Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Showing posts with label Bioness. Show all posts
Showing posts with label Bioness. Show all posts

Thursday, May 30, 2024

Told he’d never walk again, Castle Rock man defies odds after stroke

 See these doctors are so smart, they know exactly when to use the nocebo effect. Telling you you won't recover. That elicits the response of; 'I'll prove you blithering idiots wrong.'

Told he’d never walk again, Castle Rock man defies odds after stroke 

Couple encourages people to try everything and not give up
A man stands outside
After having a stroke in 2016, doctors told Dan Leffert he would never be able to walk again. Eight years later and with the help of Bioness L300 Go, Leffert is walking once again, with a goal to walk 200 miles by the end of the year. Credit: Haley Lena

Dan Leffert dedicated most of his life to traveling across the globe to places like Switzerland and Germany. He spent most of the time outside, riding his motorcycle for thousands of miles. So hearing the words “You’ll never walk again” felt like the end of the world. 

He lost his mobility after having a stroke in 2016 and now 70, he has undergone countless hours of physical and occupational therapy. 

With the inspiration from his grandkids and the help of a medical device, Dan is walking once again. And, like his motorcycle riding, he’s measuring his miles. Dan has a goal of walking 200 miles by the end of the year and even more the next year. He says it’s not about trying to get back to where he used to, but more about seeing where he can go from here.

“I’ve got to do 300 next year,” Dan said. “It’s not more what I had, it’s what I’m going to do.”

Everything changed on an ordinary February day in 2016. Dan was sitting next to his wife, Vicky, taking part in a homeowners association meeting in Castle Rock,  speaking, when his words began to slur. Their property manager asked if he was alright and when Dan responded “No,” 911 was called.

“I was coherent, but not speaking well,” said Dan. 

The initial CT scan verified Dan had suffered a hemorrhagic stroke, causing bleeding in the brain. Multiple times throughout the night, he was taken in for more scans to monitor the bleeding, which eventually stopped. 

Stroke is not only a leading cause of death for Americans, the federal Centers for Disease Control and Prevention also states that it’s the leading cause of serious long-term disability in the U.S. 

There are two main categories of strokes according to the American Stroke Association, ischemic and hemorrhagic. An ischemic stroke, which accounts for 87% of strokes, occurs when a blood vessel or artery going into the brain is obstructed. 

A hemorrhagic stroke is when a blood vessel leaks or ruptures and bleeds into the brain, putting pressure on the brain, in turn, causing damage. 

Dan was in the intensive care unit for six days before spending the next five weeks at Spalding Rehabilitation Center in Aurora. 

He didn’t know how he could keep it up, but little did he know that one of his inspirations had been born just months earlier: Hailey, his granddaughter, who he calls his angel. 

“We brought Hailey into the ICU, into rehab every single day and laid her on his belly and said, ‘This is why you have to get better,’” Vicky said. 

The stroke left Dan in a wheelchair for a year and a half. He was paralyzed on the right side of the body, his dominant side. He continues to learn how to adapt everyday, oftentimes with unique products his kids find. 

For some time, he struggled with insurance for his occupational and physical therapy, but his speech therapy was located at Sky Ridge Medical Center. While at speech therapy one day, the couple noticed occupational and physical therapists. They realized they wanted to be with those therapists. Vicky walked up to the receptionist and asked how she could get her husband in.

Dan soon began therapy to relearn movement and coordination skills for over two years at Sky Ridge. Typically with insurance, Dan said there were only 20 visits per year for occupational therapy and 20 visits for physical therapy, but he went 100 days a year, paying out of pocket. 

A man stands with his dog.
Dan Leffert uses three Bioness devices, one on his thigh, knee and hand to help stimulate the nerves in his arm and leg and help him with his mobility. Credit: Vicky Leffert

He did multiple forms of therapy, including constraint therapy, aqua therapy, acupuncture, deep needle therapy and massage therapy. 

“I was looking for anything,” said Dan . “Everything I did contributed to getting better.” 

Then, a friend from one of his motorcycle groups came to visit one day. He told Dan about a medical device called Bioness L300 Go, which the friend’s father had used after having a stroke. After some research and learning their insurance wouldn’t cover the device, the couple met with a Bioness representative. 

“It came down to, we don’t care what it costs,” Vicky said. 

With one device on his thigh and two others on a knee and a hand, the devices promote recovery by activating neuromuscular pathways required for walking and movement. It’s a functional electrical stimulation system that produces mobility improvements for patients who have instability or mobility issues. 

The device also has an app on the phone in which the patient can alter the intensity and an adaptive algorithm that can predict walking patterns and provide stimulation when needed to make it easier to move, according to Bioness. 

Needing more intense therapy, Dan began seeing a neuromuscular massage therapist in addition to using the devices.

It was during his first year with this therapist, Dan was back on his feet. He walked a mile-long track. That distance has gradually gone up each year, reaching 120 miles in 2023. 

Although the recovery has been long and frustrating at times, said Vicky, it’s also been rewarding. Their two youngest grandsons have learned how to walk alongside Dan and the walking has become easier with the help of his new puppy, Grizzly Bear. 

Both Dan and Vicky want to encourage those who have had a stroke to not give up. 

“You can do it,” said Vicky. “Try any and everything that’s out there because it all brings something to the table.”

Tuesday, March 19, 2024

Electronic device helps paralyzed stroke victim walk again

What EXACT PROTOCOL does your doctor have for getting you running again(Not just walking)?

Electronic device helps paralyzed stroke victim walk again

ACKSON, Miss. (WLBT) - A Raymond man who suffered a stroke was unable to walk until he was introduced to life-changing technology.

The avid runner regained some movement through rehab, but his quality of life was not the same. His future was uncertain until he said he found the electronic device that gave him back what he had lost.

“All anybody ever really wants is what you had before this happened,” said Darryl Blakely.

He is now walking after suffering a stroke last April that left him paralyzed. He felt a pain in his hip and suddenly lost function on his right side.

“And the day before, if you would have told me to run four miles, I would have said let’s go,” said Blakely. “And then the day this happened I couldn’t even make two steps.”

Two months ago, that changed when his Methodist Rehabilitation therapist suggested the Bioness L300 Go, which uses functional electrical stimulation. He wears it on his right leg.

“In a month, I could get around two or three steps, and since then, I’ve made a dramatic improvement,” said the recovering stroke victim. “Two weeks ago, I walked four miles. It took two hours, but you know, because I like to walk and run, I did it.”

The 55-year-old still undergoes therapy for his right arm, but with the electronic stimulation, he has resumed managing apartments and much of his daily work activity.

“This thing senses that you want to move, and it sends a signal to the muscle and stimulates it and makes your foot pick up.”

The husband, father, and grandfather admit the device is expensive, costing about $10,000, and was purchased through help from vocational rehab.

“I’m just thankful for people who spend the time to think of things to help people get their life back together,” added Blakely.

The device was developed in 2017. According to Bioness Rehab, the L300 Go is the world’s first Functional Electronic Stimulation that integrates proprietary 3D motion detection.

It detects gait events, providing stimulation precisely when needed making it easier to clear their foot at varying walking speeds, on stairs, ramps, and while navigating uneven territory. The L300 Go can help people with certain medical conditions walk more confidently.

Video at link.

Friday, August 26, 2016

Relief for Stroke Survivors with Shoulder Pain

I had shoulder pain for a couple of weeks, did nothing to address it, it went away.
http://nationalpainreport.com/relief-for-stroke-survivors-with-shoulder-pain-8831250.html
Up to 85% of stroke survivors suffer from chronic shoulder pain and that pain often stops them from continuing their efforts to rehabilitate after their stroke.
When a stroke survivor can no longer move his or her arm, the muscles will atrophy. The shoulder will essentially separate and the pain from the shoulder will often cause them to drop out of rehabilitation.
Choices like opioids, short term joint injections and immobilization might help relieve the pain in the short-term but they don’t address the cause—how to settle down the axillary nerve.
Doctors are having some success with a recently FDA cleared device that treats chronic pain of a peripheral nerve origin. In fact, it was the first implantable neuromodulation device cleared for peripheral nerve pain.
The StimRouter was developed by Bioness, a southern California company that was founded by the legendary Al Mann, the entrepreneur and philanthropist who founded companies that focused on cardiac pacemakers, insulin pumps, spinal cord stimulators and cochlear implants.  Mann passed away earlier this year.
“The goal is to get the stroke patient back into rehab,” said Mark Geiger, Global Director of Marketing Implantables for Bioness. “By targeting the pain at its origin, we believe we have an answer for the chronic shoulder pain that plagues stroke survivors.
Bioness_stimrouter_Set3_073015_implant
The StimRouter System
(Click to expand image)
The StimRouter is being marketed as a minimally invasive, long-term treatment option. No batteries are implanted. There’s less lead migration which is a big challenge for more invasive treatments.
Many pain physicians like what they see so far.
“This represents a paradigm shift in the management of post-stroke shoulder pain,” said Dr. Michael Sein, a rehabilitation physician at Weill Cornell Medicine in New York. “I like the ease of implementation which can be completed in an ambulatory setting as well as the significant levels of pain reduction that is achievable in patients that have failed to improve with prior therapy.
According to Dr. Sein, the traditional therapy has included physical therapy, medications and corticosteroid injections.
While the device was approved last year, the Company just launched the product in early 2016 and is still training pain and rehabilitation physicians around the country. Currently about 70 physicians are trained.
“That number is increasing by the month,” said Geiger.
The StimRouter is also approved for treatment of upper or lower limbs, entrapment syndromes, intercostal neuralgias and other peripheral injuries or disease.
Dr. Porter McRoberts of Fort Lauderdale, Florida is an interventional pain physician who has also used the device.
“100% of my implanted patients have had dramatic improvements in pain, said Dr. McRoberts. “One patient has even had complete resolution of her symptoms. I’ve been extremely happy.”
The Company hopes that for physical therapists and occupational therapists, the StimRouter may help these professionals successfully rehab more of the 800,000 Americans who suffer a stroke each year.

Sunday, May 29, 2016

Mediaplanet and Bioness Join to Highlight Trends and Key Players in Stroke Rehabilitation

The only awareness needed out there is that everything in stroke is a complete failure. NO stroke leadership or strategy, no one solving all the problems in stroke, no one working on stopping the neuronal cascade of death. You're fucking screwed if you have a stroke right now and I don't see that getting better anytime in the near future.

Guargantuan Fucking Whoopee.


Mediaplanet and Bioness Join to Highlight Trends and Key Players in Stroke Rehabilitation

Mediaplanet today announces the most recent issue of “Stroke Awareness.”

As patients feel increasingly concerned about the recovery process, post-stroke, they turn in larger numbers to technology to achieve health, rehabilitation and happiness.
An educational campaign aimed at everyone from caregivers to casual readers, this installment is bolstered by inspiring human-interest stories, courtesy of awareness-driven celebrities and thought leaders(Who the fuck are they?). It also provides insight to the developing trends and tech within the industry, from leading advocates, associations and industry leaders such as Bioness.
As patients feel increasingly concerned about the recovery process, post-stroke, they turn in larger numbers to technology to achieve health, rehabilitation and happiness. Those exhausted by the endless search for sustainable medical technology welcome Bioness to that process.
Bioness has been an industry leader supporting the efforts of skilled acute and outpatient practices for more than a decade. Bioness is committed to improving patients’ quality of lives through increased mobility and pain management. Their disruptive technologies are primarily focused on the rehabilitation of stroke survivors, which includes but is not limited to paralysis, pain management and vision deficits.
The print component of “Stroke Awareness” is distributed within this Friday's edition of USA Today in New York, Los Angeles, North Central Florida, Washington D.C. and Baltimore, with a circulation of approximately 250,000 copies and an estimated readership of 750,000. The digital component is distributed through a vast social media strategy, across a system of top news sites and partner outlets.
About Bioness
Bioness is the leading provider of innovative technologies helping people regain mobility and independence. Bioness solutions include external and implantable functional electrical stimulation (FES) systems, robotic systems and software based therapy programs providing functional and therapeutic benefits for individuals affected by pain, central nervous system disorders and orthopedic injuries.
About Mediaplanet
Mediaplanet is the leading independent publisher of content-marketing campaigns covering a variety of topics and industries. We turn consumer interest into action by providing readers with motivational editorial, pairing it with relevant advertisers and distributing it within top newspapers and online platforms around the world.

Wednesday, October 21, 2015

Long-Term Follow-up to a Randomized Controlled Trial Comparing Peroneal Nerve Functional Electrical Stimulation to an Ankle Foot Orthosis for Patients With Chronic Stroke

This is going to be rather useless because of the expense of the BioNess or the WalkAide compared to a cheap AFO will likely never be approved by your insurance. But they don't seem to have tested for endpoints of walking without the device. That would be the best outcome.
http://nnr.sagepub.com/content/29/10/911?etoc
  1. Francois Bethoux, MD1⇑
  2. Helen L. Rogers, PhD2
  3. Karen J. Nolan, PhD3,4
  4. Gary M. Abrams, MD5
  5. Thiru Annaswamy, MD, MA6,7
  6. Murray Brandstater, MD, PhD8
  7. Barbara Browne, MD9
  8. Judith M. Burnfield, PhD10
  9. Wuwei Feng, MD, MS11
  10. Mitchell J. Freed, MD12
  11. Carolyn Geis, MD13
  12. Jason Greenberg, MD14
  13. Mark Gudesblatt, MD15
  14. Farha Ikramuddin, MD16
  15. Arun Jayaraman, PhD17
  16. Steven A. Kautz, PhD11,18
  17. Helmi L. Lutsep, MD19
  18. Sangeetha Madhavan, PhD20
  19. Jill Meilahn, DO21
  20. William S. Pease, MD22
  21. Noel Rao, MD23
  22. Subramani Seetharama, MD24
  23. Pramod Sethi, MD25
  24. Margaret A. Turk, MD26
  25. Roi Ann Wallis, MD27,28
  26. Conrad Kufta, MD2
  1. 1Cleveland Clinic, Cleveland, OH, USA
  2. 2Innovative Neurotronics, Austin, TX, USA
  3. 3Kessler Foundation, West Orange, NJ, USA
  4. 4Rutgers—New Jersey Medical School, Newark, NJ, USA
  5. 5UCSF/San Francisco VA Medical Center, San Francisco, CA, USA
  6. 6VA North Texas Health Care System, Dallas, TX, USA
  7. 7UT Southwestern Medical Center, Dallas, TX, USA
  8. 8Loma Linda University Medical Center, Loma Linda, CA, USA
  9. 9Magee Rehabilitation Hospital, Philadelphia, PA, USA
  10. 10Madonna Rehabilitation Hospital’s Institute for Rehabilitation Science and Engineering, Lincoln, NE, USA
  11. 11Medical University of South Carolina, Charleston, SC, USA
  12. 12Florida Hospital Neuroscience and Orthopedic Research Institute, Orlando, FL, USA
  13. 13Halifax Health Center for Neurosciences, Daytona Beach, FL, USA
  14. 14Helen Hayes Hospital, West Haverstraw, NY, USA
  15. 15South Shore Neurologic Associates, Patchogue, NY, USA
  16. 16University of Minnesota Fairview, Minneapolis, MN, USA
  17. 17Rehabilitation Institute of Chicago, Chicago, IL, USA
  18. 18Ralph H Johnson VA Medical Center, Charleston, SC, USA
  19. 19Oregon Health and Science University, Portland, OR, USA
  20. 20University of Illinois at Chicago, Chicago, IL, USA
  21. 21Marshfield Clinic Research Foundation, Marshfield, WI, USA
  22. 22The Ohio State University Wexner Medical Center, Columbus, OH, USA
  23. 23Marianjoy Rehabilitation Hospital, Wheaton, IL, USA
  24. 24Hartford Hospital, Hartford, CT, USA
  25. 25Guilford Neurologic Associates, Greensboro, NC, USA
  26. 26SUNY Upstate Medical University, Syracuse, NY, USA
  27. 27West Los Angeles VA Healthcare Center, Los Angeles, CA, USA
  28. 28David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
  1. Francois Bethoux, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk U10, Cleveland, OH 44195, USA. Email: bethouf@ccf.org

Abstract

Background. Evidence supports peroneal nerve functional electrical stimulation (FES) as an effective alternative to ankle foot orthoses (AFO) for treatment of foot drop poststroke, but few long-term, randomized controlled comparisons exist. Objective. Compare changes in gait quality and function between FES and AFOs in individuals with foot drop poststroke over a 12-month period. Methods. Follow-up analysis of an unblinded randomized controlled trial (ClinicalTrials.gov #NCT01087957) conducted at 30 rehabilitation centers comparing FES to AFOs over 6 months. Subjects continued to wear their randomized device for another 6 months to final 12-month assessments. Subjects used study devices for all home and community ambulation. Multiply imputed intention-to-treat analyses were utilized; primary endpoints were tested for noninferiority and secondary endpoints for superiority. Primary endpoints: 10 Meter Walk Test (10MWT) and device-related serious adverse event rate. Secondary endpoints: 6-Minute Walk Test (6MWT), GaitRite Functional Ambulation Profile, and Modified Emory Functional Ambulation Profile (mEFAP). Results. A total of 495 subjects were randomized, and 384 completed the 12-month follow-up. FES proved noninferior to AFOs for all primary endpoints. Both FES and AFO groups showed statistically and clinically significant improvement for 10MWT compared with initial measurement. No statistically significant between-group differences were found for primary or secondary endpoints. The FES group demonstrated statistically significant improvements for 6MWT and mEFAP Stair-time subscore. Conclusions. At 12 months, both FES and AFOs continue to demonstrate equivalent gains in gait speed. Results suggest that long-term FES use may lead to additional improvements in walking endurance and functional ambulation; further research is needed to confirm these findings.

Thursday, August 14, 2014

The Effects of Peroneal Nerve Functional Electrical Stimulation Versus Ankle-Foot Orthosis in Patients With Chronic Stroke A Randomized Controlled Trial

With Walkaide and Bioness being equal to an AFO It seems highly unlikely our insurance will pay for the expensive stuff.
http://nnr.sagepub.com/content/28/7/688?etoc
  1. Francois Bethoux, MD1
  2. Helen L. Rogers, PhD2
  3. Karen J. Nolan, PhD3,4
  4. Gary M. Abrams, MD5
  5. Thiru M. Annaswamy, MD, MA6,7
  6. Murray Brandstater, MD, PhD8
  7. Barbara Browne, MD9
  8. Judith M. Burnfield, PhD10
  9. Wuwei Feng, MD, MS11
  10. Mitchell J. Freed, MD12
  11. Carolyn Geis, MD13
  12. Jason Greenberg, MD14
  13. Mark Gudesblatt, MD15
  14. Farha Ikramuddin, MD16
  15. Arun Jayaraman, PT, PhD17
  16. Steven A. Kautz, PhD11,18
  17. Helmi L. Lutsep, MD19
  18. Sangeetha Madhavan, PhD20
  19. Jill Meilahn, DO21
  20. William S. Pease, MD22
  21. Noel Rao, MD23
  22. Subramani Seetharama, MD24
  23. Pramod Sethi, MD25
  24. Margaret A. Turk, MD26
  25. Roi Ann Wallis, MD27
  26. Conrad Kufta, MD2
  1. 1Cleveland Clinic Foundation, Cleveland, OH, USA
  2. 2Innovative Neurotronics, Austin, TX, USA
  3. 3Kessler Foundation Research Center, West Orange, NJ, USA
  4. 4Rutgers–New Jersey Medical School, Newark, NJ, USA
  5. 5San Francisco VA Medical Center, San Francisco, CA, USA
  6. 6VA North Texas Health Care System, TX, USA
  7. 7UT Southwestern Medical Center, Dallas, TX, USA
  8. 8Loma Linda University Medical Center, Loma Linda, CA, USA
  9. 9Magee Rehabilitation Hospital, Philadelphia, PA, USA
  10. 10Madonna Rehabilitation Hospital, Lincoln, NE, USA
  11. 11Medical University of South Carolina, Charleston, SC, USA
  12. 12Florida Hospital Neuroscience and Orthopedic Research Institute, Orlando, FL, USA
  13. 13Halifax Health Center for Neurosciences, Daytona Beach, FL, USA
  14. 14Helen Hayes Hospital, West Haverstraw, New York, NY, USA
  15. 15South Shore Neurologic Associates, Patchogue, NY, USA
  16. 16University of Minnesota Fairview, Minneapolis, MN
  17. 17Rehabilitation Institute of Chicago, Chicago, IL, USA
  18. 18Ralph H. Johnson VA Medical Center, Charleston, SC, USA
  19. 19Oregon Health and Science University, Portland, OR, USA
  20. 20University of Illinois at Chicago, Chicago, IL, USA
  21. 21Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, USA 54449
  22. 22The Ohio State University Wexner Medical Center, Columbus, OH, USA
  23. 23Marianjoy Rehabilitation Hospital, Wheaton, IL, USA
  24. 24Hartford Hospital, Hartford, CT, USA
  25. 25Guilford Neurologic Associates, Greensboro, NC, USA
  26. 26SUNY Upstate Medical University, Syracuse, NY, USA
  27. 27West Los Angeles VA Medical Center, Los Angeles, CA, USA
  1. Francois Bethoux, The Cleveland Clinic Foundation, Desk U10, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Email: bethouf@ccf.org

Abstract

Background. Evidence supports peroneal nerve functional electrical stimulation (FES) as an effective alternative to ankle-foot orthoses (AFO) for treatment of foot drop poststroke, but few randomized controlled comparisons exist. Objective. To compare changes in gait and quality of life (QoL) between FES and an AFO in individuals with foot drop poststroke. Methods. In a multicenter randomized controlled trial (ClinicalTrials.gov #NCT01087957) with unblinded outcome assessments, 495 Medicare-eligible individuals at least 6 months poststroke wore FES or an AFO for 6 months. Primary endpoints: 10-Meter Walk Test (10MWT), a composite of the Mobility, Activities of Daily Living/Instrumental Activities of Daily Living, and Social Participation subscores on the Stroke Impact Scale (SIS), and device-related serious adverse event rate. Secondary endpoints: 6-Minute Walk Test, GaitRite Functional Ambulation Profile (FAP), Modified Emory Functional Ambulation Profile (mEFAP), Berg Balance Scale (BBS), Timed Up and Go, individual SIS domains, and Stroke-Specific Quality of Life measures. Multiply imputed intention-to-treat analyses were used with primary endpoints tested for noninferiority and secondary endpoints tested for superiority. Results. A total of 399 subjects completed the study. FES proved noninferior to the AFO for all primary endpoints. Both the FES and AFO groups improved significantly on the 10MWT. Within the FES group, significant improvements were found for SIS composite score, total mFEAP score, individual Floor and Obstacle course time scores of the mEFAP, FAP, and BBS, but again, no between-group differences were found.  

Conclusions. Use of FES is equivalent to the AFO. Further studies should examine whether FES enables better performance in tasks involving functional mobility, activities of daily living, and balance.

Tuesday, February 11, 2014

Functional Electrical Stimulation to Augment Poststroke Reach and Hand Opening in the Presence of Voluntary Effort

Isn't this precisely what Bioness would have needed to provide to prove that its orthotic worked and thus could be prescribed and paid for?
http://nnr.sagepub.com/content/28/3/241?etoc

A Pilot Study

  1. Nathaniel S. Makowski, PhD1,2
  2. Jayme S. Knutson, PhD1,2,3
  3. John Chae, MD1,2,3
  4. Patrick E. Crago, PhD1,2
  1. 1Case Western Reserve University, Cleveland, OH, USA
  2. 2Cleveland Functional Electrical Stimulation Center, Cleveland, OH, USA
  3. 3MetroHealth Medical Center, Cleveland, OH, USA
  1. Nathaniel Makowski, 2071 Martin Luther King Jr Blvd, Cleveland, OH 44106, USA. Email: nhm6@case.edu

Abstract

Background. Hemiparesis after stroke can severely limit an individual’s ability to perform activities of daily living. Functional electrical stimulation (FES) has the potential to generate functional arm and hand movements. We have observed that FES can produce functional hand opening when a stroke patient is relaxed, but the FES-produced hand opening is often overpowered by finger flexor coactivation in response to patient attempts to reach and open the hand. Objective. To determine if stimulating both reaching muscles and hand opening muscles makes it possible to achieve useful amounts of simultaneous reach and hand opening even in the presence of submaximal reaching effort. Methods. We measured reach and hand opening during a reach-then-open the hand task under different combinations of voluntary effort and FES for both reach and hand opening. Results. As effort was reduced and stimulation generated more movement, a greater amount of reach and hand opening was achieved. For the first time, this study quantified the effect of voluntary effort for reach and hand opening on stimulated hand opening. It also showed variability in the interaction of voluntary effort and stimulation between participants. Additionally, when participants were instructed to reach with partial effort during simultaneous FES, they achieved greater reach and hand opening. Conclusions. Simultaneous reaching and FES hand opening is improved by including FES for reach and reducing voluntary effort. In the future, an upper extremity neuroprosthesis that uses a combination of voluntary effort and FES assistance may enable users to perform activities of daily living.