulsive forces observed following gait training contributed to the increases in the self-selected walking speeds seen following training. Conclusions Gait retraining in the chronic phase of stroke recovery facilitates paretic limb neuromotor recovery and reduces the reliance on the non-paretic limb’s generation of propulsive force to increase walking speed. These findings support gait rehabilitation efforts directed toward improving the paretic limb’s ability to generate propulsive force.

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Section: Introductionmentioning

confidence: 99%

Contribution of Paretic and Nonparetic Limb Peak Propulsive Forces to Changes in Walking Speed in Individuals Poststroke

Hsiao

Awad

Palmer

et al. 2016

Neurorehabil Neural Repair

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“…Neurorehabilitation service delivery at homes and in the community settings can incorporate mobile-health based approaches to low-cost neurotechnologies that are tailored to an individual health condition as identified based on WHO International Classification of Functioning (ICF) [82]. Here, functional optimization of ctDCS will require a large patient outcome dataset possible using big data mobile-health (mHealth) approaches that also requires sustainable and multi-professional rehabilitation systems, including the provision of services to the rural population.…”

Section: Discussionmentioning

confidence: 99%

Deep Cerebellar Transcranial Direct Current Stimulation of the Dentate Nucleus to Facilitate Standing Balance in Chronic Stroke Survivors—A Pilot Study

et al. 2020

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Objective: Cerebrovascular accidents are the second leading cause of death and the third leading cause of disability worldwide. We hypothesized that cerebellar transcranial direct current stimulation (ctDCS) of the dentate nuclei and the lower-limb representations in the cerebellum can improve functional reach during standing balance in chronic (>6 months’ post-stroke) stroke survivors. Materials and Methods: Magnetic resonance imaging (MRI) based subject-specific electric field was computed across a convenience sample of 10 male chronic (>6 months) stroke survivors and one healthy MRI template to find an optimal bipolar bilateral ctDCS montage to target dentate nuclei and lower-limb representations (lobules VII–IX). Then, in a repeated-measure crossover study on a subset of 5 stroke survivors, we compared 15 min of 2 mA ctDCS based on the effects on successful functional reach (%) during standing balance task. Three-way ANOVA investigated the factors of interest– brain regions, montages, stroke participants, and their interactions. Results: “One-size-fits-all” bipolar ctDCS montage for the clinical study was found to be PO9h–PO10h for dentate nuclei and Exx7–Exx8 for lobules VII–IX with the contralesional anode. PO9h–PO10h ctDCS performed significantly (alpha = 0.05) better in facilitating successful functional reach (%) when compared to Exx7–Exx8 ctDCS. Furthermore, a linear relationship between successful functional reach (%) and electric field strength was found where PO9h–PO10h montage resulted in a significantly (alpha = 0.05) higher electric field strength when compared to Exx7–Exx8 montage for the same 2 mA current. Conclusion: We presented a rational neuroimaging based approach to optimize deep ctDCS of the dentate nuclei and lower limb representations in the cerebellum for post-stroke balance rehabilitation. However, this promising pilot study was limited by “one-size-fits-all” bipolar ctDCS montage as well as a small sample size.

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“…For example, smooth pursuit eye movement training 25 can be integrated with myoelectrically driven NMES/SES-assisted visuomotor task, as presented in Dutta et al 8 , where alpha event-related desynchronization at the parietal and occipital EEG electrodes may predict the normalized mean square error (MSE) in reaching the peripheral targets. Therefore, based on the evaluation of post-stroke pursuit eye movements as well as the gaze behavior during VBT task, we can objectively analyze and monitor eye-related problems contributing to balance disability thereby leveraging the residual function during rehabilitation 29 . Moreover, gaze behavior (e.g.…”

Section: Discussionmentioning

confidence: 99%

A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation

Kumar

Das²,

Lahiri

et al. 2016

JoVE

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A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to reorganize its structure, function and connections as a response to intrinsic or extrinsic stimuli is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. Beneficial neuroplastic changes may be facilitated with non-invasive electrotherapy, such as neuromuscular electrical stimulation (NMES) and sensory electrical stimulation (SES). NMES involves coordinated electrical stimulation of motor nerves and muscles to activate them with continuous short pulses of electrical current while SES involves stimulation of sensory nerves with electrical current resulting in sensations that vary from barely perceivable to highly unpleasant. Here, active cortical participation in rehabilitation procedures may be facilitated by driving the non-invasive electrotherapy with biosignals (electromyogram (EMG), electroencephalogram (EEG), electrooculogram (EOG)) that represent simultaneous active perception and volitional effort. To achieve this in a resource-poor setting, e.g., in low- and middle-income countries, we present a low-cost human-machine-interface (HMI) by leveraging recent advances in off-the-shelf video game sensor technology. In this paper, we discuss the open-source software interface that integrates low-cost off-the-shelf sensors for visual-auditory biofeedback with non-invasive electrotherapy to assist postural control during balance rehabilitation. We demonstrate the proof-of-concept on healthy volunteers.

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Feasibility of Functional Electrical Stimulation-Assisted Neurorehabilitation following Stroke in India: A Case Series

Cited by 11 publications

References 37 publications

Contribution of Paretic and Nonparetic Limb Peak Propulsive Forces to Changes in Walking Speed in Individuals Poststroke

Contribution of Paretic and Nonparetic Limb Peak Propulsive Forces to Changes in Walking Speed in Individuals Poststroke

Deep Cerebellar Transcranial Direct Current Stimulation of the Dentate Nucleus to Facilitate Standing Balance in Chronic Stroke Survivors—A Pilot Study

A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation

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