Now write this up as a proposed protocol and distribute this to all 10 million yearly stroke survivors now and into the future.
Your responsibility since we have fucking failures of stroke associations that can't even mange to do this simple thing for survivors. But then most stroke associations are not for survivors, they are to remove money from them and supposedly train doctors.
Patient-specific functional electrical stimulation strategy based on muscle synergy and walking posture analysis for gait rehabilitation of stroke patients
Junghwan Lim1,*, Taehyun Lim2,*,
Hyungjun Chang1
, Bumchul Yoon2 and
Hoeryong Jung1
Jungeun Lee1 , Junhyuk Sim1
,Hyungjun Chang1
, Bumchul Yoon2 and
Hoeryong Jung1
Abstract
Objective:To evaluate a novel multi-channel functional electrical stimulation (FES) rehabilitation
method based on the evaluation of patient-specific walking dysfunction.
Methods:
method based on the evaluation of patient-specific walking dysfunction.
Methods:
This study investigated a novel multi-channel FES-based rehabilitation method that
analysed the patient’s muscle synergy and walking posture. A patient-specific FES profile was
produced in the pre-evaluation stage by comparing the muscle synergy and walking posture of the
patient with those of healthy control subjects. During the rehabilitation phase, this profile was
used to determine an appropriate FES pulse width and amplitude for stimulating the patient’s
muscles as they walked across a flat surface.
Results:
analysed the patient’s muscle synergy and walking posture. A patient-specific FES profile was
produced in the pre-evaluation stage by comparing the muscle synergy and walking posture of the
patient with those of healthy control subjects. During the rehabilitation phase, this profile was
used to determine an appropriate FES pulse width and amplitude for stimulating the patient’s
muscles as they walked across a flat surface.
Results:
Two stroke patients with hemiplegic symptoms participated in a clinical evaluation of
the proposed method involving a 4-week course of rehabilitation. An evaluation of the rehabilitation results based on a comparison of the pre- and post-rehabilitation muscle synergy and
walking posture revealed that the rehabilitation enhanced the muscle synergy similarity between
the patients and healthy control subjects and their quantitative walking performance, as measured
by a 10-m walk test and walking speed, by up to 23.38% and 30.00%, respectively.
Conclusion:
the proposed method involving a 4-week course of rehabilitation. An evaluation of the rehabilitation results based on a comparison of the pre- and post-rehabilitation muscle synergy and
walking posture revealed that the rehabilitation enhanced the muscle synergy similarity between
the patients and healthy control subjects and their quantitative walking performance, as measured
by a 10-m walk test and walking speed, by up to 23.38% and 30.00%, respectively.
Conclusion:
These results indicated that the proposed rehabilitation method improved walking
ability by improving muscle coordination and adequately supporting weakened muscles in stroke
patients.
Keywords
Stroke rehabilitation, functional electrical stimulation, muscle synergy
Date received: 17 November 2020; accepted: 20 April 2021
most stroke patients exhibit muscle weakness and coordination problems simultaneously.4 Foot drop is associated with not only problems in terms of ankle muscle coordination but also weakness of the tibialis anterior muscle, which is noticeable relative to weaknesses in other muscles of the paretic limb.5 Because the impaired walking patterns of stroke patients such as circumduction and steppage gait are caused by a combination of coordination problems and muscle weakness, these should be considered together in constructing an effective rehabilitation strategy. Coordinated walking patterns are performed either through motor modules or muscle synergies.1,6 A muscle synergy represents a system of commands from the central nervous system (CNS) to several muscles that coordinate a single action. In
healthy individuals, walking typically involves four muscle synergies – weight acceptance (WA), push off (PO), foot clearance (FC) and leg deceleration (LD).1,7–10 Absent or weakened muscle synergies can be used to identify a patient’s muscle coordination problem. In previous studies, it has been found that stroke patients exhibit a reduced number of synergies on their paretic side as a result of the merging of motor modules; this implies that a non-functional muscle co-contraction is reflected in walking dysfunction.7,8,11 Recent studies have proposed the use of muscle synergy, along with conventional indices such as cadence, walking speed and walking posture, as an effective measure for assessing a patient’s overall walking performance.12–14 A combination of functional electrical stimulation (FES) and walking rehabilitation is an effective intervention for stroke patients.15–17 FES can effectively enhance motor learning and CNS plasticity, and single- or dual-channel FES can be applied
to the dorsiflexor muscles in the walking rehabilitation process to prevent foot drop during the swing phase.2,3,6,18 Recently, rehabilitation methods applying multichannel FES based on muscle synergy analysis have been proposed as a solution to muscle coordination problems caused by CNS damage.1,8,19 Although these methods improve muscle coordination in the lower extremities through the simultaneous electrical stimulation of multiple muscles on he paretic side, they cannot be used to individually strengthen single weakened muscles (such as the tibialis anterior muscle in the case of foot drop) because they only modulate the FES pulse width. Thus, the muscle weakening cannot be
directly elevated through these rehabilitation methods. This current report proposes a novel
multi-channel FES rehabilitation method based on the evaluation of patient-specific walking dysfunction. The proposed method utilizes muscle synergy and walking posture analysis to produce an FES profile that addresses the muscle coordination and weakness problems simultaneously by modulating both the FES pulse width and amplitude. The pulse width modulation adapts the approach used under existing methods to address muscle synergy dysfunction,1 while the amplitude modulation
addresses walking posture dysfunction by strongly contracting individual weakened muscles. Since the higher amplitude of electrical stimulation causes the larger muscle contraction,20–23 the strength of muscle contraction can be controlled effectively by amplitude modulation. In the literature, it has been shown that amplitude modulation can be used effectively for improving the muscle strength in the stroke rehabilitation.24,25 The proposed rehabilitation method was validated through clinical
evaluations of two stroke patients. The rehabilitation results were presented by comparing pre- and post-evaluation of the walking dysfunction of the two patients.
ability by improving muscle coordination and adequately supporting weakened muscles in stroke
patients.
Keywords
Stroke rehabilitation, functional electrical stimulation, muscle synergy
Date received: 17 November 2020; accepted: 20 April 2021
Introduction
Walking impairment is a major concern for stroke patients because it significantly contributes to functional disability and can lead to disruption in their quality of life.1–3Generally, strokes result in muscle weakness and spasticity of the paretic limb that can lead to disruptions in interlimb coordination control. Although the terms ‘muscle weakness’ and ‘coordination’ technically describe different phenomena, they are used interchangeably in this context becausemost stroke patients exhibit muscle weakness and coordination problems simultaneously.4 Foot drop is associated with not only problems in terms of ankle muscle coordination but also weakness of the tibialis anterior muscle, which is noticeable relative to weaknesses in other muscles of the paretic limb.5 Because the impaired walking patterns of stroke patients such as circumduction and steppage gait are caused by a combination of coordination problems and muscle weakness, these should be considered together in constructing an effective rehabilitation strategy. Coordinated walking patterns are performed either through motor modules or muscle synergies.1,6 A muscle synergy represents a system of commands from the central nervous system (CNS) to several muscles that coordinate a single action. In
healthy individuals, walking typically involves four muscle synergies – weight acceptance (WA), push off (PO), foot clearance (FC) and leg deceleration (LD).1,7–10 Absent or weakened muscle synergies can be used to identify a patient’s muscle coordination problem. In previous studies, it has been found that stroke patients exhibit a reduced number of synergies on their paretic side as a result of the merging of motor modules; this implies that a non-functional muscle co-contraction is reflected in walking dysfunction.7,8,11 Recent studies have proposed the use of muscle synergy, along with conventional indices such as cadence, walking speed and walking posture, as an effective measure for assessing a patient’s overall walking performance.12–14 A combination of functional electrical stimulation (FES) and walking rehabilitation is an effective intervention for stroke patients.15–17 FES can effectively enhance motor learning and CNS plasticity, and single- or dual-channel FES can be applied
to the dorsiflexor muscles in the walking rehabilitation process to prevent foot drop during the swing phase.2,3,6,18 Recently, rehabilitation methods applying multichannel FES based on muscle synergy analysis have been proposed as a solution to muscle coordination problems caused by CNS damage.1,8,19 Although these methods improve muscle coordination in the lower extremities through the simultaneous electrical stimulation of multiple muscles on he paretic side, they cannot be used to individually strengthen single weakened muscles (such as the tibialis anterior muscle in the case of foot drop) because they only modulate the FES pulse width. Thus, the muscle weakening cannot be
directly elevated through these rehabilitation methods. This current report proposes a novel
multi-channel FES rehabilitation method based on the evaluation of patient-specific walking dysfunction. The proposed method utilizes muscle synergy and walking posture analysis to produce an FES profile that addresses the muscle coordination and weakness problems simultaneously by modulating both the FES pulse width and amplitude. The pulse width modulation adapts the approach used under existing methods to address muscle synergy dysfunction,1 while the amplitude modulation
addresses walking posture dysfunction by strongly contracting individual weakened muscles. Since the higher amplitude of electrical stimulation causes the larger muscle contraction,20–23 the strength of muscle contraction can be controlled effectively by amplitude modulation. In the literature, it has been shown that amplitude modulation can be used effectively for improving the muscle strength in the stroke rehabilitation.24,25 The proposed rehabilitation method was validated through clinical
evaluations of two stroke patients. The rehabilitation results were presented by comparing pre- and post-evaluation of the walking dysfunction of the two patients.
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