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Electrical stimulation

Electrical stimulation in stroke recovery

Electrical stimulation is the therapy where electrical currents are delivered thru the skin electrodes to activate muscle contractions or nerve conduction. Small contractions improve muscle blood flow, relieving spasm,  pain and improving range of motion. Electrical stimulation is also important in wound healing. When combined with hyperbaric oxygen increased blood flow becomes supersaturated with oxygen yielding higher effect and faster recovery  than each therapy on its own.

When nerve is stimulated such as in people who lost the control of their muscles (i.e. stroke, brain injury, spinal cord injury) we can elicit a functional movement. Electrical stimulation promotes the muscle blood circulation which is effective also in preservation of muscle mass preventing muscle atrophy.

The mechanism is not clearly known, but the combination of nerve electrical stimulation, physio and hyperbaric oxygen therapy improves the control of the movement, reducing synergism, spasm, fatigue,  allowing for selectivity, repeatability and strength.

Electrical stimulation for post stroke rehabilitation

Electrical stimulation is commonly used in post stroke rehabilitation or in brain and spinal cord injury when people are left paralyzed. In hemiplegia for example, while one side of the body can perform movement perfectly well, the other side of the body does not have functioning communication between the brain and the muscle.

Electrical current is mimicking the signal from the brain that would as nerve signal or so called action potential, normally travel thru the nerves to the muscle to produce a desired movement. In electrical stimulation the low intensity electrical current is passed thru the electrodes on the surface of the skin to the underlying muscles and nerves that need to be “activated”.

This is a very effective and safe method of physiotherapy which can, when combined with benefits of oxygen therapy be magnified.

At BaroMedical we use functional electrical stimulation or short FES, in conjunction with hyperbaric oxygen therapy in post stroke rehabilitation. With help of FES a person can produce a functional movement that he is not able to make on his own. Typically in people after stroke who are left with hemiplegia recovery can take months even years.

Functional hand: (opening of the clenched hand)

Pictures below show a person being able to use his hand to pick up a ball. After stroke, even following initial physiotherapy rehabilitation his right arm was left with no function with hand clenched in a fist. We used customized stimulation program with one channel to gradually extend the wrist and open the hand. This exercise is very helpful also psychologically as the person is seeing his hand opening without any help of the opposite hand, for the first time. Daily electrical stimulation followed by hyperbaric oxygen therapy will allow person to gradually voluntarily initiate the movement with a goal to also finish the movement without the help of device. 

Painful shoulder:

Usual complication with arm without muscle tonus is shoulder pain due to extension of the tendons giving in to the weight of the arm, calledsubluxation. Wide electrodes on the shoulders are positioned in a way to create a field and pattern of muscle contractions, to improve the circulation in the shoulder, to strengthen stretched tendons and relief the pain. 

Stretching the arm:

In addition to be able to use the hand as pictured above, we use electrical stimulation on the forearm for arm extension to further activate the arm. 

Foot flexion:

Dropped foot is very common and  frustrating complication for person with hemiplegia. The swing phase of the gait requires initial activation of the hip, then the knee flexors before lifting the foot. Therefore training the foot flexion is  crucial to building a walking pattern. The surface electrodes are placed in a pattern to activate the peroneal nerve below the knee, which is responsible for foot dorsi flexion. Repeated daily stimulation allows the person to be able to initiate the foot flexion, with a goal to voluntarily execute foot flexion while walking. Electrical stimulation promotes the muscle blood circulation which is effective also in preservation of muscle mass preventing muscle atrophy.

Hyperbaric oxygen therapy ....

Further reading:
  1. Names et al.Title Publication
  1. Popović DB, Sinkaer T, Popović MB: Electrical stimulation as a means for achieving recovery of function in stroke patients.; NeuroRehabilitation.;25(1):45-58. Review, 2009.
  2. Kralj A, Acimovic R, Stanic U. Enhancement of hemiplegic patient rehabilitation by means of functional electrical stimulation, Prosthet Orthot Int;17(2):107-14, 1993.
  3. Baker LL, Parker K. Neuromuscular electrical stimulation of the muscles surrounding the shoulder. Phys Ther; 66(12):1930-37, 1986.
  4. Wang RY, Chan RC, Tsai MW. Functional electrical stimulation on chronic and acute hemiplegic shoulder subluxation. Am J Phys Med Rehabil;79(4):385-90, 2000
  5. Faghri PD, Rodgers MM, Glaser RM, Bors JG, Ho C, Akuthota P. The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients. Arch Phys Med Rehabil; 75(1):73-79, 1994.
  6. Fields RW. Electromyographically triggered electric muscle stimulation for chronic hemiplegia. Arch Phys Med Rehabil; 68(7):407-14, 1987.
  7. Smith LE. Restoration of volitional limb movement of hemiplegics following patterned functional electrical stimulation. Percept Mot Skills;71(3 Pt 1):851-61, 1990.
  8. Kraft GH, Fitts SS, Hammond MC. Techniques to improve function of the arm and hand in chronic hemiplegia. Arch Phys Med Rehabil;73(3):220-27, 1992.
  9. Van Swigchem R, Weerdesteyn V, van Duijnhoven HJ, den Boer J, Beems T, Geurts AC Near-normal gait pattern with peroneal electrical stimulation as a neuroprosthesis in the chronic phase of stroke: a case report.; Arch Phys Med Rehabil. Feb;92(2):320-4, 2011
  10. Kesar TM, Reisman DS, Perumal R, Jancosko AM, Higginson JS, Rudolph KS, Binder-Macleod SA: Combined effects of fast treadmill walking and functional electrical stimulation on post-stroke gait.; Gait Posture. Dec 21, 2010
  11. Leeb R, Gubler M, Tavella M, Miller H, Del Millan JR: On the road to a neuroprosthetic hand: A novel hand grasp orthosis based on functional electrical stimulation.; Conf Proc IEEE Eng Med Biol Soc.;1:146-9, 2010.
  12. Embrey DG, Holtz SL, Alon G, Brandsma BA, McCoy SW: Functional electrical stimulation to dorsiflexors and plantar flexors during gait to improve walking in adults with chronic hemiplegia.; Arch Phys Med Rehabil. May;91(5):687-96, 2010.
  13. Chantraine A, Baribeault A, Uebelhart D, Gremion G. Shoulder pain and dysfunction in hemiplegia: effects of functional electrical stimulation. Arch Phys Med Rehabil;80(3):328-31, 1999.
  14. Chae J, Sheffler L, Knutson J: Neuromuscular electrical stimulation for motor restoration in hemiplegia.; Top Stroke Rehabil. Sep-Oct;15(5):412-26. Review, 2008.
  15. Kralj B:Conservative treatment of female stress urinary incontinence with functional electrical stimulation.; Eur J Obstet Gynecol Reprod Biol. Jul;85(1):53-6, 1999.
  16. Linn SL, Granat MH, Lees KR. Prevention of shoulder subluxation after stroke with electrical stimulation. Stroke; 30(5):963-68, 1999.
  17. Bajd T, Kralj A, Stefancic M, Lavrac N: Use of functional electrical stimulation in the lower extremities of incomplete spinal cord injured patients.; Artif Organs. May;23(5):403-9, 1999.
  18. Pandyan AD, Granat MH, Stott DJ. Effects of electrical stimulation on flexion contractures in the hemiplegic wrist. Clin Rehabil;11(2):123-30, 1997.
  19. Burridge JH, Taylor PN, Hagan SA, Wood DE, Swain ID. The effects of common peroneal stimulation on the effort and speed of walking: a randomized controlled trial with chronic hemiplegic patients. Clin Rehabil;11(3): 201-10, 1997.
  20. Hummelsheim H, Maier-Loth ML, Eickhof C. The functional value of electrical muscle stimulation for the rehabilitation of the hand in stroke patients. Scand J Rehabil Med;29(1):3-10, 1997.
  21. Taylor PN, Burridge JH, Dunkerley AL, Wood DE, Norton JA, Singleton C, et al. Clinical use of the Odstock dropped foot stimulator: its effect on the speed and effort of walking. Arch Phys Med Rehabil;80(12):1577-83, 1999.
  22. Alon G, Stibrant-Sunnerhagen K, Geurts AC, Ohry A. A home-based, self-administered stimulation program to improve selected hand functions of chronic stroke. NeuroRehabilitation;18:215-25, 2003.
  23. Powell J, Pandyan AD, Granat M, Cameron M, Stott DJ. Electrical stimulation of wrist extensors in poststroke hemiplegia. Stroke; 30(7):1384-89, 1999.
  24. Glanz M, Klawansky S, Stason W, Berkey C, Chalmers TC. Functional electrostimulation in poststroke rehabilitation: a meta-analysis of the randomized controlled trials. Arch Phys Med Rehabil;77(6):549-53, 1996.

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