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Forest plots for upper extremity Fugl-Meyer assessment scores in the electrical stimulation and placebo groups at follow-up (at least one month later).

Forest plots for upper extremity Fugl-Meyer assessment scores in the electrical stimulation and placebo groups at follow-up (at least one month later).

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Objective: The aim of this study is to investigate the effectiveness of electrical stimulation in arm function recovery after stroke. Methods: Data were obtained from the PubMed, Cochrane Library, Embase, and Scopus databases from their inception until 12 January 2019. Only randomized controlled trials (RCTs) reporting the effects of electrical...

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... < 0.00001; I 2 = 19%; Figure 2) and at follow-up (12 randomized controlled trials (n = 391): standard mean differences = 0.66, 95% CI = 0.35-0.97; P < 0.0001; I 2 = 52%; Figure 3). Except the study by Sonde et al., 30 which has the follow-up period up to three years, all the other studies have the follow-period between one month and six months. ...

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... Neuromuscular electrical stimulation (NMES) is one of the most common strategies for improving limb function in the clinical setting. Studies have shown that NMES can improve muscle strength, reduce spasticity, increase joint range of motion by promoting active movement, reorganize the damaged cortico-cerebral circuit, and improve movement control [7][8][9][10]. However, during the NMES process, the hemiplegic limb is passively moved, and bilateral limbs exhibit no movement to work together, which greatly reduces the effect of the patient's rehabilitation training. ...
Article
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The electromyography bridge (EMGB) plays an important role in promoting the recovery of wrist joint function in stroke patients. We investigated the effects of the EMGB on promoting the recovery of upper limb function in hemiplegia. Twenty-four stroke patients with wrist dorsal extension dysfunction were recruited. Participants were randomized to undergo EMGB treatment or neuromuscular electrical stimulation (NMES). Treatments to wrist extensors were conducted for 25 min, twice a day, 5 days per week, for 1 month. Outcome measures: active range of motion (AROM) of wrist dorsal extension; Fugl-Meyer assessment for upper extremity (FMA-UE); Barthel index (BI); and muscle strength of wrist extensors. After interventions, patients in the NMES group had significantly greater improvement in the AROM of wrist dorsal extension at the 4th week and 1st month follow-up (p < 0.05). However, patients in the EMGB group had a statistically significant increase in AROM only at the follow-up assessment. No significant differences were observed in the AROM between the EMGB group and the NMES group (p>0.05). For secondary outcomes in the EMGB group, compared to baseline measurements, FMA-UE, BI, extensor carpi radialis and extensor carpi ulnaris muscle strength were significantly different as early as the 4th week (p < 0.05). The muscle strength of the extensor digitorum communis muscle showed significant differences at the follow-up (p < 0.05). There were no statistically significant differences between patients in the two groups in any of the parameters evaluated (p > 0.05). The combination of EMGB or NMES with conventional treatment had similar effects on the improvement of the hemiplegic upper limb as assessed by wrist dorsal extension, FMA-UE, and activities of daily living. The improvement in both groups was maintained until 1 month after the intervention.
... Therapeutic radiation CIED should be evaluated prior to radiation and a patient-specific treatment plan (including radiation dose estimation or measurement) should be outlined by CIED specialists and radiation oncologists prior to initiation of treatment CIED interrogation and ECG monitoring should be performed according to risk stratification during radiation therapy and after completion of the last fraction of treatment CIED-trained personnel readily available or on call is encouraged during radiation fractions for all CIED patients Relocation of a CIED for radiotherapy is not indicated, unless the device interferes with adequate tumour treatment Transcutaneous electrical nerve stimulation, electrical muscle stimulation, spinal cord stimulation Incidence and risk factors Electrical stimulation therapy (EST) such as transcutaneous electrical nerve stimulation (TENS), electrical muscle stimulation (EMS), or spinal cord stimulation (SCS) have been used for decades for the treatment of various pain conditions and other neuromuscular disorders including stroke, spinal cord injury, and refractory angina pectoris. [89][90][91][92][93][94] In TENS and EMS, different modalities of electrical current are applied using temporarily attached stimulation patches, whereas SCS requires surgical implantation of stimulation electrodes. In general, asymmetric biphasic impulses are delivered continuously with a frequency of 2-80 Hz. ...
... At present, western medicine has no specific and systematic treatment method for ULPSS. It mainly conducts rehabilitation training, such as physical therapy, drug therapy, botulinum toxin A (BoNT-A), and external mechanical adjuvant therapy (12)(13)(14). However, each traditional treatment method has its limitations. ...
Article
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Background Upper limb spasticity (ULS) is a common complication after stroke, which seriously affects the quality of life and rehabilitation of patients. There are different treatment methods for post-stroke spasticity (PSS). Our group found that functional acupuncture (FA) can effectively improve forearm spasticity and hand dysfunction after stroke, but the efficacy of ULS needs to be further verified. Therefore, this subject has mainly used clinical randomized controlled trials to evaluate the clinical efficacy of FA in the treatment of ULS after ischemic stroke. Method This is a parallel design and randomized controlled trial. We selected 108 patients who met the predefined criteria and randomized them into two groups, the experimental group and the control group. The experimental group receives FA and routine rehabilitation treatment. The control group received traditional acupuncture (TA) and routine rehabilitation treatment. All patients received 20 courses of treatment for 4 weeks, and the modified Ashworth score (MAS), clinical neurological deficit score (CSS), Fugl-Meyer upper extremity function assessment (FMA-UE), and the Modified Barthel Index (MBI) scores were evaluated before and after treatment. Discussion This trial is mainly to study the clinical efficacy of FA in the treatment of ULS after ischemic stroke. It will not only provide a new idea for the clinical treatment of upper limb post-stroke spasticity (ULPSS) but also will provide effective experimental support and a theoretical basis for the clinic. Trial registration China Clinical Trials Registry No. ChiCTR2100050440. Registered on 27 August 27 2021.
... Taking the large variety of clinical application areas of sEMG, more knowledge is needed to better understand the benefits, possibilities, and potential clinical effects of the different types of sEMG interventions on motor recovery after stroke (Campanini et al., 2020;Mcmanus et al., 2020). Previous reviews and metaanalyses have exclusively been dedicated to one specific type of sEMG intervention (Schleenbaker and Mainous, 1993;Bolton et al., 2004;Woodford and Price, 2007;Meilink et al., 2008;Norouzi-Gheidari et al., 2012;Basteris et al., 2014;Mehrholz et al., 2015;Eraifej et al., 2017;Takeda et al., 2017;Monte-Silva et al., 2019;Yang et al., 2019;Hameed et al., 2020), and summarized knowledge on the effect of different types of sEMGdriven interventions on upper limb function in stroke is limited. Thus, the aim of this systematic review and meta-analysis is to synthesize existing evidence on the effect of different sEMGdriven interventions on upper limb impairment in people with stroke and identify which type of sEMG intervention could be beneficial for this purpose. ...
... Final search: 1 AND 2 AND 3 AND 4 AND 5 CVA, cerebrovascular accident; EMG, Electromyography. -Gheidari et al., 2012;Basteris et al., 2014;Mehrholz et al., 2015;Eraifej et al., 2017;Takeda et al., 2017;Monte-Silva et al., 2019;Yang et al., 2019;Hameed et al., 2020;Doumas et al., 2021). ...
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Background: Upper limb impairment is common after stroke, and many will not regain full upper limb function. Different technologies based on surface electromyography (sEMG) have been used in stroke rehabilitation, but there is no collated evidence on the different sEMG-driven interventions and their effect on upper limb function in people with stroke. Aim: Synthesize existing evidence and perform a meta-analysis on the effect of different types of sEMG-driven interventions on upper limb function in people with stroke. Methods: PubMed, SCOPUS, and PEDro databases were systematically searched for eligible randomized clinical trials that utilize sEMG-driven interventions to improve upper limb function assessed by Fugl-Meyer Assessment (FMA-UE) in stroke. The PEDro scale was used to evaluate the methodological quality and the risk of bias of the included studies. In addition, a meta-analysis utilizing a random effect model was performed for studies comparing sEMG interventions to non-sEMG interventions and for studies comparing different sEMG interventions protocols. Results: Twenty-four studies comprising 808 participants were included in this review. The methodological quality was good to fair. The meta-analysis showed no differences in the total effect, assessed by total FMA-UE score, comparing sEMG interventions to non-sEMG interventions (14 studies, 509 participants, SMD 0.14, P 0.37, 95% CI -0.18 to 0.46, I2 55%). Similarly, no difference in the overall effect was found for the meta-analysis comparing different types of sEMG interventions (7 studies, 213 participants, SMD 0.42, P 0.23, 95% CI -0.34 to 1.18, I2 73%). Twenty out of the twenty-four studies, including participants with varying impairment levels at all stages of stroke recovery, reported statistically significant improvements in upper limb function at post-sEMG intervention compared to baseline. Conclusion: This review and meta-analysis could not discern the effect of sEMG in comparison to a non-sEMG intervention or the most effective type of sEMG intervention for improving upper limb function in stroke populations. Current evidence suggests that sEMG is a promising tool to further improve functional recovery, but randomized clinical trials with larger sample sizes are needed to verify whether the effect on upper extremity function of a specific sEMG intervention is superior compared to other non-sEMG or other type of sEMG interventions.
... In recent years, electrical stimulation (ES) of an upper extremity is demonstrated to be a promising intervention to improve arm and hand function in neurorehabilitation [5,6]. Data have been published on the effects of both cyclical and electromyography (EMG)-triggered single-channel ES [6][7][8]. ...
... In recent years, electrical stimulation (ES) of an upper extremity is demonstrated to be a promising intervention to improve arm and hand function in neurorehabilitation [5,6]. Data have been published on the effects of both cyclical and electromyography (EMG)-triggered single-channel ES [6][7][8]. The research exhibits the positive effects of Functional Electrical Stimulation (FES) to improve the ability to perform activities [6,8]. ...
... Data have been published on the effects of both cyclical and electromyography (EMG)-triggered single-channel ES [6][7][8]. The research exhibits the positive effects of Functional Electrical Stimulation (FES) to improve the ability to perform activities [6,8]. ...
Article
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This preliminary randomized clinical trial explores the efficacy of task-oriented electromyography (EMG)-triggered multichannel functional electrical stimulation (EMG-MES) compared to single-channel cyclic neuromuscular electrical stimulation (cNMES) on regaining control of voluntary movements (CVM) and the ability to execute arm-hand-activities in subacute stroke patients with moderate arm paresis. Twelve ischemic stroke patients (Fugl-Meyer Assessment Arm Section (FMA-AS) score: 19–47) with comparable demographics were block-randomized to receive 15 sessions of cNMES or EMG-MES over three weeks additionally to a conventional neurorehabilitation program including task-oriented arm training. FMA-AS, Box-and-Block Test (BBT), and Stroke-Impact-Scale (SIS) were recorded at baseline and follow-up. All participants demonstrated significant improvement in FMA-AS and BBT. Participants treated with EMG-MES had a higher mean gain in FMA-AS than those treated with cNMES. In the SIS daily activities domain, both groups improved non-significantly; participants in the EMG-MES group had higher improvement in arm-hand use and stroke recovery. EMG-MES treatment demonstrated a higher gain of CVM and self-reported daily activities, arm-hand use, and stroke recovery compared to cNMES treatment of the wrist only. The protocol of this proof-of-concept study seems robust enough to be used in a larger trial to confirm these preliminary findings.
... The efficacy of PES in the recovery of paralyzed muscles has long been reported and has been suggested by recent meta-analyses. [12][13][14][15][16] The putative mechanisms have been reported to include GABAergic interneurons at the level of the cerebral cortex, alteration of spinal excitability, antidromic activation of motor and Renshaw neurons, promotion of synapse formation, and release of neurotransmitters that facilitate synapse formation. [17][18][19] We examined whether the combination of tDCS and PES, which have different mechanisms of action, could restore motor function in an additive manner. ...
Article
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We report the immediate improvement of weakened muscles after combined treatment with transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) in a patient with acute central cord syndrome (CCS) who presented with severe upper limb motor dysfunction. A 70-year-old man sustained CCS with severe motor deficits in the left upper limb, which did not improve with conventional training until 6 days after injury. On the seventh day after the injury, the left upper limb was targeted with combined tDCS (1 mA for 20 minutes/day, anode on the right, cathode on the left) and PES (deltoid and wrist extensors, 20 minutes/day at the motor threshold), and his performance score immediately improved from 0 to 6 on the Box and Block test. After four sessions, the left upper limb function improved to 32 on the Box and Block test, and manual muscle test scores of the stimulated deltoid and wrist extensors improved from 1 to 2. This improvement of the left upper limb led to improved self-care activities such as eating and changing clothes. Exercise combined with tDCS and PES may be a novel treatment for upper limb movement deficits after acute CCS.
... Functional electrical stimulation can improve the function of paralyzed muscles, such as those of patients with spinal cord injury or stroke. 6,7 Recent studies, have demonstrated the potential benefits of functional electrical stimulation in patients with heart failure, including improved functional status, 8 exercise capacity, 9 endothelial function, 10 quality of life, 11 and emotional stress. 12 Three meta-analyses published in 2010, 2013, and 2016 included only two, five, and seven randomized controlled trials, respectively, that compared functional electrical stimulation and control treatments. ...
Article
Objective To investigate the effectiveness of functional electrical stimulation of the legs in patients with heart failure. Methods Data were obtained from PubMed, Cochrane Library, and Embase databases until August 12, 2021. We included randomized controlled trials that evaluated the effects of functional electrical stimulation applied to the legs of patients with heart failure, namely changes in cardiopulmonary function, muscle strength, and quality of life. Results In total, 14 randomized controlled trials (consisting of 518 patients) were included in our article. Pooled estimates demonstrated that functional electrical stimulation significantly improved peak oxygen consumption (peak VO 2 ; standardized mean difference = 0.33, 95% confidence interval = 0.07–0.59, eight randomized controlled trials, n = 321), 6-min walking distance (mean difference = 48.03 m, 95% confidence interval = 28.50–67.57 m, 10 randomized controlled trials, n = 380), and Minnesota Living with Heart Failure Questionnaire quality of life score (mean difference = − 8.23, 95% confidence interval = − 12.64 to − 3.83, nine randomized controlled trials, n = 383). Muscle strength of lower extremities was not significantly improved in the functional electrical stimulation group compared with that in the control group (standardized mean difference = 0.26, 95% confidence interval = − 0.18 to 0.71, five randomized controlled trials, n = 218). Furthermore, the subgroup analysis revealed that functional electrical stimulation significantly improved peak VO 2 , 6-min walking distance, and Minnesota Living with Heart Failure Questionnaire quality of life score in the heart failure with reduced ejection fraction and heart failure with preserved ejection fraction subgroups. Conclusion Functional electrical stimulation can effectively improve the cardiopulmonary function and quality of life in patients with heart failure. However, functional electrical stimulation did not significantly improve muscle strength in the legs.
... The available research emphasises the need for interdisciplinary and multimodal approaches in the rehabilitation of the paretic hand 8 . Neuromuscular electrical stimulation (NMES) is one of the techniques proposed for upper limb recovery following a stroke [9][10][11][12] . Based on the use of electrical current to produce repetitive contractions of muscles it helps in restoring or assisting movements that would not otherwise occur because of hemiparesis. ...
Article
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More solid data are needed regarding the application of neuromuscular electrical stimulation (NMES) in the paretic hand following a stroke. A randomised clinical trial was conducted to compare the effects of two NMES protocols with different stimulation frequencies on upper limb motor impairment and function in older adults with spastic hemiparesis after stroke. Sixty nine outpatients were randomly assigned to the control group or the experimental groups (NMES with 50 Hz or 35 Hz). Outcome measures included motor impairment tests and functional assessment. They were collected at baseline, after 4 and 8 weeks of treatment, and after a follow-up period. NMES groups showed significant changes (p < 0.05) with different effect sizes in range of motion, grip and pinch strength, the Modified Ashworth Scale, and the muscle electrical activity in the extensors of the wrist. The 35 Hz NMES intervention showed a significant effect on Barthel Index. Additionally, there were no significant differences between the groups in the Box and Block Test. Both NMES protocols proved evidence of improvements in measurements related to hand motor recovery in older adults following a stroke, nevertheless, these findings showed that the specific stimulation frequency had different effects depending on the clinical measures under study.
... Regarding in vivo applications, due to the lack of effective clinical treatments for nerve injuries and neurodegenerative diseases, ES generated from an external power source or from electroactive materials has been explored as a complement and applied in stem cell therapy and tissue engineering since many years ago. Numerous studies on ES therapy have been conducted in animal models and humans and promising results have been reported [30][31][32]. Exogenous ES in animal models not only guides the migration of stem cells and stem cellderived neural cells [33][34][35], but also significantly contributes to stem cell neuron differentiation [36]. In clinical applications, ES therapy as a nonsurgical therapeutic modality is widely adopted by physical therapists and physicians. ...
Article
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Nerve injuries and neurodegenerative disorders remain serious challenges, owing to the poor treatment outcomes of in situ neural stem cell regeneration. The most promising treatment for such injuries and disorders is stem cell-based therapies, but there remain obstacles in controlling the differentiation of stem cells into fully functional neuronal cells. Various biochemical and physical approaches have been explored to improve stem cell-based neural tissue engineering, among which electrical stimulation has been validated as a promising one both in vitro and in vivo. Here, we summarize the most basic waveforms of electrical stimulation and the conductive materials used for the fabrication of electroactive substrates or scaffolds in neural tissue engineering. Various intensities and patterns of electrical current result in different biological effects, such as enhancing the proliferation, migration, and differentiation of stem cells into neural cells. Moreover, conductive materials can be used in delivering electrical stimulation to manipulate the migration and differentiation of stem cells and the outgrowth of neurites on two- and three-dimensional scaffolds. Finally, we also discuss the possible mechanisms in enhancing stem cell neural differentiation using electrical stimulation. We believe that stem cell-based therapies using biocompatible conductive scaffolds under electrical stimulation and biochemical induction are promising for neural regeneration.
... 12 A more recent review (20 RCTs,431 participants) found no benefit of FES for ADL, unless FES was initiated in the acute phase (<2 months since stroke). 13 In 2019, Yang et al 14 found that FES-treated patients achieved higher improvements in Body Functions and Structure and Activity domains (48 RCTs, 1712 patients). 14 When FES-induced afferent feedback is synchronized with subject's volitional intention through the use of electromyograph (EMG)-controlled FES systems, neuroplasticity is further enhanced, 15,16 so as to improve motor recovery. ...
Article
Background: Robotic systems combined with Functional Electrical Stimulation (FES) showed promising results on upper-limb motor recovery after stroke, but adequately-sized randomized controlled trials (RCTs) are still missing. Objective: To evaluate whether arm training supported by RETRAINER, a passive exoskeleton integrated with electromyograph-triggered functional electrical stimulation, is superior to advanced conventional therapy (ACT) of equal intensity in the recovery of arm functions, dexterity, strength, activities of daily living, and quality of life after stroke. Methods: A single-blind RCT recruiting 72 patients was conducted. Patients, randomly allocated to 2 groups, were trained for 9 weeks, 3 times per week: the experimental group performed task-oriented exercises assisted by RETRAINER for 30 minutes plus ACT (60 minutes), whereas the control group performed only ACT (90 minutes). Patients were assessed before, soon after, and 1 month after the end of the intervention. Outcome measures were as follows: Action Research Arm Test (ARAT), Motricity Index, Motor Activity Log, Box and Blocks Test (BBT), Stroke Specific Quality of Life Scale (SSQoL), and Muscle Research Council. Results: All outcomes but SSQoL significantly improved over time in both groups (P < .001); a significant interaction effect in favor of the experimental group was found for ARAT and BBT. ARAT showed a between-group change of 11.5 points (P = .010) at the end of the intervention, which increased to 13.6 points 1 month after. Patients considered RETRAINER moderately usable (System Usability Score of 61.5 ± 22.8). Conclusions: Hybrid robotic systems, allowing to perform personalized, intensive, and task-oriented training, with an enriched sensory feedback, was superior to ACT in improving arm functions and dexterity after stroke.