Rehabilitation with Functional Electrical Stimulation in Stroke Patients

Abstract

In recent years, our understanding of motor learning, neuroplasticity and functional recovery after the occurrence of brain lesion has grown significantly. New findings in basic neuroscience have provided an impetus for research in motor rehabilitation. Several prospective studies have shown that repeated motor practice and motor activity in a real world environment have a favorable effect on motor recovery in stroke patients. Electrical stimulation can be applied in a variety of ways to the hemiparetic upper extremity following a stroke. In particular, electromyography (EMG)- triggered electrical muscle stimulation improves the motor function of the hemiparetic arm and hand. Triggered electrical stimulation is reported to be more effective than non-triggered electrical stimulation in facilitating upper extremity motor recovery after stroke. EMG-controlled functional electrical stimulation (FES) induces greater muscle contraction by electrical stimulation that is in proportion to voluntary integrated EMG signals. EMG-controlled FES and motor point block for antagonist muscles have been applied as a new hybrid FES therapy in an outpatient rehabilitation clinic for patients with stroke with good result. Daily EMG-controlled FES home-program therapy with novel equipment has been shown to effectively improve wrist, finger extension, and shoulder flexion. Combined modulation of voluntary movement, proprioceptive sensory feedback, and electrical stimulation might play an important role in improving impaired sensory-motor integration by EMG-controlled FES therapy. A multi-channel near-infrared spectroscopy (NIRS) studies in which the hemoglobin levels in the brain were non-invasively and dynamically measured during functional activity found that the cerebral blood flow in the injured sensory-motor cortex area is greater during a EMG-controlled FES session than during simple active movement or simple electrical stimulation. Nevertheless, evidence-based strategies for FES rehabilitation are more and more available, particularly for patients suffering from hemiparesis.