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Sousa ASP, Moreira J, Silva C, Mesquita I, Macedo R, Silva A, Santos R. Usability of Functional Electrical Stimulation in Upper Limb Rehabilitation in Post-Stroke Patients: A Narrative Review. SENSORS 2022; 22:s22041409. [PMID: 35214311 PMCID: PMC8963083 DOI: 10.3390/s22041409] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022]
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.
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Affiliation(s)
- Andreia S. P. Sousa
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (J.M.); (C.S.); (R.M.); (A.S.)
- Correspondence: or ; Tel.: +351-222-061-000
| | - Juliana Moreira
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (J.M.); (C.S.); (R.M.); (A.S.)
| | - Cláudia Silva
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (J.M.); (C.S.); (R.M.); (A.S.)
| | - Inês Mesquita
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Functional Sciences, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal;
| | - Rui Macedo
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (J.M.); (C.S.); (R.M.); (A.S.)
| | - Augusta Silva
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (J.M.); (C.S.); (R.M.); (A.S.)
| | - Rubim Santos
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physics, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal;
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El-Shamy SM, El Kafy EMA. Effect of functional electrical stimulation on postural control in children with hemiplegic cerebral palsy: a randomized controlled trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Children with cerebral palsy have impairments of postural control during static and dynamic activities. Improving postural control is one of the primary objectives of rehabilitation for children with cerebral palsy. Therefore, the objective of this study was to study the effect of functional electric stimulation on postural control in children with hemiplegic cerebral palsy. A randomized controlled study was conducted on 30 children with hemiplegic cerebral palsy (18 boys and 12 girls) between the ages of 8 and 12 years. The children were distributed in two equal groups. The experimental group received functional electrical stimulation (pulse width 300 μs, frequency 33 Hz, 2 h/day, 3 days/week, / 3 consecutive months) in addition to the traditional physical therapy program. While the control group received the traditional physiotherapy program only for the same duration. The outcomes included postural stability indices that were measured at baseline and following 3 months of intervention using the Biodex balance system.
Results
A significant improvement was found in the postural stability indices of children in both groups, comparing their mean values before and after treatment. Furthermore, the results revealed a greater improvement in the postural stability of the experimental group (P < 0.001).
Conclusion
Functional electrical stimulation may be a useful tool to enhance the postural stability of children with hemiplegic cerebral palsy.
Clinical trial registration
This study was registered in the ClinicalTrial.gov PRS (NCT04269798). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009LHP&selectaction=Edit&uid=U0003GAI&ts=4&cx=74k74l
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Ramstrand N, Stevens PM. Clinical outcome measures to evaluate the effects of orthotic management post-stroke: a systematic review. Disabil Rehabil 2021; 44:3019-3038. [PMID: 33438496 DOI: 10.1080/09638288.2020.1859630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify, and classify, according to International Classification of Functioning, Disability and Health (ICF), clinically applicable outcome measures that have been used to evaluate lower limb orthotic management post-stroke and to investigate which outcome measures recorded the largest effect sizes. MATERIALS AND METHODS Electronic searches were performed in Pubmed, Cochrane, Web of Science, Cinahl, Scopus and Embase databases from inception to May 2020. Articles were included if they investigated clinical outcomes in people post-stroke who had received a lower-limb orthotic intervention. RESULTS 88 articles underwent full-text review and 54 were included in the review, which was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. 48 different outcome measures were identified; effect sizes were able to be calculated from 39 studies. The most frequently applied outcome measures were the 10-metre Walk Test and the timed-up-and-go test. Outcome measures that recorded large effect sizes in two or more studies were the 10-metre Walk Test, Functional Reach Test, and Physiological Cost Index. When coded according to the ICF, the most frequently represented codes were d450 (Walking) and d455 (moving around). CONCLUSIONS Results suggest that outcome measures related to mobility (ICF chapter d4) are most often applied to evaluate orthotic management post-stroke. Effect sizes appear to be greatest in outcome measures related to velocity, balance, and energy expenditure.IMPLICATIONS FOR REHABILITATIONThe 10-meter Walk Test appears to have the greatest effect size when evaluating orthotic management post-stroke.While outcome measures related to mobility are commonly applied when evaluating orthotic management post-stroke, rehabilitation professionals should consider complementing these with measures representing the participation domain of the ICF.
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Affiliation(s)
- Nerrolyn Ramstrand
- CHILD Research Group, Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Phillip M Stevens
- Department of Clinical and Scientific Affairs, Hanger Clinic, Salt Lake City, UT, USA.,Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA
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Reeves ML, Chotiyarnwong C, Nair KPS, Slovak M, Healey TJ, McCarthy AD, Patterson L, Lavender K, Strachan L, Ali AN, Baster K. Caregiver Delivered Sensory Electrical Stimulation for Post Stroke Upper Limb Spasticity: A Single Blind Crossover Randomized Feasibility Study. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00436-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractWe developed a 64 channel sensory electrical stimulator which delivers a dynamic and variable ‘Sensory Barrage’ Stimulation (SBS). Our aim was to assess the feasibility of caregivers delivering the stimulation in the community for a clinical trial comparing single channel Transcutaneous Electrical Nerve Stimulation (TENS) with SBS for post stroke upper limb spasticity. We trained caregivers of 16 participants with post stroke upper limb spasticity to sequentially administer SBS and TENS for 60 min daily for four weeks each, with a washout period of two weeks in between. Outcome measures tested were recruitment and retention rates, compliance with interventions and daily recording of Participant -reported Numerical Rating Scale (NRS). We also collected results of Action Research Arm Test (ARAT), Leeds Arm Spasticity Impact Scale (LASIS) and Modified Ashworth Scale (MAS) for spasticity. Out of 21 potential participants, 16 consented and 15 completed the protocol. Ten participants received TENS for 80% (23/28) of the intended hours. Eleven participants completed NRS for at 80% (45/56) of the study days. All participants attended all visits. The MAS reduced by at least one in five participants after SBS and in three after TENS. Minimal Clinically Important Difference (MCID) of four points increase in ARAT was seen in five participants following TENS, and in four following SBS. A MCID of 18% decrease in NRS was reported by eight participants after TENS and three after SBS. This study demonstrated the feasibility of undertaking a trial of sensory electrical stimulation for post-stroke spasticity with caregivers delivering intervention in community. The study was not powered to detect efficacy of the interventions. Trial registration number: NCT02907775.Date 20-9-2016.
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Gil-Castillo J, Alnajjar F, Koutsou A, Torricelli D, Moreno JC. Advances in neuroprosthetic management of foot drop: a review. J Neuroeng Rehabil 2020; 17:46. [PMID: 32213196 PMCID: PMC7093967 DOI: 10.1186/s12984-020-00668-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
This paper reviews the technological advances and clinical results obtained in the neuroprosthetic management of foot drop. Functional electrical stimulation has been widely applied owing to its corrective abilities in patients suffering from a stroke, multiple sclerosis, or spinal cord injury among other pathologies. This review aims at identifying the progress made in this area over the last two decades, addressing two main questions: What is the status of neuroprosthetic technology in terms of architecture, sensorization, and control algorithms?. What is the current evidence on its functional and clinical efficacy? The results reveal the importance of systems capable of self-adjustment and the need for closed-loop control systems to adequately modulate assistance in individual conditions. Other advanced strategies, such as combining variable and constant frequency pulses, could also play an important role in reducing fatigue and obtaining better therapeutic results. The field not only would benefit from a deeper understanding of the kinematic, kinetic and neuromuscular implications and effects of more promising assistance strategies, but also there is a clear lack of long-term clinical studies addressing the therapeutic potential of these systems. This review paper provides an overview of current system design and control architectures choices with regard to their clinical effectiveness. Shortcomings and recommendations for future directions are identified.
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Affiliation(s)
- Javier Gil-Castillo
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Fady Alnajjar
- College of Information Technology (CIT), The United Arab Emirates University, P.O. Box 15551, Al Ain, UAE.
| | - Aikaterini Koutsou
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
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Taylor MJ, Schils S, Ruys AJ. Home FES: An Exploratory Review. Eur J Transl Myol 2019; 29:8285. [PMID: 31969976 PMCID: PMC6974778 DOI: 10.4081/ejtm.2019.8285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/31/2019] [Indexed: 12/28/2022] Open
Abstract
This review of literature focuses on the multiple uses of Functional Electrical Stimulation (FES) and how this modality may be a valuable home-based therapy. Papers pertaining to home FES exercise were collected using the Web of Science, Google Scholar databases and collegial hints. In our opinion, the following statements summarize the results. FES may be used to induce health benefits in populations with paralysis, and in persons with musculoskeletal, cardiorespiratory and renal pathology. The EU Project Rise showed how FES could have a variety of encouraging outcomes for patients with denervated muscles following traumatic injuries. As suggested by recent literature, FES has proven to be a viable form of exercise for elderly individuals. Thus, Home FES may be an option for patients looking for an additional form of muscle and cardiopulmonary physical therapy.
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Affiliation(s)
- Matthew J. Taylor
- Faculty of Engineering and IT, The University of Sydney, Camperdown, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
- Discipline of Anatomy and Histology, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Sheila Schils
- EquiNew, River Falls, Wisconsin, United States of America
| | - Andrew J. Ruys
- Faculty of Engineering and IT, The University of Sydney, Camperdown, Australia
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Imatz-Ojanguren E, Sánchez-Márquez G, Asiain-Aristu JR, Cueto-Mendo J, Jaunarena-Goicoechea E, Zabaleta H, Keller T. A foot drop compensation device based on surface multi-field functional electrical stimulation-Usability study in a clinical environment. J Rehabil Assist Technol Eng 2019; 6:2055668319862141. [PMID: 31516730 PMCID: PMC6724492 DOI: 10.1177/2055668319862141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 05/31/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Functional electrical stimulation applies electrical pulses to the peripheral nerves to artificially achieve a sensory/motor function. When applied for the compensation of foot drop it provides both assistive and therapeutic effects. Multi-field electrodes have shown great potential but may increase the complexity of these systems. Usability aspects should be checked to ensure their success in clinical environments. Methods We developed the Fesia Walk device, based on a surface multi-field electrode and an automatic calibration algorithm, and carried out a usability study to check the feasibility of integrating this device in therapeutic programs in clinical environments. The study included 4 therapists and 10 acquired brain injury subjects (8 stroke and 2 traumatic brain injury). Results Therapists and users were “very satisfied” with the device according to the Quebec User Evaluation of Satisfaction with Assistive Technology scale, with average scores of 4.1 and 4.2 out of 5, respectively. Therapists considered the Fesia Walk device as “excellent” according to the System Usability Scale with an average score of 85.6 out of 100. Conclusions This study showed us that it is feasible to include surface multi-field technology while keeping a device simple and intuitive for successful integration in common neurorehabilitation programs.
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Affiliation(s)
| | | | | | | | | | | | - Thierry Keller
- TECNALIA, Health Division, Donostia-San Sebastián, Spain
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Ten Haken I, Ben Allouch S, van Harten WH. The use of advanced medical technologies at home: a systematic review of the literature. BMC Public Health 2018; 18:284. [PMID: 29482550 PMCID: PMC6389044 DOI: 10.1186/s12889-018-5123-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/26/2018] [Indexed: 11/30/2022] Open
Abstract
Background The number of medical technologies used in home settings has increased substantially over the last 10–15 years. In order to manage their use and to guarantee quality and safety, data on usage trends and practical experiences are important. This paper presents a literature review on types, trends and experiences with the use of advanced medical technologies at home. Methods The study focused on advanced medical technologies that are part of the technical nursing process and ‘hands on’ processes by nurses, excluding information technology such as domotica. The systematic review of literature was performed by searching the databases MEDLINE, Scopus and Cinahl. We included papers from 2000 to 2015 and selected articles containing empirical material. Results The review identified 87 relevant articles, 62% was published in the period 2011–2015. Of the included studies, 45% considered devices for respiratory support, 39% devices for dialysis and 29% devices for oxygen therapy. Most research has been conducted on the topic ‘user experiences’ (36%), mainly regarding patients or informal caregivers. Results show that nurses have a key role in supporting patients and family caregivers in the process of homecare with advanced medical technologies and in providing information for, and as a member of multi-disciplinary teams. However, relatively low numbers of articles were found studying nurses perspective. Conclusions Research on medical technologies used at home has increased considerably until 2015. Much is already known on topics, such as user experiences; safety, risks, incidents and complications; and design and technological development. We also identified a lack of research exploring the views of nurses with regard to medical technologies for homecare, such as user experiences of nurses with different technologies, training, instruction and education of nurses and human factors by nurses in risk management and patient safety.
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Affiliation(s)
- Ingrid Ten Haken
- Saxion University of Applied Sciences, Research Group Technology, Health & Care (TH&C), P.O. Box 70.000, 7500, KB, Enschede, The Netherlands.
| | - Somaya Ben Allouch
- Saxion University of Applied Sciences, Research Group Technology, Health & Care (TH&C), P.O. Box 70.000, 7500, KB, Enschede, The Netherlands
| | - Wim H van Harten
- Department Health Technology & Services Research (HTSR), University of Twente, Faculty Behavioural, Management and Social Sciences (BMS), Ravelijn 5246, P.O. Box 217, 7500, AE, Enschede, The Netherlands.,Rijnstate General Hospital, Arnhem, The Netherlands
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Malešević J, Dedijer Dujović S, Savić AM, Konstantinović L, Vidaković A, Bijelić G, Malešević N, Keller T. A decision support system for electrode shaping in multi-pad FES foot drop correction. J Neuroeng Rehabil 2017; 14:66. [PMID: 28673311 PMCID: PMC5496361 DOI: 10.1186/s12984-017-0275-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional electrical stimulation (FES) can be applied as an assistive and therapeutic aid in the rehabilitation of foot drop. Transcutaneous multi-pad electrodes can increase the selectivity of stimulation; however, shaping the stimulation electrode becomes increasingly complex with an increasing number of possible stimulation sites. We described and tested a novel decision support system (DSS) to facilitate the process of multi-pad stimulation electrode shaping. The DSS is part of a system for drop foot treatment that comprises a custom-designed multi-pad electrode, an electrical stimulator, and an inertial measurement unit. METHODS The system was tested in ten stroke survivors (3-96 months post stroke) with foot drop over 20 daily sessions. The DSS output suggested stimulation pads and parameters based on muscle twitch responses to short stimulus trains. The DSS ranked combinations of pads and current amplitudes based on a novel measurement of the quality of the induced movement and classified them based on the movement direction (dorsiflexion, plantar flexion, eversion and inversion) of the paretic foot. The efficacy of the DSS in providing satisfactory pad-current amplitude choices for shaping the stimulation electrode was evaluated by trained clinicians. The range of paretic foot motion was used as a quality indicator for the chosen patterns. RESULTS The results suggest that the DSS output was highly effective in creating optimized FES patterns. The position and number of pads included showed pronounced inter-patient and inter-session variability; however, zones for inducing dorsiflexion and plantar flexion within the multi-pad electrode were clearly separated. The range of motion achieved with FES was significantly greater than the corresponding active range of motion (p < 0.05) during the first three weeks of therapy. CONCLUSIONS The proposed DSS in combination with a custom multi-pad electrode design covering the branches of peroneal and tibial nerves proved to be an effective tool for producing both the dorsiflexion and plantar flexion of a paretic foot. The results support the use of multi-pad electrode technology in combination with automatic electrode shaping algorithms for the rehabilitation of foot drop. TRIAL REGISTRATION This study was registered at the Current Controlled Trials website with ClinicalTrials.gov ID NCT02729636 on March 29, 2016.
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Affiliation(s)
- Jovana Malešević
- Tecnalia Serbia Ltd., Belgrade, Serbia. .,University of Belgrade, Belgrade, Serbia.
| | - Suzana Dedijer Dujović
- University of Belgrade, Belgrade, Serbia.,Clinic for Rehabilitation "Dr Miroslav Zotović", Belgrade, Serbia
| | - Andrej M Savić
- Tecnalia Serbia Ltd., Belgrade, Serbia.,University of Belgrade, School of Electrical Engineering, Belgrade, Serbia
| | - Ljubica Konstantinović
- Clinic for Rehabilitation "Dr Miroslav Zotović", Belgrade, Serbia.,University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Aleksandra Vidaković
- Clinic for Rehabilitation "Dr Miroslav Zotović", Belgrade, Serbia.,University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Goran Bijelić
- Tecnalia Research & Innovation - Health Division, Donostia-San Sebastián, Spain
| | - Nebojša Malešević
- University of Belgrade, School of Electrical Engineering, Belgrade, Serbia.,Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Thierry Keller
- Tecnalia Research & Innovation - Health Division, Donostia-San Sebastián, Spain
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Mufti T, Slovak M, Barker AT, Farrow TF. 24-channel transcutaneous electrical sensory stimulation of the forearm: Effects on cognitive performance and autonomic arousal compared with single-electrode stimulation. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1149992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Tabitha Mufti
- SCANLab (Sheffield Cognition and Neuroimaging Laboratory), Academic Clinical Psychiatry, University of Sheffield, Sheffield, UK
| | - Martin Slovak
- Department of Medical Physics and Clinical Engineering, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anthony T. Barker
- Department of Medical Physics and Clinical Engineering, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Tom F.D. Farrow
- Academic Clinical Neurology, University of Sheffield, Rm. N129, N-Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
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A review of the design and clinical evaluation of the ShefStim array-based functional electrical stimulation system. Med Eng Phys 2016; 38:1159-1165. [PMID: 27639656 DOI: 10.1016/j.medengphy.2016.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/15/2016] [Accepted: 08/13/2016] [Indexed: 11/22/2022]
Abstract
Functional electrical stimulation has been shown to be a safe and effective means of correcting foot drop of central neurological origin. Current surface-based devices typically consist of a single channel stimulator, a sensor for determining gait phase and a cuff, within which is housed the anode and cathode. The cuff-mounted electrode design reduces the likelihood of large errors in electrode placement, but the user is still fully responsible for selecting the correct stimulation level each time the system is donned. Researchers have investigated different approaches to automating aspects of setup and/or use, including recent promising work based on iterative learning techniques. This paper reports on the design and clinical evaluation of an electrode array-based FES system for the correction of drop foot, ShefStim. The paper reviews the design process from proof of concept lab-based study, through modelling of the array geometry and interface layer to array search algorithm development. Finally, the paper summarises two clinical studies involving patients with drop foot. The results suggest that the ShefStim system with automated setup produces results which are comparable with clinician setup of conventional systems. Further, the final study demonstrated that patients can use the system without clinical supervision. When used unsupervised, setup time was 14min (9min for automated search plus 5min for donning the equipment), although this figure could be reduced significantly with relatively minor changes to the design.
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Pečlin P, Rozman J, Krajnik J, Ribarič S. Evaluation of the Efficacy and Robustness of a Second Generation Implantable Stimulator in a Patient With Hemiplegia During 20 Years of Functional Electrical Stimulation of the Common Peroneal Nerve. Artif Organs 2016; 40:1085-1091. [DOI: 10.1111/aor.12693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Polona Pečlin
- ITIS d.o.o. Ljubljana, Centre for Implantable Technology and Sensors; University of Ljubljana; Ljubljana Republic of Slovenia
| | - Janez Rozman
- ITIS d.o.o. Ljubljana, Centre for Implantable Technology and Sensors; University of Ljubljana; Ljubljana Republic of Slovenia
| | - Janez Krajnik
- University Rehabilitation Institute, University of Ljubljana; Ljubljana Republic of Slovenia
| | - Samo Ribarič
- Institute of Pathophysiology; Faculty of Medicine; University of Ljubljana; Ljubljana Republic of Slovenia
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Park HJ, Durand DM. Motion control of the rabbit ankle joint with a flat interface nerve electrode. Muscle Nerve 2015; 52:1088-95. [PMID: 25786911 DOI: 10.1002/mus.24654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/02/2015] [Accepted: 03/06/2015] [Indexed: 11/08/2022]
Abstract
INTRODUCTION A flat interface nerve electrode (FINE) has been shown to improve fascicular and subfascicular selectivity. A recently developed novel control algorithm for FINE was applied to motion control of the rabbit ankle. METHODS A 14-contact FINE was placed on the rabbit sciatic nerve (n = 8), and ankle joint motion was controlled for sinusoidal trajectories and filtered random trajectories. To this end, a real-time controller was implemented with a multiple-channel current stimulus isolator. RESULTS The performance test results showed good tracking performance of rabbit ankle joint motion for filtered random trajectories and sinusoidal trajectories (0.5 Hz and 1.0 Hz) with <10% average root-mean-square (RMS) tracking error, whereas the average range of ankle joint motion was between -20.0 ± 9.3° and 18.1 ± 8.8°. CONCLUSIONS The proposed control algorithm enables the use of a multiple-contact nerve electrode for motion trajectory tracking control of musculoskeletal systems.
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Affiliation(s)
- Hyun-Joo Park
- Neural Engineering Center, Department of Biomedical Engineering, Case Western Reserve University, Wickenden 112, Cleveland, Ohio, 44106, USA
| | - Dominique M Durand
- Neural Engineering Center, Department of Biomedical Engineering, Case Western Reserve University, Wickenden 112, Cleveland, Ohio, 44106, USA
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