Multi-contact functional electrical stimulation for hand opening: electrophysiologically driven identification of the optimal stimulation site

If you are getting FES from your therapist or like me bought your own device you will need to have your therapist get this to know the exact location to trigger specific muscles.  Another reason we need public stroke protocols.
http://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-016-0129-6

• Cristiano De MarchisEmail author,
• Thiago Santos Monteiro,
• Cristina Simon-Martinez,
• Silvia Conforto and
• Alireza GharabaghiEmail author

Journal of NeuroEngineering and Rehabilitation201613:22

DOI: 10.1186/s12984-016-0129-6

©  De Marchis et al. 2016

Received: 11 November 2015

Accepted: 24 February 2016

Published: 8 March 2016

Abstract

Background

Functional Electrical Stimulation (FES) is increasingly applied in neurorehabilitation. Particularly, the use of electrode arrays may allow for selective muscle recruitment. However, detecting the best electrode configuration constitutes still a challenge.

Methods

A multi-contact set-up with thirty electrodes was applied for combined FES and electromyography (EMG) recording of the forearm. A search procedure scanned all electrode configurations by applying single, sub-threshold stimulation pulses while recording M-waves of the extensor digitorum communis (EDC), extensor carpi radialis (ECR) and extensor carpi ulnaris (ECU) muscles. The electrode contacts with the best electrophysiological response were then selected for stimulation with FES bursts while capturing finger/wrist extension and radial/ulnar deviation with a kinematic glove.

Results

The stimulation electrodes chosen on the basis of M-waves of the EDC/ECR/ECU muscles were able to effectively elicit the respective finger/wrist movements for the targeted extension and/or deviation with high specificity in two different hand postures.

Conclusions

A subset of functionally relevant stimulation electrodes could be selected fast, automatic and non-painful from a multi-contact array on the basis of muscle responses to subthreshold stimulation pulses. The selectivity of muscle recruitment predicted the kinematic pattern. This electrophysiologically driven approach would thus allow for an operator-independent positioning of the electrode array in neurorehabilitation.