Implications of neuromuscular electrical stimulation on gait ability, balance and kinematic parameters after stroke: a systematic review and meta-analysis

 Survivors don't need lazy 'implications' research! They need EXACT PROTOCOLS THAT DELIVER RECOVERY! When the fuck will you GET THERE? You're all fired.

Implications of neuromuscular electrical stimulation on gait ability, balance and kinematic parameters after stroke: a systematic review and meta-analysis

• Shishi Chen,
• Jingjing Gao,
• Ye Zhou,
• Beisi Zheng,
• Yuxiang Liu,
• Manting Cao,
• Haiping Huang,
• Xinyi Su &
• Jianer Chen 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 164 (2024) Cite this article

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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(NOT GOOD ENOUGH!) 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.

Introduction

Globally, 12.2 million new strokes occur each year, one every three seconds [1]. Stroke survivors generally have limited activity due to impairments in body structure and function, with about 60% of these survivors suffer from walking dysfunction [2]. Motor function of the lower extremities can significantly improve within the first 30 days after stroke [3]. However, the ultimate degree of recovery in stroke patients remain uncertain, as it depends on factors such as patient-specific spontaneous neurologic recovery, rehabilitation training, and environmental enrichment. Moreover, stroke survivors have been continually plagued by problems like improper gait patterns, muscle spasms, impaired balance and foot drop [4], which impede their ability to walk independently and safely. Independent and safe ambulation is the most commonly cited goal and a key component of functional recovery for stroke survivors [5,6,7].

Neuromuscular electrical stimulation (NMES) technology utilizes electrical stimulation to alleviate the inability of muscles to produce joint movements in stroke patients due to weak or absent innervation. It enables survivors with lower extremity motor dysfunction to reactivate their muscles and regain motor coordination [8, 9]. And there is a traceable history of generating physical movement through electrical stimulation and using it in the therapeutic field. As early as the 1960s, clinical trials were conducted to correct foot drop in stroke survivors by electrically stimulating the peroneal nerve in the affected leg [10].

Generally, NMES is divided into two categories: functional electrical stimulation (FES) and transcutaneous electrical nerve stimulation (TENS). FES, which typically uses electrical stimulation at 20–50 Hz, is designed to activate motor nerve fibers causing the target muscle to contract and generate functional movements [9, 11]. TENS, which usually utilizes electrical stimulation at 2–10 Hz, can activate sensory nerve fibers and override pain impulses without produce significant muscle contraction [12]. Currently, numerous studies have pointed out the effectiveness of NMES in improving balance, ankle stability, gait symmetry and muscle spasticity in stroke patients [13,14,15]. However, it has also been noted that NMES, despite contributing to functional improvement in stroke survivors, did not differ significantly from conventional treatment in terms of improvements in speed, step length symmetry, other spatiotemporal gait parameters, or walking capacity [16,17,18]. A 2018 meta-analysis indicates that further analysis of high-quality randomized controlled trials on NMES is warranted [19]. Notably, scientific evidences regarding the role of NMES in stroke-induced lower limb motor dysfunction may have been unwittingly updated as the research progressed, making an updated review indispensable. Furthermore, few studies have focused on the role of NMES in temporal and spatial parameters and on comparing the efficacy of functional rehabilitation in patients with different post-stroke time and different treatment sessions.

Based on these considerations, the objective of this study was to undertake a systematic review and meta-analysis of all the existing literature and to explore the following queries:

1. 1)

   What is the contribution of NMES to temporal and spatial parameters in individuals with stroke-induced lower limb motor dysfunction?

2. 2)

   Does NMES play a different role for stroke survivors in the acute, subacute, or chronic phase?

3. 3)

   Can an optimal treatment cycle be indicated based on the existing studies?

   More at link.