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Hahn A, Moeller S, Schlausch A, Ekmann M, de Chelle G, Westerlund M, Braatz F, Mayr W. Effects of a full-body electrostimulation garment application in a cohort of subjects with cerebral palsy, multiple sclerosis, and stroke on upper motor neuron syndrome symptoms. BIOMED ENG-BIOMED TE 2024; 69:49-59. [PMID: 38354212 DOI: 10.1515/bmt-2023-0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/31/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Dysfunction of the central nervous system may inflict spastic movement disorder (SMD). Electrical stimuli were identified as promising therapeutic option. Electrical stimulation provided by a 58-electrode full body garment was investigated based on data from regular trial fittings. METHODS Data from 72 testees were investigated. Age averages 36.6 (19.8) ys with 44 females. The cohort spans infantile cerebral paresis (CP) (n=29), multiple sclerosis (MS) (n=23) and stroke (n=20). Data were stratified by etiology and an entry BBS Score<45. RESULTS Effect sizes (Cohen`s d) related BBS, TUG, FGA, 10mWT, WMFT, EQ5D5L and Pain. Significance levels are indicated by *: p<0.05, **: p<0.01, ***: p<0.001, (t): p<0.1: CP: 1.64***, 0.29*, 1.59***, 0.76(t), 1.00***, 0.5*, 1.28***; MS: 1.83***, 0.83***, 1.28**, 1.07***, 0.93*, 1,11**, 0.78*; Stroke: 1.28**, 0.78**, 0.89, 0.92**, 0.71, 1.26*, 0.78*. CONCLUSIONS Multi-site transcutaneous electrical stimulation may increase ambulation related skills in subjects with SMD stemming from CP, MS and stroke. The results indicate effects on static and dynamic balance, fall risk, mobility, upper extremity improvement and an overall increase in health utility and a reduction in spasticity related pain. Effects are immediate as well as sustained. These results may inspire individual trial fittings and inform further controlled trials.
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Affiliation(s)
- Andreas Hahn
- Ottobock Healthcare Products GmbH, Vienna, Austria
| | - Susan Moeller
- Academy, Otto Bock HealthCare Deutschland GmbH, Duderstadt, Germany
| | - Arne Schlausch
- Clinical Research & Services Otto Bock HealthCare Deutschland GmbH, Duderstadt, Germany
| | - Matilda Ekmann
- Clinical Research, Exoneural Network AB, Danderyd, Sweden
| | | | | | - Frank Braatz
- Private Hochschule Göttingen, Göttingen, Germany
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Perpetuini D, Russo EF, Cardone D, Palmieri R, De Giacomo A, Intiso D, Pellicano F, Pellegrino R, Merla A, Calabrò RS, Filoni S. Assessing the Impact of Electrosuit Therapy on Cerebral Palsy: A Study on the Users' Satisfaction and Potential Efficacy. Brain Sci 2023; 13:1491. [PMID: 37891858 PMCID: PMC10605024 DOI: 10.3390/brainsci13101491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
The aim of this study is to evaluate the effectiveness of electrosuit therapy in the clinical treatment of children with Cerebral Palsy, focusing on the effect of the therapy on spasticity and trunk control. Moreover, the compliance of caregivers with respect to the use of the tool was investigated. During the period ranging from 2019 to 2022, a total of 26 children (18 M and 8 F), clinically stable and affected by CP and attending the Neurorehabilitation Unit of the "Padre Pio Foundation and Rehabilitation Centers", were enrolled in this study. A subset of 12 patients bought or rented the device; thus, they received the administration of the EMS-based therapy for one month, whereas the others received only one-hour training to evaluate the feasibility (by the caregivers) and short-term effects. The Gross Motor Function Classification System was utilized to evaluate gross motor functions and to classify the study sample, while the MAS and the LSS were employed to assess the outcomes of the EMS-based therapy. Moreover, between 80% and 90% of the study sample were satisfied with the safety, ease of use, comfort, adjustment, and after-sales service. Following a single session of electrical stimulation with EMS, patients exhibited a statistically significant enhancement in trunk control. For those who continued this study, the subscale of the QUEST with the best score was adaptability (0.74 ± 0.85), followed by competence (0.67 ± 0.70) and self-esteem (0.59 ± 0.60). This study investigates the impact of the employment of the EMS on CP children's ability to maintain trunk control. Specifically, after undergoing a single EMS session, LSS showed a discernible improvement in children's trunk control. In addition, the QUEST and the PIADS questionnaires demonstrated a good acceptability and satisfaction of the garment by the patients and the caregivers.
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Affiliation(s)
- David Perpetuini
- Department of Engineering and Geology, University G. D’Annunzio of Chieti-Pescara, 65127 Pescara, Italy; (D.P.); (D.C.); (A.M.)
| | - Emanuele Francesco Russo
- Padre Pio Foundation and Rehabilitation Centers, 71013 San Giovanni Rotondo, Italy; (E.F.R.); (F.P.)
| | - Daniela Cardone
- Department of Engineering and Geology, University G. D’Annunzio of Chieti-Pescara, 65127 Pescara, Italy; (D.P.); (D.C.); (A.M.)
| | - Roberta Palmieri
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy; (R.P.); (A.D.G.)
| | - Andrea De Giacomo
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy; (R.P.); (A.D.G.)
| | - Domenico Intiso
- Unit of Neuro-Rehabilitation, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (D.I.); (S.F.)
| | - Federica Pellicano
- Padre Pio Foundation and Rehabilitation Centers, 71013 San Giovanni Rotondo, Italy; (E.F.R.); (F.P.)
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland;
| | - Arcangelo Merla
- Department of Engineering and Geology, University G. D’Annunzio of Chieti-Pescara, 65127 Pescara, Italy; (D.P.); (D.C.); (A.M.)
| | | | - Serena Filoni
- Unit of Neuro-Rehabilitation, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (D.I.); (S.F.)
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Perpetuini D, Russo EF, Cardone D, Palmieri R, De Giacomo A, Pellegrino R, Merla A, Calabrò RS, Filoni S. Use and Effectiveness of Electrosuit in Neurological Disorders: A Systematic Review with Clinical Implications. Bioengineering (Basel) 2023; 10:680. [PMID: 37370612 DOI: 10.3390/bioengineering10060680] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Electrical stimulation through surface electrodes is a non-invasive therapeutic technique used to improve voluntary motor control and reduce pain and spasticity in patients with central nervous system injuries. The Exopulse Mollii Suit (EMS) is a non-invasive full-body suit with integrated electrodes designed for self-administered electrical stimulation to reduce spasticity and promote flexibility. The EMS has been evaluated in several clinical trials with positive findings, indicating its potential in rehabilitation. This review investigates the effectiveness of the EMS for rehabilitation and its acceptability by patients. The literature was collected through several databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Positive effects of the garment on improving motor functions and reducing spasticity have been shown to be related to the duration of the administration period and to the dosage of the treatment, which, in turn, depend on the individual's condition and the treatment goals. Moreover, patients reported wellbeing during stimulation and a muscle-relaxing effect on the affected limb. Although additional research is required to determine the efficacy of this device, the reviewed literature highlights the EMS potential to improve the motor capabilities of neurological patients in clinical practice.
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Affiliation(s)
- David Perpetuini
- Department of Engineering and Geology, University G. D'Annunzio of Chieti-Pescara, 65127 Pescara, Italy
| | | | - Daniela Cardone
- Department of Engineering and Geology, University G. D'Annunzio of Chieti-Pescara, 65127 Pescara, Italy
| | - Roberta Palmieri
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Andrea De Giacomo
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland
| | - Arcangelo Merla
- Department of Engineering and Geology, University G. D'Annunzio of Chieti-Pescara, 65127 Pescara, Italy
| | | | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Centers, 71013 San Giovanni Rotondo, Italy
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Wagner V, Knudsen MS, Curtis DJ, Riberholt CG. Use of the EXOPULSE Mollii for severe ataxia in an adult male 4 months after cardiac arrest. BMJ Case Rep 2023; 16:e249574. [PMID: 36963762 PMCID: PMC10040057 DOI: 10.1136/bcr-2022-249574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
The EXOPULSE Mollii is designed to reduce spasticity through low-current electrical stimulation of major muscle groups. The effect on severe cerebellar ataxia has not been investigated. This case describes the use of the EXOPULSE Mollii in an adult male with severe cerebellar ataxia 4 months after cardiac arrest and ischaemic stroke. The patient used the suit in 15 of 19 possible sessions (78.9%). He improved in the sit-to-stand test, arm function test and 10 m walking test. He described improved visual focus, ability to speak and swallow. Improvements were maintained for 1 week after the last session. The EXOPULSE Mollii is relevant to consider in the early stages of inpatient rehabilitation for patients with severe ataxia, but further research is warranted.
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Affiliation(s)
- Vibeke Wagner
- Department of Neurorehabilitation TBI Unit, Rigshospitalet, Hvidovre, Denmark
| | | | - Derek John Curtis
- Child and Youth Administration, City of Copenhagen, Copenhagen, Denmark
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Rubio-Zarapuz A, Apolo-Arenas MD, Clemente-Suárez VJ, Costa AR, Pardo-Caballero D, Parraca JA. Acute Effects of a Session with The EXOPULSE Mollii Suit in a Fibromyalgia Patient: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2209. [PMID: 36767576 PMCID: PMC9915440 DOI: 10.3390/ijerph20032209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain and associated fatigue, sleep disturbances, and other cognitive and somatic symptoms. A multidisciplinary approach including pharmacological therapies along with behavioral therapy, exercise, patient education, and pain management is a possible solution for the treatment of this disease. The EXOPULSE Mollii® method (EXONEURAL NETWORK AB, Danderyd, Sweden) is an innovative approach for non-invasive and self-administered electrical stimulation with multiple electrodes incorporated in a full-body suit, with already proven benefits for other diseases. Therefore, the present case report study aims to evaluate the effects that a 60 min session with the EXOPULSE Mollii suit has on a female fibromyalgia patient. After the intervention, we can conclude that a 60 min session with the EXOPULSE Mollii suit has beneficial effects on pain perception, muscle oxygenation, parasympathetic modulation, and function in a female fibromyalgia patient.
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Affiliation(s)
- Alejandro Rubio-Zarapuz
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain
| | - María Dolores Apolo-Arenas
- Facultad de Medicina y Ciencias de la Salud, Research Group FhysioH, Universidad de Extremadura, 06006 Badajoz, Spain
| | | | - Ana Rodrigues Costa
- Departamento de Ciências Médicas e da Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
| | - David Pardo-Caballero
- AlgeaSalud, Clinica Neurorrehabilitación Deportiva, Avenida de Elvas, 06006 Badajoz, Spain
| | - Jose A. Parraca
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7004-516 Évora, Portugal
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Electro-suit treatment of children with unilateral cerebral palsy alters nonlinear dynamics of walking. Clin Biomech (Bristol, Avon) 2022; 98:105714. [PMID: 35839741 DOI: 10.1016/j.clinbiomech.2022.105714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cerebral palsy (CP) is characterized by spasticity and muscle contracture development and associated with mild to severe motor impairments including reduced gait function. Treatment with the Exopulse® suit has been shown to reduce spasticity of the affected muscles and constitutes a non-invasive alternative to pharmaceutical agents and surgical denervation. The present study investigated the effect of systematic treatment with the Exopulse® suit on the nonlinear dynamics and variability of trunk accelerations during walking in children with unilateral CP. METHODS Twelve patients (mean age: 12 years, range 7-17 years) with unilateral CP (GMFCS level 1 and 2) received 24 weeks Exopulse® suit treatment with patient-specific muscle stimulation. Before and after the treatment, the patients completed 4 min treadmill walking while trunk accelerometry was obtained. The nonlinear dynamics was quantified by the largest Lyapunov exponent and the complexity index from the multiscale entropy and movement variability was quantified by the root mean square ratio. Pre- vs post-treatment differences were evaluated by a paired Student's t-test. FINDINGS The largest Lyapunov exponent (p-value = 0.041) and the complexity index (p-value = 0.030) of the acceleration in the anterior-posterior direction was significantly lower post-treatment. No other between-trial differences were observed. INTERPRETATION The present study suggests that 24 weeks of Exopulse® suit treatment alters the nonlinear dynamics but not the variability of the trunk accelerations during walking in children with unilateral CP. The temporal structure of the trunk acceleration in the anterior-posterior direction was altered towards that of healthy individuals.
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Jonasson LL, Sörbo A, Ertzgaard P, Sandsjö L. Patients' experiences of self-administered electrotherapy for spasticity in stroke and cerebral palsy: A qualitative study. J Rehabil Med 2021; 54:jrm00263. [PMID: 34935050 PMCID: PMC8892303 DOI: 10.2340/jrm.v53.1131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore patients' experiences of a self-administered electrotherapy treatment for muscle spasticity in cerebral palsy and stroke; the Exopulse Mollii Suit®. DESIGN Qualitative design with an inductive approach Subjects: Fifteen patients with spasticity due to stroke or cerebral palsy, participating in a previous randomized controlled trial (RCT) evaluating the treatment concept. Methods: Information letters were sent to all potential participants (n = 27) in the previous study. Semi-structured interviews (21-57 min) were carried out with all subjects who volunteered (n = 15), administered by an experienced interviewer who was not involved in the previous study. Transcribed interviews were subject to content analysis. Results: The 5 categories that emerged from the content analysis were "New method gives hope", experiences related to "Using the assistive technology", "Outcome from training with the assistive technology", "The assistive technology" and "Taking part in the study". Respondents felt hopeful when included in the previous study, motivated when experiencing a treatment effect, and disappointed when not. Conclusion: The qualitative approach used in this study elicited complementary information that was not evident from the previous RCT. This included statements regarding increased mobility, reduced spasticity, reduced use of medication, and problems related to using the treatment concept.
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Affiliation(s)
- Lise-Lotte Jonasson
- Department of Nursing, School of Health and Welfare, Jönköping University, Sweden.
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