Symmetry and limb dominance in able-bodied gait: a review.

Hemiparetic gait following stroke. Part I: Characteristics

▪ 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

ObjectiveThe aim of this study was to assess the safety and performance of ReWalk in enabling people with paraplegia due to spinal cord injury to carry out routine ambulatory functions.DesignThis was an open, noncomparative, nonrandomized study of the safety and performance of the ReWalk pow

The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury.

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.

Multichannel electrical stimulation for correction of hemiplegic gait. Methodology and preliminary results.

We report about the results on positioning of the ankle joint of a hemiplegic patient and of normal experimental subjects, using functional electrical stimulation (FES) of antagonistic muscle groups and position feedback. Such a controller is intended to be used as the execution level of a multilevel orthotic system. The synthesis of the controller has been made with the aid of the components of an analog hybrid computer. Experimental results show that the static and dynamic properties of regulated movements are not essentially inferior to the properties of voluntary movements. There are stated technological problems that will have to be solved before the controller can be clinically applied for rehabilitation purposes. At the present state of the art, the poor technology of FES, the unsolved problem of fatigue with FES muscles, size, price, and bad cosmetic effect prevent the position controller from being clinically applicable.

Closed-Loop Positioning of Hemiplegic Patient's Joint by Means of Functional Electrical Stimulation

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.

Although the functional electrical stimulation orthosis is one of the most recent approaches to the rehabilitation of hemiplegic patients, the quantitative estimate of its influence on the patients walking is not satisfactorily solved. In this communication the variables necessary for gait evaluation are defined and two quantitative methods for their interpretation are given. The second method was tested on eight hemiplegic patients. The results show the applicability of the described techniques of evaluation.

Quantitative Gait Evaluation of Hemiplegic Patients Using Electrical Stimulation Orthoses

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.

U. Stanič

Papers

Multichannel electrical stimulation for correction of hemiplegic gait. Methodology and preliminary results.

Closed-Loop Positioning of Hemiplegic Patient's Joint by Means of Functional Electrical Stimulation

Gait evaluation in hemiparetic patients using subcutaneous peroneal electrical stimulation.

Quantitative Gait Evaluation of Hemiplegic Patients Using Electrical Stimulation Orthoses

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