Way too many big words used to have any clue on how to explain this to therapists and doctors for our use. I see no objective damage diagnosis that would point to which patients this would work on. Without that, this research is not repeatable and thus useless.
Variation of Finger Activation Patterns Post-stroke Through Non-invasive Nerve Stimulationh
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, United States
Purpose: A transcutaneous proximal
nerve stimulation technique utilizing an electrode grid along the nerve
bundles has previously shown flexible activation of multiple fingers.
This case study aimed to further demonstrate the ability of this novel
stimulation technique to induce various finger grasp patterns in a
stroke survivor.
Methods: An individual with chronic
hemiplegia and severe hand impairment was recruited. Electrical
stimulation was delivered to different pairs of an electrode grid along
the ulnar and median nerves to selectively activate different finger
flexor muscles, with an automated electrode switching method. The
resultant individual isometric flexion forces and forearm flexor
high-density electromyography (HDEMG) were acquired to evaluate the
finger activation patterns. A medium and low level of overall activation
were chosen to gauge the available finger patterns for both the
contralateral and paretic hands. All the flexion forces were then
clustered to categorize the different types of grasp patterns.
Results: Both the contralateral and
paretic sides demonstrated various force clusters including single and
multi-finger activation patterns. The contralateral hand showed finger
activation patterns mainly centered on median nerve activation of the
index, middle, and ring fingers. The paretic hand exhibited fewer total
activation patterns, but still showed activation of all four fingers in
some combination.
Conclusion: Our results show that
electrical stimulation at multiple positions along the proximal nerve
bundles can elicit a select variety of finger activation patterns even
in a stroke survivor with minimal hand function. This system could be
further implemented for better rehabilitative training to help induce
functional grasp patterns or to help regain muscle mass.
Introduction
Following a stroke, a majority of individuals have
paresis due to a loss of excitatory input and subsequent complications,
such as disuse atrophy (1) and altered spinal organization (2–4).
This loss of voluntary control of muscle activation often limits
activities of daily living. Neuromuscular electrical stimulation (NMES)
has been widely utilized both in the clinic and in research settings to
help restore atrophied muscle and lost functions (5–7). Electrical stimulation has been particularly successful with post-stroke survivors for functional recovery (8–10). Research in NMES also aims to restore functional activation of muscles, such as the restoration of hand grasps (11).
Traditionally, NMES uses large electrode pads, targeting
the distal branches of the nerve, known as the motor point stimulation (12).
Although stimulation of the motor point is straightforward
methodologically, NMES is limited to localized muscle activation, which
limits its functional efficacy and also leads to rapid muscle fatigue (13).
Advances in NMES techniques to alleviate these issues involve various
multi-electrode techniques, which can stimulate multiple small regions
of the muscle to help distribute the current and potentially activate
more muscle fibers (14, 15).
Crema et al. has also demonstrated flexible activation of multiple
fingers using a multi-electrode array across the forearm and hand (16).
Other approaches to NMES involve stimulation of the nerve bundle prior
to branching and innervating a muscle, which has shown to allow for a
larger area of muscle activation and potentially reduce long-term
fatigue effects (17–19).
Recent developments have demonstrated the capabilities of
an alternative non-invasive transcutaneous electrical nerve stimulation
method targeting the ulnar and median nerves proximal to the elbow to
flexibly activate individual and multiple fingers (20, 21). In addition, this technique shows the ability to delay the force decline (22, 23).
A stimulation electrode grid placed along the two nerves allows us to
activate different muscles or muscle portions to elicit varied desired
movements, but manually switching between different electrode pairs is
time-consuming. To shorten this process, an automated electrode pair
searching method has been developed and tested on intact control
subjects (24).
This new method can further categorize the total available sets of
finger activation patterns across the entire electrode grid, providing
valuable information on electrode selection and the force generation
capacity of stroke muscles. However, the efficiency of this method has
not been tested on stroke survivors. Therefore, this case study
recruited a control subject and a stroke survivor with severe weakness
of the right arm, and evaluated the available finger activation patterns
of the subjects. Our results showed varied activation of multiple
fingers from both subjects. Further development of this stimulation
technique can provide valuable alternatives to current rehabilitation
for the restoration of hand movements.
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