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Abstract
This article reviews the most common therapeutic and neuroprosthetic applications of neuromuscular electrical stimulation (NMES) for upper and lower extremity stroke rehabilitation. Fundamental NMES principles and purposes in stroke rehabilitation are explained. NMES modalities used for upper and lower limb rehabilitation are described, and efficacy studies are summarized. The evidence for peripheral and central mechanisms of action is also summarized.
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Chae J, Yu DT. Neuromuscular Electrical Stimulation for Motor Restoration in Hemiparesis. Top Stroke Rehabil 2015; 8:24-39. [PMID: 14523728 DOI: 10.1310/rexb-akv9-2xbe-u5qa] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article assesses the clinical efficacy of established neuromuscular electrical stimulation (NMES) technologies for motor restoration in hemiparesis and provides an overview of evolving technologies. Transcutaneous NMES facilitates motor recovery. However, its impact on physical disability remains uncertain. Transcutaneous NMES also decreases shoulder subluxation, but its effect on shoulder pain remains uncertain. Clinically deployable upper extremity neuroprosthesis systems will not be available until sometime in the distant future. However, there is stronger evidence for the clinical utility of lower extremity neuroprosthesis systems. Evolving technology utilizes semi-implanted or fully implanted systems with more sophisticated control paradigms. Initial experiences with these systems are reviewed and directions for future research are discussed in this article.
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Affiliation(s)
- John Chae
- Physical Medicine and Rehabilitation and Biomedical Engineering, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
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Ferris DP, Lewis CL. Robotic lower limb exoskeletons using proportional myoelectric control. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2009:2119-24. [PMID: 19964579 DOI: 10.1109/iembs.2009.5333984] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Robotic lower limb exoskeletons have been built for augmenting human performance, assisting with disabilities, studying human physiology, and re-training motor deficiencies. At the University of Michigan Human Neuromechanics Laboratory, we have built pneumatically-powered lower limb exoskeletons for the last two purposes. Most of our prior research has focused on ankle joint exoskeletons because of the large contribution from plantar flexors to the mechanical work performed during gait. One way we control the exoskeletons is with proportional myoelectric control, effectively increasing the strength of the wearer with a physiological mode of control. Healthy human subjects quickly adapt to walking with the robotic ankle exoskeletons, reducing their overall energy expenditure. Individuals with incomplete spinal cord injury have demonstrated rapid modification of muscle recruitment patterns with practice walking with the ankle exoskeletons. Evidence suggests that proportional myoelectric control may have distinct advantages over other types of control for robotic exoskeletons in basic science and rehabilitation.
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Affiliation(s)
- Daniel P Ferris
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109-2013 USA.
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Mesci N, Ozdemir F, Kabayel DD, Tokuc B. The effects of neuromuscular electrical stimulation on clinical improvement in hemiplegic lower extremity rehabilitation in chronic stroke: A single-blind, randomised, controlled trial. Disabil Rehabil 2009; 31:2047-54. [DOI: 10.3109/09638280902893626] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chae J, Harley MY, Hisel TZ, Corrigan CM, Demchak JA, Wong YT, Fang ZP. Intramuscular Electrical Stimulation for Upper Limb Recovery in Chronic Hemiparesis: An Exploratory Randomized Clinical Trial. Neurorehabil Neural Repair 2009; 23:569-78. [DOI: 10.1177/1545968308328729] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Surface electrical stimulation (ES) has been shown to improve the motor impairment of stroke survivors. However, surface ES can be painful and motor activation can be inconsistent from session to session. Percutaneous intramuscular ES may be an effective alternative. Objective. Evaluate the effectiveness of percutaneous intramuscular ES in facilitating the recovery of the hemiparetic upper limb of chronic stroke survivors. Methods. A total of 26 chronic stroke survivors were randomly assigned to percutaneous intramuscular ES for hand opening (n = 13) or percutaneous ES for sensory stimulation only (n = 13). The intramuscular ES group received cyclic, electromyography (EMG)-triggered or EMG-controlled ES depending on baseline motor status. All participants received 1 hour of stimulation per day for 6 weeks. After completion of ES, participants received 18 hours of task-specific functional training. The primary outcome measure was the Fugl-Meyer Motor Assessment. Secondary measures included the Arm Motor Ability Test and delay and termination of EMG activity. Outcomes were assessed in a blinded manner at baseline, at the end of ES, at the end of functional training, and at 1, 3, and 6 months follow-up. Results. Repeated measure analysis of variance did not yield any significant treatment, or time by treatment interaction effects for any of the outcome measures. Conclusion. Percutaneous intramuscular ES does not appear to be any more effective than sensory ES in enhancing the recovery of the hemiparetic upper limb among chronic stroke survivors. However, because of the exploratory nature of the study and its inherent limitations, conclusions must be drawn with caution.
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Affiliation(s)
- John Chae
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio,
| | - Mary Y. Harley
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio
| | - Terri Z. Hisel
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio
| | - Catherine M. Corrigan
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio
| | - Jeffrey A. Demchak
- NeuroControl Corporation, North Ridgeville, Ohio, Life Line Screening, Cleveland, Ohio
| | - Yu-Tung Wong
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio
| | - Zi-Ping Fang
- NeuroControl Corporation, North Ridgeville, Ohio, Nevro Corporation, Palo Alto, California
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Shimada Y, Davis R, Matsunaga T, Misawa A, Aizawa T, Itoi E, Zilberman Y, Cosendai G, Ripley AM. Electrical Stimulation Using Implantable Radiofrequency Microstimulators to Relieve Pain Associated With Shoulder Subluxation in Chronic Hemiplegic Stroke. Neuromodulation 2006; 9:234-8. [DOI: 10.1111/j.1525-1403.2006.00065.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dipietro L, Ferraro M, Palazzolo JJ, Krebs HI, Volpe BT, Hogan N. Customized interactive robotic treatment for stroke: EMG-triggered therapy. IEEE Trans Neural Syst Rehabil Eng 2005; 13:325-34. [PMID: 16200756 PMCID: PMC2752646 DOI: 10.1109/tnsre.2005.850423] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A system for electromyographic (EMG) triggering of robot-assisted therapy (dubbed the EMG game) for stroke patients is presented. The onset of a patient's attempt to move is detected by monitoring EMG in selected muscles, whereupon the robot assists her or him to perform point-to-point movements in a horizontal plane. Besides delivering customized robot-assisted therapy, the system can record signals that may be useful to better understand the process of recovery from stroke. Preliminary experiments aimed at testing the proposed system and gaining insight into the potential of EMG-triggered, robot-assisted therapy are reported.
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Affiliation(s)
- Laura Dipietro
- Newman Laboratory for Biomechanics and Human Rehabilitation, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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Abstract
Neuromuscular electrical stimulation may have an important role in improving the motor function of stroke survivors. Active, repetitive movement training mediated by transcutaneous cyclic and EMG-triggered NMES may facilitate the motor recovery of stroke survivors. Multicenter, double-blinded, randomized clinical trials should be pursued to confirm the motor-relearning effects of transcutaneous NMES and to define appropriate prescriptive specifications. Intramuscular EMG-controlled NMES may be superior to transcutaneous systems and is presently undergoing preliminary randomized clinical trials. Neuroprostheses systems may provided the highest level of goal-oriented activity and cognitive investments, which may lead to significant motor relearning. Implementation of clinically viable neuroprosthesis systems, however, will probably require additional technical developments including more reliable control paradigms and methods for blocking undesirable muscle contractions. In view of the dynamic nature of the present health care environment, the future of NMES technology is difficult to predict. By necessity, scientists and clinicians must continue to explore new ideas and to improve on the present systems. Components will be smaller, more durable, and more reliable. Control issues will remain critical for both motor relearning and neuroprosthetic applications, and the implementation of cortical control is likely to dictate the nature of future generations of NMES systems. Finally, consumers will direct future developments. In the present health care environment, where cost has become an overwhelming factor in the development and implementation of new technology, the consumer will become one of technology's greatest advocates. The usual drive toward greater complexity will be tempered by the practical issues of clinical implementation, where patient acceptance is often a function of a tenuous balance between the burden or cost associated with using a system and the system's impact on the user's life.
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Affiliation(s)
- John Chae
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA.
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Chae J, Fang ZP, Walker M, Pourmehdi S. Intramuscular electromyographically controlled neuromuscular electrical stimulation for upper limb recovery in chronic hemiplegia. Am J Phys Med Rehabil 2001; 80:935-41. [PMID: 11821677 DOI: 10.1097/00002060-200112000-00011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report three cases of survivors of chronic stroke who were treated with active repetitive movement training of the paretic finger extensors mediated by intramuscular electromyographically controlled neuromuscular electrical stimulation for the purpose of motor relearning. These case reports demonstrate the feasibility of using intramuscular electromyographically controlled neuromuscular electrical stimulation for facilitating the upper limb motor recovery of chronic stroke survivors with mild to moderate hemiplegia.
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Affiliation(s)
- J Chae
- Center for Physical Medicine and Rehabilitation and Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44109, USA
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