Functional Electrical Stimulation Therapy for Retraining Reaching and Grasping After Spinal Cord Injury and Stroke

Abstract

Neurological conditions like hemiplegia following stroke or tetraplegia following spinal cord injury, result in a massive compromise in motor function. Each of the two conditions can leave individuals dependent on caregivers for the rest of their lives. Once medically stable, rehabilitation is the main stay of treatment. This article will address rehabilitation of upper extremity function. It is long known that moving the affected limb is crucial to recovery following any kind of injury. Overtime, it has also been established that just moving the affected extremities does not suffice, and that the movements have to involve patient's participation, be as close to physiologic movements as possible, and should ideally stimulate the entire neuromuscular circuitry involved in producing the desired movement. For over four decades now, functional electrical stimulation (FES) is being used to either replace or retrain function. The FES therapy discussed in this article has been used to retrain upper extremity function for over 15 years. Published data of pilot studies and randomized control trials show that FES therapy produces significant changes in arm and hand function. There are specific principles of the FES therapy as applied in our studies: (i) stimulation is applied using surface stimulation electrodes, (ii) there is minimum to virtually no pain during application, (iii) each session lasts no more than 45-60 min, (iv) the technology is quite robust and can make up for specificity to a certain extent, and (v) fine motor function like two finger precision grip can be trained (i.e., thumb and index finger tip to tip pinch). The FES therapy protocols can be successfully applied to individuals with paralysis resulting from stroke or spinal cord injury.

A Flexible Pulse Generator Based on a Field Programmable Gate Array Architecture for Functional Electrical Stimulation

“…In the future, the proposed FPGA-based architecture of the PG-nFES could be used to develop a flexible multichannel stimulation system, involving multiple target structures being stimulated in a coordinated manner, as required for noninvasive upper limb FES therapy (Kapadia et al, 2020). When combining such multichannel FES system with a properly designed rehabilitation intervention and clinical study, the potential of this sytem for motor neurorehabilitation could be assessed thoroughly.…”

Feasibility and significance of stimulating interscapular muscles using transcutaneous functional electrical stimulation in able-bodied individuals

“…Participants recruited to the study took part in a single two-hour session. The set-up for the experiment consisted in: (a) identifying motor points for all the muscle groups and securing FES surface self-adhesive electrodes;(b) determining the sensory, motor, functional and maximum electrical stimulation threshold for all muscles 22 ; and (c) placing reflective markers for collecting the kinematic data.…”

Multicentre, single-blind randomised controlled trial comparing MyndMove neuromodulation therapy with conventional therapy in traumatic spinal cord injury: a protocol study

“…The therapist then instructs the participant to voluntarily attempt the movement for about 10 s, after which electrical stimulation is provided with the appropriate MyndMove protocol. 39 †Muscles not listed in order of stimulation. ‡Unilateral or bilateral stimulation may be used.…”

“…The therapist then instructs the participant to voluntarily attempt the movement for about 10 s, after which electrical stimulation is provided with the appropriate MyndMove protocol. 39 …”