Beneficial effects of eight weeks of FES-assisted cycling on aerobic capacity and paretic quadriceps thickness in post-stroke hemiparesis

 'Improved' IS STILL FAILURE! It means your competent? doctor and hospital has lots more work to do to get to 100% recovery! Make sure you DEMAND 100% RECOVERY PROTOCOLS from your doctor! Nothing less!

Beneficial effects of eight weeks of FES-assisted cycling on aerobic capacity and paretic quadriceps thickness in post-stroke hemiparesis

• Maël Descollonges,
• Julie Di Marco,
• Pierre-Henri Pouillart,
• Ehsan Jafari,
• Lana Popović-Maneski,
• Ana Z. Radić,
• Olivera C. Djordjević,
• Ljubica M. Konstantinović,
• Sindi Z. Mitrović,
• Julien V. Brugniaux &
• Gaëlle Deley 

• 43 Accesses

• Explore all metrics

We’re sharing this article early to provide faster access to peer-reviewed, accepted research. It is citable and carries a permanent DOI. This version is subject to further edits and will be replaced automatically by the final Version of Record. All legal disclaimers apply.

Abstract

Background

Stroke is a leading cause of long-term disability worldwide, frequently impairing walking ability, postural control, and muscle strength. Hemiparesis, affecting nearly 90% of stroke survivors, results in unilateral motor deficits and presents substantial rehabilitation challenges. Functional electrical stimulation-assisted cycling (FES-assisted cycling) has shown potential to activate paretic muscles, improve aerobic capacity, and enhance motor coordination.

Objective

This study aimed to compare the effects of an 8-week FES-assisted cycling program (Kurage, Lyon, France) versus traditional cycling (without stimulation) on aerobic fitness, muscle thickness, and walking performance in post-stroke participants.

Methods

This randomized study included 31 post-stroke participants (21 men, 10 women; age: 57 ± 12 years), who were randomly assigned to either an FES-assisted cycling group or a conventional cycling group. Both groups completed 24 cycling sessions (30 min each) over 8 weeks, in addition to standard rehabilitation. Outcomes included peak oxygen uptake (V̇O₂peak), maximal power output, muscle thickness (rectus femoris and vastus intermedius), and walking ability (6-Minute and 10-Meter Walk Tests).

Results

Both groups showed significant improvements in V̇O₂peak, power output, muscle thickness, and walking test performance. The FES group showed greater gains in V̇O₂peak (+ 27% vs. +12% in the control group; P = 0.038) and in paretic muscle thickness (rectus femoris: +17% vs. +3%, P = 0.036; vastus intermedius: +24.6% vs. +7%, P = 0.029). A trend toward greater improvement in the 6-Minute Walk Test was also observed in the FES group (+ 43% vs. +25%; P = 0.082).

Conclusion

FES-assisted and traditional cycling improved exercise capacity, muscle thickness, and walking ability in post-stroke participants. FES-assisted cycling led to additional benefits specifically for V̇O₂peak and localized hypertrophy in the paretic muscles targeted by FES, suggesting specific neuromuscular adaptations that are not commonly described in previous studies. These peripheral changes indicate that FES-assisted cycling may offer unique muscular benefits, particularly for individuals with limited voluntary control. These findings refine our understanding of FES as a complementary tool in stroke rehabilitation. Further research with larger cohorts and longer follow-up is needed to confirm these effects and assess long-term outcomes.

Functional electrical stimulation and brain-machine interfaces for simultaneous control of wrist and finger flexion

 When is the intervention that opens the hand(extension)? You can't grasp anything if you can't even open it. DO THINGS IN THE CORRECT ORDER!

Not applicable for stroke spasticity!

Functional electrical stimulation and brain-machine interfaces for simultaneous control of wrist and finger flexion

• Matthew J. Mender,
• Ayobami L. Ward,
• Luis H. Cubillos,
• Madison M. Kelberman,
• Joseph T. Costello,
• Hisham Temmar,
• Dylan M. Wallace,
• Edanjen T. Lin,
• Jordan L. W. Lam,
• Matthew S. Willsey,
• Nishant Ganesh Kumar,
• Theodore A. Kung,
• Parag G. Patil &
• Cynthia A. Chestek 

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract

Background

Restoring dexterous hand movements in individuals with cervical spinal cord injury requires continuous control of multiple biomechanically linked degrees-of-freedom (DOF). Brain-machine interface (BMI) controlled functional electrical stimulation (FES) is a promising method to restore hand movements. We explored the suitability of restoring movement to two biomechanically linked DOF simultaneously, finger flexion and wrist flexion, using previously introduced FES methods, namely stimulation targeting individual DOFs independently. We then demonstrate a finger and wrist movement BMI that, when combined with the FES system, could restore simultaneous control of wrist and finger flexion.

Methods

Two monkeys were implanted with intramuscular electrodes in muscles of the hand. Stimulation on these electrodes was used to evoke finger and wrist movements in both monkeys. Additionally, one of these monkeys was implanted with intracortical electrode arrays in the primary motor cortex and used a BMI to control wrist and finger flexion in a virtual hand without FES.

Results

First we demonstrate a monkey using an intracortical BMI to control the wrist and finger flexion in a virtual hand, both before and after the hand is temporarily paralyzed, achieving success rates and acquisition times equivalent to able-bodied control with BMI control after temporary paralysis in two sessions. We then show that intramuscular FES with two predetermined stimulation patterns, one targeting finger flexion and one targeting wrist flexion, can move the monkeys’ fingers and wrist across a functional range of motion. Due to the biomechanical coupling of the wrist and fingers, stimulation targeting finger or wrist flexion individually ultimately evokes movements in both DOF. However, we demonstrate that a simple control strategy treating each DOF independently was able to control both DOF simultaneously in a closed-loop task, achieving greater than 80% success rates.

Conclusions

We outline a method using an artificial brain-to-body interface that could restore continuous wrist and finger movements after spinal cord injury.

Biomechanical and neural correlates of FastFES versus Fast gait training in individuals post stroke: a randomized control trial study protocol

 You're going to have to cure a lot of survivors of spasticity before you can even get to fast gait training! If I walk fast my left knee hyperextends and snaps, eventually knee replacement will be needed, all because of not doing anything about my spasticity.

30% get spasticity

Biomechanical and neural correlates of FastFES versus Fast gait training in individuals post stroke: a randomized control trial study protocol

• 

  Vyoma Parikh 1

• A

  Alexandra Slusarenko 1

• J

  Jacob Spencer 2

• J

  Jasmine M. Hope 3

• F

  Fisayo K. Aloba 4

• 

  Amit S. Grewal 5

• 

  Bennett L. Alterman 1

• K

  Keenan Batts 1

• C

• L

• S

• 

• 

• 

  Trisha M. Kesar 1,4,7*

• 1. Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States

• 2. Department of Physical Therapy, College of Allied Health Sciences, University of Illinois Chicago, Chicago, IL, United States

Abstract

Background: 

Fast gait training, individually and when combined with functional electrical stimulation (FastFES), has been shown to improve walking function in individuals post stroke. However, the neural mechanisms underlying the effects of these two gait training interventions are poorly understood. The purpose of this mechanism-focused gait rehabilitation randomized clinical trial is to assess the effects of Fast and FastFES gait training interventions on corticospinal neurophysiology, gait biomechanics, energy cost, and walking function in individuals with chronic post-stroke hemiparesis.

Methods: 

In this randomized clinical trial, participants with chronic stroke are recruited and randomized to receive one of two gait training interventions—FastFES or Fast. Participants in each intervention group receive 12 sessions of gait training, with each training session comprising 30 min of training. During FastFES training, electrical stimulation is delivered to ankle dorsi- and plantar-flexor muscles during paretic swing phase and late stance phase, respectively. Evaluations of clinical, gait biomechanics, neurophysiological, and energy cost outcomes are performed at baseline, after completion of 12 training session (post12), and at 3-weeks and 6-weeks after completion of training (3-week follow up, 6-week follow up), to measure longitudinal effects of gait training. Additional evaluations are performed at completion of 3 and 6 training sessions (post3 and post6) to measure the time course of change during gait training. Upon completion of the study, planned analyses will include between-group comparisons of FastFES versus Fast gait training on training-induced changes in corticomotor and spinal excitability, gait biomechanics outcomes such as peak anterior ground reaction force, as well as association of training-induced changes in corticospinal neurophysiology and gait biomechanics with clinical and energy cost measures.

Discussion: 

By elucidating the biomechanical and neural correlates underlying gait training-induced changes in locomotor function, this study promises to build on existing evidence supporting the clinical effects of FastFES and Fast gait training. The long-term goal of this study is to inform the development of neurobiology-informed, personalized, and innovative strategies to enhance the effectiveness of stroke gait rehabilitation.

Clinical trial registration:

clinicaltrials.gov, identifier NCT04380454.

Exploring occupational therapists’ perceptions of the use of functional electrical stimulation in adult stroke rehabilitation

Who cares what therapists think? Survivors are the client; you ask them how well you as a therapist are providing EXACT recovery protocols! If you're willing to listen, they'll tell you you have NOTHING concrete for recovery!

 Exploring occupational therapists’ perceptions of the use of functional electrical stimulation in adult stroke rehabilitation

Sarah Frew

 &

Fiona Breytenbach

, Accepted 29 May 2026, Published online: 09 Jun 2026

Abstract

Purpose: Stroke is one of the leading global causes of disability, with motor deficits, particularly in the upper limb, being among the most common and debilitating consequences. Occupational therapists are crucial members of the multidisciplinary team, working to enhance patients’ participation in daily activities by addressing motor impairments through interventions such as Functional Electrical Stimulation (FES). However, an evidence-practice gap exists in the application of FES. This study aimed to explore occupational therapists’ perceptions of using FES in adult stroke rehabilitation in Gauteng, South Africa. This study employed a descriptive qualitative research design. Twelve occupational therapists participated in semi-structured interviews conducted via an online platform. The research population included clinicians working in the neurorehabilitation field in Gauteng, South Africa from both public and private healthcare sectors. An inductive thematic analysis was used to analyse the data.  Three themes emerged from this qualitative study, namely, ‘A Tug of War’, ‘The Lost Leading the Lost’ and ‘A Puzzle of Practicality’. These themes unravel the perceptions of occupational therapists and explore the factors that influence the use of FES in stroke rehabilitation. Conclusion: Many identified perceptions and factors challenge the use of FES in adult stroke rehabilitation. Addressing these challenges is essential for improving evidence-based practices in occupational therapy, especially for motor impairments after stroke.

IMPLICATIONS FOR REHABILITATION

Training on FES needs to be enhanced at an undergraduate and postgraduate level for improved application of the technology.Open-loop FES currently does not align with the complex movement patterns required for occupation-based intervention and is therefore best suited as a preparatory modality. Policy, protocol, and guideline development is needed for a unified approach to FES use in stroke rehabilitation. The commercial availability and access to closed-loop FES systems should be explored by rehabilitation technology manufacturers and sales representatives.

A Compact Wearable sEMG–FES System for Bilateral Post-Stroke Rehabilitation

 No clue what this can do to get survivors recovered. A complete failure of the mentors and senior researchers to state EXACTLY what stroke research is for; TO GET SURVIVORS RECOVERED!

No protocols delivered or results discussed; so useless!

A Compact Wearable sEMG–FES System for Bilateral Post-Stroke Rehabilitation

Martina Vita; Giuseppe Coviello; Maurizio Pellegrini; Giuseppe Brunetti; Caterina Ciminelli

All Authors

 

Abstract:

 Stroke-related upper limb motor impairment frequently leads to chronic muscle weakness and reduced functional mobility, significantly affecting patients’ independence and quality of life. Functional Electrical Stimulation (FES) combined with surface electromyography (sEMG) feedback has shown significant potential in promoting neuroplasticity and supporting motor recovery by reinforcing the association between voluntary intention and muscle activation. However, existing systems typically rely on multiple independent devices for signal acquisition, processing and stimulation. This fragmented architecture increases cost, size, latency and integration complexity. This work presents a new wearable hardware platform that integrates sEMG acquisition and FES delivery within a single compact module. The proposed solution embeds an ADS1299- based front-end for low-noise sEMG recording and a digitally controlled high-voltage stimulator, enabling simultaneous acquisition and stimulation in two muscle groups. The platform supports a bilateral closed-loop rehabilitation paradigm in which voluntary sEMG activity recorded from the dominant arm is used to drive FES delivered to the contralateral limb. In this study, a trigger-based control strategy is adopted, whereby stimulation is activated when the root mean square (RMS) of the processed sEMG signal exceeds an adaptive threshold, and preliminary experimental results demonstrate the feasibility of the proposed system for bilateral sEMG-driven FES applications in post-stroke rehabilitation.

Efficacy of functional electrical stimulation at different frequencies for post-stroke foot drop: a retrospective cohort study

 

NO efficacy percentages and NO PROTOCOLS, so you completely failed at your research! Are your mentors and senior researchers that incompetent they don't know how to direct research?

Efficacy of functional electrical stimulation at different frequencies for post-stroke foot drop: a retrospective cohort study

• 

  Bin Zhang *

• C

  Chen Fang

• Y

  Youqing Su

• Department of Rehabilitation, Hangzhou Ninth Hospital, Hangzhou, China

Abstract

Objective: 

To compare the efficacy and safety of low, medium, and high-frequency functional electrical stimulation (FES) in post-stroke foot drop (FD), aiming to identify optimal frequency parameters for clinical practice.

Methods: 

In this retrospective cohort study, 90 patients with post-stroke FD admitted between January 2021–December 2023 were grouped based on received FES frequency: low-frequency (20–30 Hz, n = 30), medium-frequency (31–40 Hz, n = 30), and high-frequency (41–50 Hz, n = 30). All patients received conventional rehabilitation combined with FES. The primary efficacy outcome was the improvement in 10-meter maximum walking speed (10MWS). Secondary outcomes included Fugl-Meyer Assessment for Lower Extremity (FMA-LE) scores and Functional Ambulation Category (FAC), and ankle dorsiflexor muscle strength.

Results: 

Baseline characteristics were comparable (all p > 0.05). The medium-frequency group showed significantly greater improvement in 10MWS (0.246 ± 0.095 m/s) versus low (0.154 ± 0.063 m/s) and high-frequency groups (0.145 ± 0.050 m/s) (p < 0.001). FMA-LE improvement was also superior in the medium-frequency group (8.60 ± 1.99 points; p < 0.001). Ankle dorsi-flexor strength improvement was significantly greater in the medium-frequency group (1.93 ± 0.25 grade) compared to both low (0.97 ± 0.18 grade) and high-frequency groups (1.03 ± 0.18 grade) (p < 0.001), with a favorable trend also observed in FAC. Adverse event incidence was low (3.3%) and similar across groups (p = 0.355). Subgroup analysis indicated consistent medium-frequency efficacy across stroke types.

Conclusion: 

In this retrospective comparative study, medium-frequency (31–40 Hz) FES was associated with optimal efficacy and safety outcomes for post-stroke FD, showing significantly greater improvement in walking speed and lower limb function without added risk. These findings suggest it as a promising parameter for clinical evaluation, though verification by prospective trials is warranted.

1 Introduction

Stroke remains one of the leading global causes of disability and mortality (1, 2). Epidemiological data indicate a significant increase in the overall burden of stroke from 1990 to 2021, reflected by a 70.0% rise in new cases, a 44.0% increase in deaths, an 86.0% growth in prevalence, and a corresponding 32% increase in disability-adjusted life years (3). Stroke-induced impairments extensively affect multiple dimensions, including physical function, occupational participation, communication ability, and social integration (4), with motor dysfunction being particularly prominent; approximately 80% of survivors experience varying degrees of limb motor impairment (5). Foot drop (FD), a common manifestation of motor dysfunction, is characterized primarily by weakness in ankle dorsiflexion and eversion. This leads to diminished mobility, impaired balance, and reduced walking efficiency, subsequently increasing the risk of falls and significantly constraining patients’ quality of daily life and level of social participation (6).

Electrical stimulation is among the effective treatments for alleviating walking dysfunction after stroke. In particular, functional electrical stimulation (FES) has become a standard neurorehabilitation intervention for post-stroke FD (7, 8). This is supported by high-level evidence, such as a systematic review and meta-analysis of randomized controlled trials which concluded that FES significantly improves walking speed in ambulatory stroke survivors (9). This technique involves stimulating the common peroneal nerve via surface electrodes during the swing phase of gait to elicit ankle dorsiflexion, thereby effectively correcting gait abnormalities (10). The underlying mechanisms include FES’s ability not only to stimulate voluntary muscle activity, directly ameliorating FD and reducing spasticity, but also to promote long-term functional reorganization of the sensorimotor cortex (11, 12).

However, despite the established efficacy of FES, optimizing its treatment parameters remains a key challenge in current rehabilitation medicine research. Stimulation frequency, as a core FES parameter, directly influences muscle contraction characteristics, the degree of neuromuscular fatigue, and the ultimate functional output. Although the commonly used clinical frequency range is broad (20–50 Hz), aiming to elicit functional contraction of target muscles by activating motor nerve fibers (11), a consensus on the optimal frequency is lacking and significant controversy persists. Some studies support the use of lower frequencies to achieve smoother muscle contractions (13), while other evidence suggests that higher frequencies offer advantages in improving muscle strength and motor activation characteristics (14). This uncertainty in clinical practice stems primarily from a lack of high-quality studies directly and systematically comparing different frequencies. Indeed, recent reviews have explicitly highlighted the need for further comparisons of the effects of neuromuscular electrical stimulation with different stimulation frequencies (11).

Based on the premise that higher frequencies might generate stronger muscle contractions, we initially hypothesized that high-frequency FES would yield superior functional outcomes compared to low-frequency stimulation. Therefore, this clinical efficacy study aims, via a retrospective cohort design, to systematically compare the functional outcomes of FES at three commonly used frequency ranges (low: 20–30 Hz, medium: 31–40 Hz, high: 41–50 Hz) on walking function, lower limb motor function, and safety in patients with post-stroke FD. The primary goal is to inform optimal parameter selection for clinical practice, rather than to elucidate underlying neurophysiological mechanisms.

More at link.