▪ Abstract Paralyzed or paretic muscles can be made to contract by applying electrical currents to the intact peripheral motor nerves innervating them. When electrically elicited muscle contractions are coordinated in a manner that provides function, the technique is termed functional electrical stimulation (FES). In more than 40 years of FES research, principles for safe stimulation of neuromuscular tissue have been established, and methods for modulating the strength of electrically induced muscle contractions have been discovered. FES systems have been developed for restoring function in the upper extremity, lower extremity, bladder and bowel, and respiratory system. Some of these neuroprostheses have become commercialized products, and others are available in clinical research settings. Technological developments are expected to produce new systems that have no external components, are expandable to multiple applications, are upgradable to new advances, and are controlled by a combination of signals, ...

https://www.annualreviews.org/doi/pdf/10.1146/annurev.bioeng.6.040803.140103

Functional electrical stimulation for neuromuscular applications

This review provides a comprehensive overview of the clinical uses of neuromuscular electrical stimulation (NMES) for functional and therapeutic applications in subjects with spinal cord injury or stroke. Functional applications refer to the use of NMES to activate paralyzed muscles in precise sequence and magnitude to directly accomplish functional tasks. In therapeutic applications, NMES may lead to a specific effect that enhances function, but does not directly provide function. The specific neuroprosthetic or "functional" applications reviewed in this article include upper- and lower-limb motor movement for self-care tasks and mobility, respectively, bladder function, and respiratory control. Specific therapeutic applications include motor relearning, reduction of hemiplegic shoulder pain, muscle strengthening, prevention of muscle atrophy, prophylaxis of deep venous thrombosis, improvement of tissue oxygenation and peripheral hemodynamic functioning, and cardiopulmonary conditioning. Perspectives on future developments and clinical applications of NMES are presented.

Neuromuscular electrical stimulation in neurorehabilitation.

Normative data of knee joint motion and ground reaction forces in adult level walking

Both aging and diseases that are more prevalent with aging affect how older adults walk. This review addresses the evaluation and treatment of gait disorders in older adults. The focus is on comfortable gait, the most common clinically evaluated aspect of walking. GAIT AND DISABILITY From 8 to 19% of noninstitutionalized older adults have difficulty walking or require the assistance of another person or special equipment to walk. J,2 Walking disability increases with age. For example, 6% of female East Boston respon­ dents aged 65 to 69, compared with 38% of those aged 85 and older, need assistance in walking.:' Limitations in walk­ ing can be seen in as many as 63% of nursing home resi­ dents." In older adults with diseases such as arthritis, 35% admit to difficulty in walking one-quarter mile:' Measures such as gait speed provide an index of func­ tional status. Even in those who report no difficulty in walk­ ing one-half mile, a timed 8-foot walk, in addition to other lower-extremity function tests, ultimately predicts mobility­ related and ADL disability at 4-year follow-up." Self-selected gait speed predicts self-perceived physical function, as mea­ sured by the Sickness Impact Profile (SIP), better than other physical measures such as balance and grip strength, partic­ ularly among frail nursing home residents." Prolonged 50­ foot walk time relates to increased arthritis activity, although improvements in symptoms and signs predict walk time im­ provement inconsistently.v" Walking speed is particularly important for crossing traffic intersections safely. In a 1994 study, 27% of 592 older adult pedestrians were unable to reach the opposite curb before the light changes to allow cross traffic to enter the intersection.!" Finally, faster gait speed on admission predicts success in rehabilitation, 11 and slow gait speed on discharge predicts institutionalization. 12 Fifty-four percent of those requiring skilled care compared with none of those discharged home or to nonskilled levels of care have discharge walking speeds below 0.15 m/sec.'? Gait speed assessment is particularly useful in patients with cardiopulmonary disease.Pv'" Self-paced 6-minute walking distance discriminates between NYHA levels of con­ gestive heart failure l5-17 and predicts hospitalization rates

https://deepblue.lib.umich.edu/bitstream/handle/2027.42/111109/j.1532-5415.1996.tb06417.x.pdf?sequence=1

Gait Disorders in Older Adults

Justification of triaxial goniometer for the measurement of joint rotation.

In hemiparetic patients with an implantable peroneal stimulator for correction of drop foot the gait pattern was studied over several years. The gait parameters and M-waves of subcutaneously stimulated muscles were compared with the results obtained before implantation and their variation was observed over time. Of a group of 35 patients with previously implanted electrodes 19 were evaluated. Significant improvements of gait were found although in some cases an excessive eversion of the foot was observed. Nine of these patients had reimplantation because of displacement of the stimulation electrodes after an average time of 3.5 years of proper functioning of the implant. After the reimplantations, similar gait patterns and muscular responses to stimulation were observed as after the initial implantation.

Gait evaluation in hemiparetic patients using subcutaneous peroneal electrical stimulation.

The estimation of patients gait in the field of rehabilitation is the starting point for an appropirate therapy decision and convenient prosthesis or orthosis choice. The measurement and estimation of human locomotion is increasingly being transferred to every day clinical use. In recent times many systems are intended for kinematic gait parameters measurements: stroboscopic photography, movie camera, TV picture analysis, TV signal analysis, chronocyclographical measurement, polarised light goniometer, the "Selspot" system, parallelgram goniometers, exoskeleton goniometers. In the paper the role of the computer in gait measurements is also determined. The problems of the choice of parameters to be measured, unique reference coordinate systems and normal gait pattern are encountered in this work. Finally two versions of pathological gait pattern estimation are described: clinical gait analysis and mathematical quantitative gait analysis. A combination of both methods provides an efficient, compact automatic pathological gait pattern diagnostics.

Acimović R

Papers

Gait evaluation in hemiparetic patients using subcutaneous peroneal electrical stimulation.

Standardization of kinematic gait measurements and automatic pathological gait pattern diagnostics.