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Chen S, Gao J, Zhou Y, Zheng B, Liu Y, Cao M, Huang H, Su X, Chen J. Implications of neuromuscular electrical stimulation on gait ability, balance and kinematic parameters after stroke: a systematic review and meta-analysis. J Neuroeng Rehabil 2024; 21:164. [PMID: 39294678 PMCID: PMC11409629 DOI: 10.1186/s12984-024-01462-2] [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: 06/19/2024] [Accepted: 09/06/2024] [Indexed: 09/21/2024] Open
Abstract
INTRODUCTIN Improper gait patterns, impaired balance and foot drop consistently plague stroke survivors, preventing them from walking independently and safely. Neuromuscular electrical stimulation (NMES) technology can help patients reactivate their muscles and regain motor coordination. This study aims to systematically review and summarize the evidence for the potential benefits of NMES on the improvement of gait patterns after stroke. EVIDENCE ACQUISITION PubMed, Cochrane Library, Embase, Science Direct and Web of Science were systematically searched until April 2024, to identify randomized controlled trials with the following criteria: stroke survivors as participants; NMES as intervention; conventional rehabilitation as a comparator; and gait assessment, through scales or quantitative parameters, as outcome measures. EVIDENCE SYNTHESIS 29 publications involving 1711 patients met the inclusion criteria. Meta-analysis showed no significant differences in Ten-meter walk test, Fugl-Meyer assessment lower extremity, Modified Ashworth Assessment and asymmetry between the NMES group and the control group. Besides, NMES was associated with changes in outcome indicators such as quantitative gait analysis speed [SMD = 0.53, 95% CI (0.20, 0.85), P = 0.001], cadence [SMD = 0.76, 95% CI (0.32, 1.20), P = 0.0008], affected side step length [SMD = 0.73, 95% CI (0.16, 1.31), P = 0.01], angle of ankle dorsiflexion [WMD = 1.57, 95% CI (0.80, 2.33), P < 0.0001], Six-Minute Walk Test [WMD = 14.83, 95% CI (13.55, 16.11), P<0.00001]. According to the PEDro scale, 21 (72.4%) studies were of high quality and 8 were of moderate quality (27.6%). CONCLUSIONS Taken together, the review synthesis indicated that NMES might play a potential role in stroke-induced walking dysfunction. And NMES may be superior for survivors in the chronic phase than the acute and subacute phases, and the efficacy of short sessions received by patients was greater than that of those who participated in a longer session. Additionally, further comparisons of the effects of NMES with different types or stimulation frequencies may provide unexpected benefits.
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Affiliation(s)
- Shishi Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Hangzhou, Zhejiang, China
| | - Jingjing Gao
- The Third Clinical Medical College, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Hangzhou, Zhejiang, China
| | - Ye Zhou
- Department of Rehabilitation Medicine (Second Division), People's Hospital of Integrative Medicine, Gongshu District, Hangzhou, Zhejiang, China
| | - Beisi Zheng
- The Third Clinical Medical College, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Hangzhou, Zhejiang, China
| | - Yuxiang Liu
- The Third Clinical Medical College, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
| | - Manting Cao
- The Third Clinical Medical College, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Hangzhou, Zhejiang, China
| | - Haiping Huang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Hangzhou, Zhejiang, China
| | - Xinyi Su
- The Third Clinical Medical College, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Hangzhou, Zhejiang, China
| | - Jianer Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China.
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Hangzhou, Zhejiang, China.
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Teodoro J, Fernandes S, Castro C, Fernandes JB. Current Trends in Gait Rehabilitation for Stroke Survivors: A Scoping Review of Randomized Controlled Trials. J Clin Med 2024; 13:1358. [PMID: 38592172 PMCID: PMC10932333 DOI: 10.3390/jcm13051358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Stroke stands as a significant global health concern, constituting a leading cause of disability worldwide. Rehabilitation interventions are crucial in aiding the recovery of stroke patients, contributing to an overall enhancement in their quality of life. This scoping review seeks to identify current trends in gait rehabilitation for stroke survivors. METHODS The review followed the methodological framework suggested by Arksey and O'Malley. Electronic databases, such as CINAHL Complete, MEDLINE Complete, and Nursing & Allied Health Collection, were systematically searched in November 2023. Inclusion criteria comprised papers published in either English or Portuguese from 2013 to 2023. RESULTS From the initial search, a total of 837 papers were identified; twenty-one papers were incorporated into this review. Thirteen distinct categories of gait rehabilitation interventions were identified, encompassing diverse approaches. These categories comprise conventional rehabilitation exercises, traditional gait training with integrated technology, and gait training supported by modern technologies. CONCLUSIONS Although traditional rehabilitation exercises have historically proven effective in aiding stroke survivors, a recent trend has emerged, emphasizing the development and integration of innovative therapeutic approaches that harness modern technologies.
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Affiliation(s)
- Joana Teodoro
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
- Nurs* Lab, 2829-511 Almada, Portugal; (S.F.); (C.C.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Sónia Fernandes
- Nurs* Lab, 2829-511 Almada, Portugal; (S.F.); (C.C.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Cidália Castro
- Nurs* Lab, 2829-511 Almada, Portugal; (S.F.); (C.C.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Júlio Belo Fernandes
- Nurs* Lab, 2829-511 Almada, Portugal; (S.F.); (C.C.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
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Hwang S, Song CS. Rehabilitative effects of electrical stimulation on gait performance in stroke patients: A systematic review with meta-analysis. NeuroRehabilitation 2024; 54:185-197. [PMID: 38306066 DOI: 10.3233/nre-230360] [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: 02/03/2024]
Abstract
BACKGROUND Electrical stimulation techniques are widely utilized for rehabilitation management in individuals with stroke patients. OBJECTIVES This review aims to summarize the rehabilitative effects of electrical stimulation therapy on gait performance in stroke patients. METHODS This review included randomized controlled trials (RCT) investigating the therapeutic effects of electrical stimulation in stroke patients throughout five databases. This review qualitatively synthesized 20 studies and quantitatively analyzed 11 RCTs. RESULTS Functional electrical stimulation (FES) was the most commonly used electrical stimulation type to improve postural stability and gait performance in stroke patients. The clinical measurement tools commonly used in the three studies to assess the therapeutic effects of FES were Berg balance scale (BBS), 10-meter walk test (10MWT), 6-minute walk test (6mWT), and gait velocity. The BBS score and gait velocity had positive effects in the FES group compared with the control group, but the 10MWT and 6mWT showed the same effects between the two groups. The heterogeneity of BBS scores was also high. CONCLUSION The results of this review suggest that electrical stimulation shows little evidence of postural stability and gait performance in stroke patients, although some electrical stimulations showed positive effects on postural stability and gait performance.
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Affiliation(s)
- Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, South Korea
- Graduate School of Health and Welfare, Baekseok University, Seoul, South Korea
| | - Chiang-Soon Song
- Department of Occupational Therapy, College of Natural Science and Public Health and Safety, Chosun University, Gwangju, South Korea
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Seok H, Choi YH. The Impact of Mental Practice on Motor Function in Patients With Stroke: A Systematic Review and Meta-analysis. BRAIN & NEUROREHABILITATION 2023; 16:e31. [PMID: 38047096 PMCID: PMC10689861 DOI: 10.12786/bn.2023.16.e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 12/05/2023] Open
Abstract
Mental practice (MP), the cognitive rehearsal of physical activities without overt movements, has recently emerged as a promising rehabilitation method for patients with stroke. This paper presents a systematic review and meta-analysis critically evaluating the existing evidence to offer a comprehensive estimate of the overall effect of MP on motor function in stroke patients. A systematic search of 3 international databases (PubMed, Embase, and the Cochrane Library) was conducted for randomized controlled trials. We finally selected 31 randomized clinical trials and conducted meta-analysis to determine the effectiveness of MP on motor recovery of upper extremity, upper extremity function, activities of daily living, and gait velocity in stroke patients. The results of the systematic reviews showed that MP combined with conventional therapy has a positive impact on improving upper extremity motor function, with a moderate quality of evidence. However, the beneficial effect of MP on gait velocity was not demonstrated. It is recommended to treat with MP in addition to conventional rehabilitation therapy to improve the motor outcome of stroke depending on the patient's condition (Recommendation level: Conditional Recommend Evidence certainty: Moderate).
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Affiliation(s)
- Hyun Seok
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Scano A, Mira RM, Gabbrielli G, Molteni F, Terekhov V. Whole-Body Adaptive Functional Electrical Stimulation Kinesitherapy Can Promote the Restoring of Physiological Muscle Synergies for Neurological Patients. SENSORS 2022; 22:s22041443. [PMID: 35214345 PMCID: PMC8877830 DOI: 10.3390/s22041443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 02/11/2022] [Indexed: 12/03/2022]
Abstract
Background: Neurological diseases and traumas are major factors that may reduce motor functionality. Functional electrical stimulation is a technique that helps regain motor function, assisting patients in daily life activities and in rehabilitation practices. In this study, we evaluated the efficacy of a treatment based on whole-body Adaptive Functional Electrical Stimulation Kinesitherapy (AFESK™) with the use of muscle synergies, a well-established method for evaluation of motor coordination. The evaluation is performed on retrospectively gathered data of neurological patients executing whole-body movements before and after AFESK-based treatments. Methods: Twenty-four chronic neurologic patients and 9 healthy subjects were recruited in this study. The patient group was further subdivided in 3 subgroups: hemiplegic, tetraplegic and paraplegic. All patients underwent two acquisition sessions: before treatment and after a FES based rehabilitation treatment at the VIKTOR Physio Lab. Patients followed whole-body exercise protocols tailored to their needs. The control group of healthy subjects performed all movements in a single session and provided reference data for evaluating patients’ performance. sEMG was recorded on relevant muscles and muscle synergies were extracted for each patient’s EMG data and then compared to the ones extracted from the healthy volunteers. To evaluate the effect of the treatment, the motricity index was measured and patients’ extracted synergies were compared to the control group before and after treatment. Results: After the treatment, patients’ motricity index increased for many of the screened body segments. Muscle synergies were more similar to those of healthy people. Globally, the normalized synergy similarity in respect to the control group was 0.50 before the treatment and 0.60 after (p < 0.001), with improvements for each subgroup of patients. Conclusions: AFESK treatment induced favorable changes in muscle activation patterns in chronic neurologic patients, partially restoring muscular patterns similar to healthy people. The evaluation of the synergic relationships of muscle activity when performing test exercises allows to assess the results of rehabilitation measures in patients with impaired locomotor functions.
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Affiliation(s)
- Alessandro Scano
- UOS STIIMA Lecco—Human-Centered, Smart & Safe, Living Environment, Italian National Research Council (CNR), Via Previati 1/E, 23900 Lecco, Italy;
- Correspondence: (A.S.); (V.T.)
| | - Robert Mihai Mira
- UOS STIIMA Lecco—Human-Centered, Smart & Safe, Living Environment, Italian National Research Council (CNR), Via Previati 1/E, 23900 Lecco, Italy;
| | | | - Franco Molteni
- Villa Beretta Rehabilitation Center, Ospedale Valduce, Via N. Sauro 17, 23845 Costa Masnaga, Italy;
| | - Viktor Terekhov
- VIKTOR S.r.l.—Via Pasubio, 5, 24044 Dalmine (BG), Italy;
- Correspondence: (A.S.); (V.T.)
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Malesevic J, Kostic M, Kojic V, Dordevic O, Konstantinovic L, Keller T, Strbac M. BEAGLE-A Kinematic Sensory System for Objective Hand Function Assessment in Technology-Mediated Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1817-1826. [PMID: 34460377 DOI: 10.1109/tnsre.2021.3108848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We present a hand functions assessment system (BEAGLE) for kinematic tracking of hand and finger movements, envisioned as a technology-mediated rehabilitation tool. The system is custom-designed for fast and easy placement on an impaired hand (spastic or flaccid), featuring inertial sensors integrated into simple finger caps and a hand strap. An algorithm for a range of motion (ROM) estimation was implemented to provide an objective assessment of hand functions. The efficacy and feasibility of the BEAGLE system were examined in a pilot clinical study performed with ten stroke survivors in the subacute phase. Participants received therapy within two consecutive intensity-matched rehabilitation cycles. The first consisted of conventional therapy, while the second involved a combination of conventional therapy and advanced functional electrical stimulation. Assessments were performed before and after each phase. These included BEAGLE estimates of active voluntary ROM for wrist and various digits, as well as two referent clinical measures for hand functions assessment, Fugl-Meyer and Action Research Arm Test. The results indicate that the ROM assessments can detect change with sensitivity comparable to the standardized clinical scales. Statistically significant changes between the beginning and the end of the second cycle existed in all observed measures, whereas none of these measurements showed a statistically significant improvement in the first therapy cycle. The noted usability metrics indicate that the BEAGLE could be integrated into the rehabilitation workflow in a clinical environment.
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Elsner VR, Trevizol L, de Leon I, da Silva M, Weiss T, Braga M, Pochmann D, Blembeel AS, Dani C, Boggio E. Therapeutic effectiveness of a single exercise session combined with WalkAide functional electrical stimulation in post-stroke patients: a crossover design study. Neural Regen Res 2021; 16:805-812. [PMID: 33229713 PMCID: PMC8178791 DOI: 10.4103/1673-5374.297078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A growing body of evidence has suggested that the imbalance of epigenetic markers and oxidative stress appears to be involved in the pathophysiology and progression of stroke. Thus, strategies that modulate these biomarkers might be considered targets for neuroprotection and novel therapeutic opportunities for these patients. Physical exercise has been reported to induce changes in these epigenetic markers and improve clinical outcomes in different populations. However, little is reported on this in post-stroke patients. The purpose of this study was to investigate the effect of a single exercise session with WalkAide functional electrical stimulation (FES) on cognitive performance, clinical functional parameters, oxidative stress and epigenetic modulation in post-stroke individuals. In this crossover design study, 12 post-stroke individuals aged 54–72 years of either sexes were included and subjected to a single session of exercise (45 minutes) without WalkAide functional electrical stimulation (EXE alone group), followed by another single session of exercise (45 minutes) with WalkAide functional electrical stimulation (EXE + FES group). The clinical functional outcome measures, cognitive performance and blood collections for biomarker measurements were assessed pre- and post-intervention. After intervention, higher Berg Balance Scale scores were obtained in the EXE + FES group than in the EXE alone group. There was no significant difference in the Timed Up and Go test results post-intervention between EXE alone and EXE + FES groups. After intervention, a better cognitive performance was found in both groups compared with before the intervention. After intervention, the Timed Up and Go test scores were higher in the EXE + FES group than in the EXE alone group. In addition, the intervention induced lower levels of lipid peroxidation. After intervention, carbonyl level was lower, superoxide dismutase activity and superoxide dismutase/catalase activity ratio were higher in the EXE + FES group, compared with the EXE group alone. In each group, both histone deacetylase (HDAC2) and histone acetyltransferase activities were increased after intervention compared with before the intervention. These findings suggest that a single exercise session with WalkAide FES is more effective on balance ability and cognitive performance compared with conventional exercise alone in post-stroke patients. This is likely to be related to the regulation of oxidative stress markers. The present study was approved by the Research Ethics Committee of the Methodist University Center-IPA (approval No. 2.423.376) on December 7, 2017 and registered in the Brazilian Registry of Clinical Trials—ReBEC (RBR-9phj2q) on February 11, 2019.
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Affiliation(s)
- Viviane Rostirola Elsner
- Curso de Fisioterapia do Centro Universitário Metodista-IPA; Programa de Pós-Graduação em Biociências e Reabilitação do Centro Universitário Metodista-IPA; Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Lucieli Trevizol
- Curso de Fisioterapia do Centro Universitário Metodista-IPA, Porto Alegre, RS, Brasil
| | - Isadora de Leon
- Curso de Fisioterapia do Centro Universitário Metodista-IPA, Porto Alegre, RS, Brasil
| | - Marcos da Silva
- Curso de Fisioterapia do Centro Universitário Metodista-IPA, Porto Alegre, RS, Brasil
| | - Thayná Weiss
- Curso de Fisioterapia do Centro Universitário Metodista-IPA, Porto Alegre, RS, Brasil
| | - Milena Braga
- Curso de Fisioterapia do Centro Universitário Metodista-IPA, Porto Alegre, RS, Brasil
| | - Daniela Pochmann
- Programa de Pós-Graduação em Biociências e Reabilitação do Centro Universitário Metodista-IPA, Porto Alegre, RS, Brasil
| | - Amanda Stolzenberg Blembeel
- Programa de Pós-Graduação em Biociências e Reabilitação do Centro Universitário Metodista-IPA, Porto Alegre, RS, Brasil
| | - Caroline Dani
- Programa de Pós-Graduação em Biociências e Reabilitação do Centro Universitário Metodista-IPA, Porto Alegre, RS, Brasil
| | - Elenice Boggio
- Programa de Pós-Graduação em Biociências e Reabilitação do Centro Universitário Metodista-IPA, Porto Alegre, RS, Brasil
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Silva S, Borges LR, Santiago L, Lucena L, Lindquist AR, Ribeiro T. Motor imagery for gait rehabilitation after stroke. Cochrane Database Syst Rev 2020; 9:CD013019. [PMID: 32970328 PMCID: PMC8094749 DOI: 10.1002/14651858.cd013019.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Motor imagery (MI) is defined as a mentally rehearsed task in which movement is imagined but is not performed. The approach includes repetitive imagined body movements or rehearsing imagined acts to improve motor performance. OBJECTIVES To assess the treatment effects of MI for enhancing ability to walk among people following stroke. SEARCH METHODS We searched the Cochrane Stroke Group registry, CENTRAL, MEDLINE, Embase and seven other databases. We also searched trial registries and reference lists. The last searches were conducted on 24 February 2020. SELECTION CRITERIA Randomized controlled trials (RCTs) using MI alone or associated with action observation or physical practice to improve gait in individuals after stroke. The critical outcome was the ability to walk, assessed using either a continuous variable (walking speed) or a dichotomous variable (dependence on personal assistance). Important outcomes included walking endurance, motor function, functional mobility, and adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected the trials according to pre-defined inclusion criteria, extracted the data, assessed the risk of bias, and applied the GRADE approach to evaluate the certainty of the evidence. The review authors contacted the study authors for clarification and missing data. MAIN RESULTS We included 21 studies, involving a total of 762 participants. Participants were in the acute, subacute, or chronic stages of stroke, and had a mean age ranging from 50 to 78 years. All participants presented at least some gait deficit. All studies compared MI training versus other therapies. Most of the included studies used MI associated with physical practice in the experimental groups. The treatment time for the experimental groups ranged from two to eight weeks. There was a high risk of bias for at least one assessed domain in 20 of the 21 included studies. Regarding our critical outcome, there was very low-certainty evidence that MI was more beneficial for improving gait (walking speed) compared to other therapies at the end of the treatment (pooled standardized mean difference (SMD) 0.44; 95% confidence interval (CI) 0.06 to 0.81; P = 0.02; six studies; 191 participants; I² = 38%). We did not include the outcome of dependence on personal assistance in the meta-analysis, because only one study provided information regarding the number of participants that became dependent or independent after interventions. For our important outcomes, there was very low-certainty evidence that MI was no more beneficial than other interventions for improving motor function (pooled mean difference (MD) 2.24, 95% CI -1.20 to 5.69; P = 0.20; three studies; 130 participants; I² = 87%) and functional mobility at the end of the treatment (pooled SMD 0.55, 95% CI -0.45 to 1.56; P = 0.09; four studies; 116 participants; I² = 64.2%). No adverse events were observed in those studies that reported this outcome (seven studies). We were unable to pool data regarding walking endurance and all other outcomes at follow-up. AUTHORS' CONCLUSIONS We found very low-certainty evidence regarding the short-term benefits of MI on walking speed in individuals who have had a stroke, compared to other therapies. Evidence was insufficient to estimate the effect of MI on the dependence on personal assistance and walking endurance. Compared with other therapies, the evidence indicates that MI does not improve motor function and functional mobility after stroke (very low-certainty evidence). Evidence was also insufficient to estimate the effect of MI on gait, motor function, and functional mobility after stroke compared to placebo or no intervention. Motor Imagery and other therapies used for gait rehabilitation after stroke do not appear to cause significant adverse events.
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Affiliation(s)
- Stephano Silva
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Lorenna Rdm Borges
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Lorenna Santiago
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Larissa Lucena
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ana R Lindquist
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Tatiana Ribeiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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Ekechukwu END, Olowoyo P, Nwankwo KO, Olaleye OA, Ogbodo VE, Hamzat TK, Owolabi MO. Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries-A Systematic Review. Front Neurol 2020; 11:337. [PMID: 32695058 PMCID: PMC7336355 DOI: 10.3389/fneur.2020.00337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.
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Affiliation(s)
- Echezona Nelson Dominic Ekechukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu, Nigeria
- LANCET Physiotherapy and Wellness and Research Centre, Enugu, Nigeria
| | - Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido Ekiti, Nigeria
- College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kingsley Obumneme Nwankwo
- Stroke Control Innovations Initiative of Nigeria, Abuja, Nigeria
- Fitness Global Consult Physiotherapy Clinic, Abuja, Nigeria
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Talhatu Kolapo Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Ojo Owolabi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
- Blossom Specialist Medical Centre, Ibadan, Nigeria
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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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Balance Training with Electromyogram-Triggered Functional Electrical Stimulation in the Rehabilitation of Stroke Patients. Brain Sci 2020; 10:brainsci10020080. [PMID: 32024262 PMCID: PMC7071601 DOI: 10.3390/brainsci10020080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
This study was conducted to investigate the effects of balance training with electromyogram-triggered functional electrical stimulation (EMG-triggered FES) to improve static balance, dynamic balance, and ankle muscle activation in stroke patients. Forty-nine participants (>6 months after stroke) were randomly assigned to the experimental group (n = 25) and the control group (n = 24). The experimental group underwent balance training with EMG-triggered FES for 40 min a day, 5 days a week, for a 6-week period in addition to general rehabilitation. The control group underwent balance training without EMG-triggered FES along with conventional therapy. Outcome measures included static balance ability, dynamic balance ability, and leg muscle activation. The static and dynamic balance abilities were significantly improved after intervention in both groups (p < 0.05), although the experimental group showed considerably greater improvement than the control group (p < 0.05). Leg muscle activation on the affected side resulted in significant improvements in the experimental group (p < 0.05) when compared with baseline but not in the control group. Balance training with EMG-triggered FES is an acceptable and effective intervention to improve the static balance, dynamic balance, and ankle muscle activation in stroke patients.
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Mendes LA, Lima INDF, Souza T, do Nascimento GC, Resqueti VR, Fregonezi GAF. Motor neuroprosthesis for promoting recovery of function after stroke. Cochrane Database Syst Rev 2020; 1:CD012991. [PMID: 31935047 PMCID: PMC6984639 DOI: 10.1002/14651858.cd012991.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Motor neuroprosthesis (MN) involves electrical stimulation of neural structures by miniaturized devices to allow the performance of tasks in the natural environment in which people live (home and community context), as an orthosis. In this way, daily use of these devices could act as an environmental facilitator for increasing the activities and participation of people with stroke. OBJECTIVES To assess the effects of MN for improving independence in activities of daily living (ADL), activities involving limbs, participation scales of health-related quality of life (HRQoL), exercise capacity, balance, and adverse events in people after stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (searched 19 August 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (August 2019), MEDLINE (1946 to 16 August 2019), Embase (1980 to 19 August 2019), and five additional databases. We also searched trial registries, databases, and websites to identify additional relevant published, unpublished, and ongoing trials. SELECTION CRITERIA Randomized controlled trials (RCTs) and randomized controlled cross-over trials comparing MN for improving activities and participation versus other assistive technology device or MN without electrical stimulus (stimulator is turned off), or no treatment, for people after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and assessed risk of bias of the included studies. Any disagreements were resolved through discussion with a third review author. We contacted trialists for additional information when necessary and performed all analyses using Review Manager 5. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included four RCTs involving a total of 831 participants who were more than three months poststroke. All RCTs were of MN that applied electrical stimuli to the peroneal nerve. All studies included conditioning protocols to adapt participants to MN use, after which participants used MN from up to eight hours per day to all-day use for ambulation in daily activities performed in the home or community context. All studies compared the use of MN versus another assistive device (ankle-foot orthosis [AFO]). There was a high risk of bias for at least one assessed domain in three of the four included studies. No studies reported outcomes related to independence in ADL. There was low-certainty evidence that AFO was more beneficial than MN on activities involving limbs such as walking speed until six months of device use (mean difference (MD) -0.05 m/s, 95% confidence interval (CI) -0.10 to -0.00; P = 0.03; 605 participants; 2 studies; I2 = 0%; low-certainty evidence); however, this difference was no longer present in our sensitivity analysis (MD -0.07 m/s, 95% CI -0.16 to 0.02; P = 0.13; 110 participants; 1 study; I2 = 0%). There was low to moderate certainty that MN was no more beneficial than AFO on activities involving limbs such as walking speed between 6 and 12 months of device use (MD 0.00 m/s, 95% CI -0.05 to 0.05; P = 0.93; 713 participants; 3 studies; I2 = 17%; low-certainty evidence), Timed Up and Go (MD 0.51 s, 95% CI -4.41 to 5.43; P = 0.84; 692 participants; 2 studies; I2 = 0%; moderate-certainty evidence), and modified Emory Functional Ambulation Profile (MD 14.77 s, 95% CI -12.52 to 42.06; P = 0.29; 605 participants; 2 studies; I2 = 0%; low-certainty evidence). There was no significant difference in walking speed when MN was delivered with surface or implantable electrodes (test for subgroup differences P = 0.09; I2 = 65.1%). For our secondary outcomes, there was very low to moderate certainty that MN was no more beneficial than another assistive device for participation scales of HRQoL (standardized mean difference 0.26, 95% CI -0.22 to 0.74; P = 0.28; 632 participants; 3 studies; I2 = 77%; very low-certainty evidence), exercise capacity (MD -9.03 m, 95% CI -26.87 to 8.81; P = 0.32; 692 participants; 2 studies; I2 = 0%; low-certainty evidence), and balance (MD -0.34, 95% CI -1.96 to 1.28; P = 0.68; 692 participants; 2 studies; I2 = 0%; moderate-certainty evidence). Although there was low- to moderate-certainty evidence that the use of MN did not increase the number of serious adverse events related to intervention (risk ratio (RR) 0.35, 95% CI 0.04 to 3.33; P = 0.36; 692 participants; 2 studies; I2 = 0%; low-certainty evidence) or number of falls (RR 1.20, 95% CI 0.92 to 1.55; P = 0.08; 802 participants; 3 studies; I2 = 33%; moderate-certainty evidence), there was low-certainty evidence that the use of MN in people after stroke may increase the risk of participants dropping out during the intervention (RR 1.48, 95% CI 1.11 to 1.97; P = 0.007; 829 participants; 4 studies; I2 = 0%). AUTHORS' CONCLUSIONS Current evidence indicates that MN is no more beneficial than another assistive technology device for improving activities involving limbs measured by Timed Up and Go, balance (moderate-certainty evidence), activities involving limbs measured by walking speed and modified Emory Functional Ambulation Profile, exercise capacity (low-certainty evidence), and participation scale of HRQoL (very low-certainty evidence). Evidence was insufficient to estimate the effect of MN on independence in ADL. In comparison to other assistive devices, MN does not appear to increase the number of falls (moderate-certainty evidence) or serious adverse events (low-certainty evidence), but may result in a higher number of dropouts during intervention period (low-certainty evidence).
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Affiliation(s)
- Luciana A Mendes
- Federal University of Rio Grande do NortePneumoCardioVascular Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH) & Department of Biomedical EngineeringNatalRio Grande do NorteBrazil59078‐970
| | - Illia NDF Lima
- Federal University of Rio Grande do NorteFaculty of Health Sciences of TrairiSanta CruzRio Grande do NorteBrazil59200‐000
| | - Tulio Souza
- Federal University of Rio Grande do NorteDepartment of Physical TherapyNatalBrazil59078‐970
| | - George C do Nascimento
- Federal University of Rio Grande do NorteDepartment of Biomedical EngineeringCaixa Postal 1524 ‐ Campus Universitário Lagoa NovaDepartamento de Engenharia BiomédicaNatalRio Grande do NorteBrazil59078‐970
| | - Vanessa R Resqueti
- Federal University of Rio Grande do NortePneumoCardioVascular Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH) & Department of Physical TherapyCampus Universitario Lagoa NovaCaixa Postal 1524NatalRio Grande do NorteBrazil59078‐970
| | - Guilherme AF Fregonezi
- Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH)PneumoCardioVascular LabNatalRio Grande do NorteBrazil59078‐970
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Silva S, Borges LRDM, Santiago L, Lucena L, Lindquist AR, Ribeiro T. Motor imagery for gait rehabilitation after stroke. Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd013019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Stephano Silva
- Federal University of Rio Grande do Norte; Department of Physical Therapy; Natal Rio Grande do Norte Brazil
| | - Lorenna RDM Borges
- Federal University of Rio Grande do Norte; Department of Physical Therapy; Natal Rio Grande do Norte Brazil
| | - Lorenna Santiago
- Federal University of Rio Grande do Norte; Department of Physical Therapy; Natal Rio Grande do Norte Brazil
| | - Larissa Lucena
- Federal University of Rio Grande do Norte; Department of Physical Therapy; Natal Rio Grande do Norte Brazil
| | - Ana R Lindquist
- Federal University of Rio Grande do Norte; Department of Physical Therapy; Natal Rio Grande do Norte Brazil
| | - Tatiana Ribeiro
- Federal University of Rio Grande do Norte; Department of Physical Therapy; Natal Rio Grande do Norte Brazil
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