Forget long walks, these 6 seated exercises build more functional strength after 60

 

Have your competent? doctor EXPLAIN EXACTLY HOW YOU'LL RECOVER YOUR STRENGTH POST STROKE! Can't do that; COMPLTELY FUCKING INCOMPETENT!

Maybe these will help:

• NMES (38 posts to November 2013)
• 'Exercise-in-a-pill' (9 posts to May 2017)

Forget long walks, these 6 seated exercises build more functional strength after 60

Ok, let’s start with a caveat — do not forget long walks entirely. Walking is a fantastic way to build cardiovascular health; it’s low-impact and extremely accessible, but it often fails (alone) to build the functional muscle mass required to protect your joints as you age.

This is where strength training comes into play; however, when we think about strength training, it’s often hours spent in the gym lifting weights. This doesn’t have to be the case — read on to find a simple seated workout you can add to your routine to help build muscle, increase bone density and protect your joints.

As a reminder, if you’re returning to exercise following an extended break or you’re recovering from a specific injury, it’s always a good idea to seek personalized advice from a qualified professional before trying something new.

What is the workout?

The workout is devised by personal trainer Laura Ghiacy and involves six different exercises. You can complete all of them using just your bodyweight, but to increase the intensity, it’s worth grabbing one of the best resistance bands and a set of light weights.

You can check out the best adjustable dumbbells for working out at home here. If you don’t have weights, you could always use two cans of food or bottles of water.

You’ll also need a chair. Make sure you can sit comfortably on the edge of the chair, and place both feet flat on the floor. Preferably, the chair shouldn’t have armrests. It’s also important that it doesn’t have wheels.

Here are the exercises involved:

• Seated clams: Start sitting tall, engaging your core, with your back straight. If you have one, loop a resistance band around your legs above your knees. Keeping your feet on the floor, push both knees out to the side, pushing against the resistance band if you have one. Think about squeezing your glutes during this movement.
• Leg extensions: This exercise works your quads. Sitting on the edge of your seat, extend one leg out in front of you, keeping your foot flexed. Only lift your leg as high as your hip. Pause, then lower to your starting position. For a harder challenge, lift both legs at the same time.
• Bicep curl to shoulder press: For this exercise, hold something heavy in both hands. If you’re using a set of dumbbells, remember that the right weight will feel challenging, but not impossible, by the final few reps. Holding the weights by your side, engage your core and sit tall. Bend at the elbow to bring both weights up towards your torso, then press both up above your head. Slowly, and with control, reverse the movement so you are back in your starting position.
• Reverse flyes: This exercise works your shoulder muscles. Holding a dumbbell or something heavy in each hand, hinge your hips forward, keeping your back straight. From here, lift both weights out to the side of your body, keeping a gentle bend in your elbows. Think about squeezing your shoulder blades together as you lift the weights, slowly lowering them to your starting position.
• Seated crunch: This exercise really works your abdominal muscles. Sitting on the edge of your chair, lean your torso back slightly, keeping your back straight and really think about squeezing your abdominal muscles. From here, lift both legs off the floor, crunching your knees into your chest, then extending them back down to the floor. Tap both feet on the floor, then lift them again. To increase the intensity, lift your arms to your sides and don’t hold onto the chair.
• Side bend: Hold a dumbbell in one hand and lightly place the fingers of your opposite hand next to your head. Squeeze your core slowly with control, lower the dumbbell to the floor, completing a side crunch, then reverse the movement to sit tall. Complete all of your reps on one side and switch to the opposite side.

Ghiacy doesn’t offer reps for the workout, but try doing each for 40 seconds, followed by a 20-second rest. Repeat the circuit twice.

What are the benefits?

 Related video: Seven seated exercises that help seniors build strength and everyday independence (Senior Book)

Finally, your core will be working harder during this strength session than it will during a walk. You’ll have to engage your core to keep your spine tall during the movements, and exercises like the seated crunches will work the deep stabilizer muscles in your midsection.

It’s important not to disregard the importance of cardiovascular fitness, and seated strength training workouts like this one shouldn’t replace your walking workouts, but instead, should be used alongside walking to build functional strength and endurance.

More from Tom's Guide

• 6 simple exercises that prevent muscle loss faster than walking workouts after 60
• My dad is 72, and I still train him like a 30-year-old using these 5 strength exercises for longevity, muscle and strength
• 'I'm a 63-year-old personal trainer: These are the 5 simple bodyweight exercises I give to my clients that build muscle faster than walking workouts.'

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I'm a trainer and these are the 5 exercises men over 55 need to do each morning to rebuild arm muscle

 Have your competent? doctor EXPLAIN EXACTLY HOW YOU'LL RECOVER ARM MUSCLE POST STROKE! Can't do that; COMPLTELY FUCKING INCOMPETENT!

Maybe these:

• NMES (38 posts to November 2013)
• 'Exercise-in-a-pill' (9 posts to May 2017)

I'm a trainer and these are the 5 exercises men over 55 need to do each morning to rebuild arm muscle

Men over 55, listen up! You may not know this, but in this stage of life, arm strength naturally declines due to sarcopenia (the loss of muscle and strength), lower hormone levels, and a more sedentary lifestyle. It's something to be mindful of and proactive about. Strong arms are more essential now than ever before. After all, without strength, you place yourself at risk of being less independent. The little things in life—like carrying a golf club or picking up groceries—involve solid arm strength.

We spoke with Rob Moal, CPT with Train Like Rob, who's based in Vancouver, BC, and has over 20 years of experience helping clients build strength, shed fat, and move without pain, to learn how you can improve this strength. Moal holds certifications in personal training, nutrition, TRX, FMS, CAFS (Grey Institute), kettlebell training, corrective exercise, Twist Conditioning, and CrossFit, specializing in strength, mobility, and recovery for individuals over 35.

Moal encourages you to focus on your grip and forearms first. After all, they decline the quickest after 55. As he puts it, your curl is only as strong as your grip strength.

"Triceps second. They make up roughly two-thirds of the arm and are the most visually impactful, but most men underwork them because pushing activity naturally decreases with age," Moal adds. "The rear delt and rotator cuff are the most important for shoulder longevity. Build those, and the whole arm functions better. Biceps hold on longer than most because daily tasks keep them somewhat stimulated passively. They still need direct work, but they're not the priority most guys treat them as."

Below, Moal shares five exercises men over 55 should do each morning to build arm muscle. They're easy to add to your routine, and this small commitment will go a long way in living an active, independent lifestyle.

1. Rope Cable Tricep Pushdowns

"The rope cable pushdown keeps the shoulder in a neutral position with no overhead stress. By 55, most guys have some shoulder history and skull crushers and overhead extensions aren't worth the risk," Moal tells us.

1. Attach a rope to a cable machine's high pulley.
2. Stand facing the cable machine with your feet shoulder-distance apart, and take hold of the rope using a neutral grip—palms facing each other.
3. Keep your elbows close to the sides of your body and begin with your forearms bent to roughly 90 degrees.
4. Press the rope downward by extending your elbows until your arms are completely straight, separating the rope ends at the bottom of the movement to promote further tricep engagement.
5. Hold at the bottom for a moment before using the control to return to the start position.

RELATED: If Your Body Can Handle These 6 Tests, You're Aging Like a Pro

2. Farmer's Carry

"The farmer carry is there because grip and forearm strength decline the fastest with age, and it's the most functional thing you can do for overall arm strength and longevity," Moal points out.

1. Hold a heavy dumbbell or kettlebell—50% of your body weight—in each hand at your sides.
2. Start walking forward, keeping your torso still.
3. Continue to walk for the prescribed distance or time.

RELATED: 3 Daily Movements That Keep Your Body 10 Years Younger After 44

3. Zottman Curls

© Shutterstock

"The Zottman curl hits the biceps, brachialis, and forearms in one movement with a slow eccentric that builds muscle without a heavy load," Moal says.

1. Begin standing tall with your feet hip-width apart, holding a dumbbell in each hand by your sides with your palms facing forward.
2. Activate your core and keep your elbows close to your sides.
3. Curl the dumbbells up toward your shoulders.
4. At the top of the movement, rotate your wrists so your palms face down.
5. Slowly lower the dumbbells.
6. At the bottom, rotate your wrists so your palms face up.

RELATED: These 5 Daily Moves Reverse Muscle Loss Faster Than Gym Workouts After 45

4. Lying Side Lateral Raises

"The lying side lateral raise eliminates momentum and removes the impingement risk of standing variations," Moal explains.

1. Begin by lying on your side on a mat, with your bottom arm supporting your head.
2. Hold a lightweight dumbbell in your top hand, with your arm resting along your side.
3. Stack your shoulders and hips.
4. Lift your top arm up toward the sky in a lateral motion, maintaining a slight bend in that elbow.
5. Hold at the top for a moment.
6. Use control to lower.
7. Repeat on the other side.

RELATED: 5 Easy Bodyweight Tests That Show Your Real Fitness After 45

5. Rear Delt Machine Fly With Protraction

"The rear delt machine fly with protraction at the end of the movement activates the rear delt fully through a fixed path. The rear delt and rotator cuff atrophy fast after 55, and most people never train them directly," Moal notes.

1. Begin sitting tall, facing the machine with your chest against the pad.
2. Make sure the handles are set so your arms begin slightly ahead of your chest with a soft bend in the elbows.
3. Press your arms slightly forward, gently rounding your upper back as you do so.
4. Once you achieve the forward reach, use control to sweep your arms out wide in a reverse fly motion, squeezing your shoulder blades.
5. Gradually return forward.

Read the original article on Eat This Not That.

Comparative effectiveness of neuromuscular electrical stimulation-based combination interventions for post-stroke lower limb rehabilitation: a systematic review and network meta-analysis

 Why didn't you write protocols for the effective ones?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem!

Comparative effectiveness of neuromuscular electrical stimulation-based combination interventions for post-stroke lower limb rehabilitation: a systematic review and network meta-analysis

• Kaiqi Zheng,
• Yuan Yang,
• Pengcheng Liu,
• Weidong Liang,
• Xiaokun Gong,
• Tiangeng Li &
• Liang Guo 

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

Objective

This study aimed to comparatively evaluate the efficacy of different neuromuscular electrical stimulation (NMES)-based combination protocols for improving lower limb dysfunction in patients with stroke, in order to provide evidence-based support for clinical rehabilitation practice.

Methods

Randomized controlled trials (RCTs) investigating NMES-based combination interventions for lower limb dysfunction in patients with stroke published up to September 2, 2025 were systematically identified through searches of PubMed, Embase, the Cochrane Library, and Web of Science. The risk of bias of eligible studies was evaluated using the Cochrane Risk of Bias 2.0 (ROB 2.0) tool. Network meta-analysis (NMA) and subgroup analyses were conducted using R software (version 4.5.1) and Stata (version 15.0).

Results

In total, 37 RCTs were incorporated into the present NMA, involving 1,764 patients with stroke and encompassing nine distinct NMES-based combination intervention protocols. Regarding balance ability, core stability training (CST) combined with NMES (SMD = 0.99, 95% CrI: 0.33–1.67), gait training (GT) combined with NMES (SMD = 0.83, 95% CrI: 0.35–1.27), and NMES alone (SMD = 0.71, 95% CrI: 0.21–1.22) demonstrated significant therapeutic effects. CST+NMES (SUCRA = 76.02%) ranked highest among the NMES-based combined interventions for balance ability in patients with stroke. With respect to walking ability, no statistically significant differences were observed among the NMES-based intervention comparisons. Nevertheless, cycling exercise (CE) combined with NMES (SUCRA = 77.46%) received the highest ranking probability for walking ability, although this exploratory finding should be interpreted with caution given the absence of statistically significant differences among interventions and the lack of closed loops in the network. In terms of lower limb functional mobility, augmented reality technology (ART) combined with GT and NMES (SMD = 1.38, 95% CrI: 0.25–2.52), GT+NMES (SMD = 0.85, 95% CrI: 0.39–1.36), and NMES alone (SMD = 0.55, 95% CrI: 0.06–1.05) showed significant improvements. ART+GT+NMES (SUCRA = 84.23%) ranked highest for lower limb functional mobility. The results of the two-dimensional cluster ranking indicated that GT+NMES (SUCRA = 65.22%/49.29%/62.22%) demonstrated relatively stable ranking performance across multiple domains of lower limb dysfunction in patients with stroke. Subgroup analyses further indicated that CST+NMES appeared to be more effective for patients in the acute phase, GT+NMES for those in the subacute phase, and ART+GT+NMES for patients in the chronic phase. These subgroup-level rankings were based on limited evidence and should be considered exploratory.

Conclusions

NMES-based combination strategies have demonstrated beneficial effects on the recovery of lower limb function among individuals after stroke. Based on the results of this NMA, GT+NMES demonstrated relatively stable ranking performance across multiple outcomes, including balance, walking ability, and lower limb functional mobility, suggesting that it warrants further investigation(Why? You incompetently didn't do your job correctly?) as a combined intervention for clinical application. In addition, patients at different stages of stroke showed variable responses to NMES-based combined interventions, highlighting the importance of stage-specific and individualized rehabilitation strategies.

Trial registration: PROSPERO CRD420251229835.

Effect of Neuromuscular Electrical Stimulation on Muscle Atrophy in Patients with Acute Stroke: A Randomized Controlled Trial

 Of course, your competent? doctor put together EXACT PROTOCOLS ON NMES USE YEARS AGO, RIGHT? Too bad, your doctor is incompetent and still gets paid for not getting you fully recovered! Let's check on how long your doctor and hospital have been incompetent!

NMES (43 posts to November 2013)

Effect of Neuromuscular Electrical Stimulation on Muscle Atrophy in Patients with Acute Stroke: A Randomized Controlled Trial

Kota Yamauchi ^a, Yuri Hayashi ^b, Shota Tanaka ^a, Yoshihisa Fujino ^c, Kenichi Kumagae ^a, Kei Goto ^a, Eisei Harayama ^a, Shuji Arakawa ^d

PMCID: PMC12626773  PMID: 41267677

ABSTRACT

Objectives:

This study aimed to assess the effectiveness of neuromuscular electrical stimulation (NMES) in reducing muscle atrophy in patients with acute stroke.

Methods:

In acute stroke patients with hemiparesis, NMES or control treatment was applied to the quadriceps muscles for 2 weeks. The change of the quadriceps muscle thickness was assessed using ultrasound after 2 weeks.

Results:

Sixty-three patients were randomized to control treatment or NMES treatment. On the paretic side, muscle thickness changed by −2.65 ± 4.24 mm in the NMES group and −4.64 ± 4.58 mm in the control group (P=0.119). On the non-paretic side, the respective changes were −0.42 ± 5.19 mm and −1.93 ± 3.36 mm (P=0.223). In an exploratory subgroup analysis, no significant effect was observed in severely affected patients, whereas patients with mild-to-moderate stroke (National Institute of Health Stroke Scale score <12, n=23) showed a smaller reduction in quadriceps thickness on the paretic side in the NMES group compared with controls (0.00 ± 3.21 mm vs. −3.88 ± 5.11 mm, P=0.043). These exploratory subgroup findings should be regarded as hypothesis-generating.

Conclusions:

This underpowered trial did not demonstrate a significant preventive effect of 2 weeks of NMES on quadriceps atrophy in patients with acute stroke. Exploratory subgroup findings suggest a potential benefit in patients with less severe stroke, but these results should be considered hypothesis-generating and require confirmation in future adequately powered trials.

AI-Driven Hybrid Rehabilitation: Synergizing Robotics and Electrical Stimulation for Upper-Limb Recovery After Stroke

You'll have to depend on your competent? doctor to get this. Do you have a functioning stroke doctor or not?

AI-Driven Hybrid Rehabilitation: Synergizing Robotics and Electrical Stimulation for Upper-Limb Recovery After Stroke

Ismail Ben Abdallah¹Yassine Bouteraa^2*Ahmed Alotaibi³

• ¹Advanced Technologies in Medicine and Signals (ATMS), Ecole Nationale d’Ingénieurs de Sfax (ENIS), University of Sfax, Sfax 3038, Tunisia, Sfax, Tunisia
• ²Department of Computer Engineering, College of Computer Engineering and Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia, Riadh, Saudi Arabia
• ³Department of Mechanical Engineering, College of Engineering, Taif University, Taif 21944, Saudi Arabia., Taif, Saudi Arabia

This study presents an AI-enhanced hybrid rehabilitation system that integrates a dual-arm robotic platform with electromyography (EMG)-guided neuromuscular electrical stimulation (NMES) to support upper-limb motor recovery in stroke survivors. The system features a symmetrical robotic arm with real-time anatomical adaptation for bilateral therapy and incorporates a Support Vector Machine (SVM)-based model for continuous muscle fatigue detection using time-frequency features extracted from EMG signals. A ROS2-based architecture enables real-time signal processing, adaptive control, and remote supervision by clinicians. The system dynamically adjusts stimulation parameters based on fatigue classification results, allowing personalized and responsive therapy. Preliminary clinical validation with three post-stroke patients demonstrated a 44% increase in range of motion, 45% enhancement in active torque, and 36% reduction in passive torque. The SVM model achieved a 95% accuracy in fatigue detection, and initial patient results suggest the feasibility and potential benefits of this intelligent, closed-loop rehabilitation approach.

Effects and mechanisms of synchronous virtual reality action observation and electrical stimulation on upper extremity motor function and activities of daily living in patients with stroke: a protocol for a randomized controlled trial

 You somehow expect that this complicated intervention will be implemented? Just write up an EXACT PROTOCOL ON ACTION OBSERVATION ALONE!

There's plenty of research on that already which your incompetent doctor has done nothing with! Competence is implementing new research as it comes out. NO EXCUSES!

action observation (137 posts to June 2014)

Effects and mechanisms of synchronous virtual reality action observation and electrical stimulation on upper extremity motor function and activities of daily living in patients with stroke: a protocol for a randomized controlled trial

Yao Cui^1,2*Fang Cong^1,2*Ming Zeng³Jun Wang⁴

• ¹Department of Physical Therapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
• ²School of Rehabilitation Medicine, Capital Medical University, Beijing, China
• ³Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, The Second Hospital of Jiaxing City, Jiaxing, Zhejiang, China
• ⁴Department of Physical Therapy, Hangzhou Geriatric Hospital, Hangzhou, Zhejiang, China

Background: Existing rehabilitation techniques are not satisfactory in improving motor function after stroke, resulting in heavy social burdens. With discovery of mirror neuron system (MNS), action observation (AO) has become a promising strategy to promote motor learning in rehabilitation. Based on MNS theory and virtual reality (VR) technology, we designed an innovative rehabilitative approach: synchronous 360° VR video AO (VRAO) and neuromuscular electrical stimulation (NMES). We hypothesized that VRAO+NMES could enhance MNS activation, thus to improve upper limb motor function and activities of daily living in stroke survivors.

Methods: To explore the efficacy and mechanism of VRAO+NMES, we designed this single center, evaluator blinded, prospective, two arm parallel group randomized controlled trial with 1:1 allocation ratio. The experiment group will receive VRAO+NMES, while the control group will receive VR landscape observation combined with NMES. The Fugl-Meyer Assessment for Upper Extremity is the primary outcome of this study, Brunstrom Recovery Stages for Upper Extremity, Manual Muscle Test, Range of Motion, Modified Barthel Index, and Functional Independence Measure are the secondary outcomes. In addition, functional near-infrared spectroscopy (fNIRS) and surface electromyography (sEMG) will be used to evaluate the activation of MNS brain regions and related muscles, respectively.

Discussion: Applying VR in AO therapy (AOT) has become popular, another study direction to improve AOT is to combine it with peripheral stimulations simultaneously. Due to its full immersive characteristic and multi-sensory input, 360° videos based VRAO+NMES could improve the motivation and engagement level of participants. In addition, fNIRS and sEMG test results may act as good biomarkers to predict rehabilitation outcomes, helping select suitable candidates for this new intervention.

Conclusion: The results of this study will provide evidence for the feasibility and potential clinical efficacy of VRAO+NMES in stroke rehabilitation, thus to promote the clinical applicability and generalize its use in hospital, community, and home rehabilitation settings.

Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=178276, Identifier [ChiCTR2200063552].

1 Introduction

Stroke is the second-leading cause of mortality and the third-leading cause of disability globally (1). The physical, cognitive, and emotional disorders caused by stroke influence the patients’ life comprehensively and dramatically; approximately half of stroke survivors are chronically disabled and need long-term rehabilitation (2). Promoting changes in brain structural plasticity and functional reorganization are critical to rehabilitation of motor function following stroke (3). In physiotherapy, motor learning and relearning have become important strategies to induce neuroplasticity (4). Recently, the discovery of mirror neuron system (MNS) has further advanced our understandings of the neuroscientific mechanisms underlying motor learning and brain functional reorganization (5). Mirror neurons are a special class of neuron that excites during both observation and execution of actions. It is, therefore, possible to activate the motor system by simply observing actions without actual motor outputs (6).

The motor system has the potential to learn new skills or to recover from injury by observing others’ actions through activation of MNS (7). Meta analysis results have showed that AO therapy (AOT) is helpful to improve stroke patients’ upper extremity and hand functions, walking ability, and activities of daily living (ADLs); it has been accepted as an effective method in neurorehabilitation (8–10).

With technological advances, two important study directions have recently emerged to further promote motor learning effects induced by activation of MNS. The first direction is to change the implementation methods and techniques of AOT to improve participants’ engagement. The second direction is to combine AOT with other rehabilitation techniques, thus to obtain synergistic effects and improve treatment efficacy (11).

In the first research direction, virtual reality (VR) technology has become increasingly important. As a new modality of rehabilitative approach, VR can offer multisensory integration, including visual, tactile, vestibular, proprioceptive, interoceptive, emotional, and somatosensory inputs, creating a favorable rehabilitation environment (12). According to immersion level, VR can be divided into immersive, semi-immersive, and non-immersive VR (13). There are several types of immersive VR, graphical computational three-dimensional (3D) animations VR and 180°/360° videos VR are the most common ones (14). Compared with watching two-dimensional (2D) videos on a computer screen, participants can change their point of view freely to watch the demonstration from different angles wearing a VR headset (15).

With advances in technology, 360° videos based fully immersive VR treatments are becoming more accessible and flexible, playing an important role in enhancing wellbeing (16). The immersive feelings facilitate engagement and motivation of participants; 360° VR videos are good choices to improve immersive feelings (17). With the highest levels of immersion and reality, the novelty of 360° VR videos will make AOT more interesting and motivating. Furthermore, by capturing or displaying a full spherical view, 360° VR provides a more authentic and immersive experience, closely resembling real-life perception (18). As the result, the enhanced immersive feelings will motivate participants to view the videos and try to imitate the actions (19, 20). In addition, the high frame rate (e.g., 100 fps) of the modern 360° camera allows users to capture slow motions of the observed actions, helping to show step-by-step details of daily life actions.

The second research direction involves obtaining synergistic effects through combination of AOT with other rehabilitation techniques. This is mainly based on the theory that central-peripheral synchronous stimulations have the potential to improve brain activity (21). To further evoke plasticity in human motor system, AOT has been reported to be combined with different treatments, including transcranial magnetic stimulation (TMS), electrical stimulation (ES), and rehabilitation robots (11). The most common peripheral stimulation is low-frequency ES, which is a kind of physiotherapy modality used to improve motor and sensory function, including neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES), and peripheral nerve stimulation (PNS) (22). When applying AOT+PNS in healthy individuals, the PNS-generated afferent signals from the periphery induce neural plasticity in primary motor cortex (M1) (23). Seitz et al. (24) studied the immediate effect of concurrent applications of AO, motor imagery (MI), and PNS, showing that AO+MI+PNS can induce plasticity in M1.

Based on the above background, we designed a new kind of rehabilitative technique: concurrent VR-based AO combine with NMES (VRAO+NMES). By playing immersive 360° videos in a VR headset, we present visual information to participants. We have tested the validity of combination of AO and NMES in a previous study, using 2D video clips of hand extension movements as the modality of AOT. We tested brain activation patterns of left MNS during AO, action execution, and imitation combined with NMES in healthy participants, the results proved that MNS-based rehabilitation approaches may enhance cortical activation of MNS (21). In addition, we also confirmed that compared with action execution and 2D video based action imitation, the activation of MNS was enhanced when combing them with NMES (11). Here, we will further test the VRAO+NMES application in stroke rehabilitation.

Due to the effects of action visual stimulation on MNS and ES on motor units (MUs), VRAO+NMES may be helpful to accelerate the process of motor learning. In addition, the enhanced multisensory interactions generated by VRAO+NMES have potential to improve the alteration of body ownership and induce self-body recognition (23). To investigate the potential neuromuscular control mechanism underlying this new intervention, we will use functional near-infrared spectroscopy (fNIRS) and surface electromyography (sEMG) to evaluate the activation of brain regions and muscles, respectively. In addition, MNS network-based neuroplasticity changes have been confirmed recently, we will also explore the brain functional connection changes before and after the interventions (25).

We, therefore, aim to determine whether a concurrent application of VRAO and NMES would result in significant improvements in behavioral assessments and neurophysiological parameters, and to test whether the changes in motor function evaluated by clinical scales are related to the brain functional imaging results measured by fNIRS. We hypothesize that VRAO+NMES is superior in improving upper extremity and hand motor functions, ADLs, and MNS cortical activation levels compared to conventional therapy plus NMES. The underlying mechanism may be that the brain-muscle synchronous intervention enhances activation of the MNS and recruitment of MUs, thereby promoting brain plasticity changes, improving neuromuscular control function, and enhancing therapeutic effects.

More at link.

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

• Metrics details

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.