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1.
Artif Organs ; 48(3): 285-296, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37431960

ABSTRACT

PURPOSE: A Clinical Practice Guideline (CPG) is required to provide guidance on optimal service delivery for Functional Electrical Stimulation (FES) to support upright mobility in people living with mobility difficulties due to an upper motor neuron lesion, such as stroke or multiple sclerosis. A modified Delphi consensus study was used to provide expert consensus on best practice. METHODS: A Steering Group supported the recruitment of an Expert Panel, which included a range of stakeholders who participated in up to three survey rounds. In each round, panelists were asked to rate their agreement with draft statements about best practice using a 6-point Likert scale and add free text to explain their answer. Statements that achieved over 75% agree/strongly agree on the Likert scale were included in the CPG. Those that did not were revised based on free text comments and proposed in the next survey round. RESULTS: The first round included 82 statements with seven substatements. Sixty-five people (84% response rate) completed survey round 1 leading to 62 statements and four substatements being accepted. Fifty-six people responded to survey round 2, and consensus was achieved for all remaining statements. CONCLUSION: The accepted statements are included within the CPG and provide recommendations about who can benefit from FES and how they can be optimally supported through FES service provision. As such the CPG will support advocacy for, and optimal design of, FES services.


Subject(s)
Motor Neurons , Humans , Consensus , Delphi Technique , Surveys and Questionnaires , Practice Guidelines as Topic
2.
Artif Organs ; 48(3): 210-231, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37259954

ABSTRACT

PURPOSE: To conduct an umbrella review of systematic reviews on functional electrical stimulation (FES) to improve walking in adults with an upper motor neuron lesion. METHODS: Five electronic databases were searched, focusing on the effect of FES on walking. The methodological quality of reviews was evaluated using AMSTAR2 and certainty of evidence was established through the GRADE approach. RESULTS: The methodological quality of the 24 eligible reviews (stroke, n = 16; spinal cord injury (SCI), n = 5; multiple sclerosis (MS); n = 2; mixed population, n = 1) ranged from critically low to high. Stroke reviews concluded that FES improved walking speed through an orthotic (immediate) effect and had a therapeutic benefit (i.e., over time) compared to usual care (low certainty evidence). There was low-to-moderate certainty evidence that FES was no better or worse than an Ankle Foot Orthosis regarding walking speed post 6 months. MS reviews concluded that FES had an orthotic but no therapeutic effect on walking. SCI reviews concluded that FES with or without treadmill training improved speed but combined with an orthosis was no better than orthosis alone. FES may improve quality of life and reduce falls in MS and stroke populations. CONCLUSION: FES has orthotic and therapeutic benefits. Certainty of evidence was low-to-moderate, mostly due to high risk of bias, low sample sizes, and wide variation in outcome measures. Future trials must be of higher quality, use agreed outcome measures, including measures other than walking speed, and examine the effects of FES for adults with cerebral palsy, traumatic and acquired brain injury, and Parkinson's disease.


Subject(s)
Electric Stimulation Therapy , Stroke , Adult , Humans , Quality of Life , Systematic Reviews as Topic , Walking/physiology , Lower Extremity , Stroke/complications , Stroke/therapy , Electric Stimulation , Motor Neurons
4.
J Rehabil Assist Technol Eng ; 10: 20556683231200181, 2023.
Article in English | MEDLINE | ID: mdl-37667734

ABSTRACT

Dr. Tamsyn Street is an interdisciplinary researcher working for the National Health Service (NHS) in the UK with a background in motor neurorehabilitation. In the last couple of decades there has been a rapid advancement in assistive technology solutions using electrical stimulation for neurorehabilitation. This editorial examines whether these advancements have translated into good inclusive design performance for clinician and patient end users. Suggestions for overcoming some of the existing challenges are proposed.

6.
Front Rehabil Sci ; 4: 1062356, 2023.
Article in English | MEDLINE | ID: mdl-36776737

ABSTRACT

Functional Electrical Stimulation (FES) has been used to support mobility for people with upper motor neuron conditions such as stroke and multiple sclerosis for over 25 years. Recent development and publication of clinical practice guidelines (CPGs) provide evidence to guide clinical decision making for application of FES to improve mobility. Understanding key barriers to the implementation of these CPGs is a critical initial step necessary to create tailored knowledge translation strategies. A public involvement and engagement consultation was conducted with international stakeholders including researchers, clinicians and engineers working with FES to inform implementation strategies for CPG use internationally. Reflexive thematic analysis of the consultation transcripts revealed themes including inconsistent use of CPGs, barriers to implementation such as limited access to FES and low clinician confidence, and the need for a tiered education approach with ongoing support. Insights derived from this consultation will inform the development of knowledge translation strategies to support the next steps to implementing FES use for mobility.

8.
Trials ; 22(1): 621, 2021 Sep 15.
Article in English | MEDLINE | ID: mdl-34526100

ABSTRACT

BACKGROUND: Colorectal cancer is associated with secondary sarcopenia (muscle loss) and myosteatosis (fatty infiltration of muscle) and patients who exhibit these host characteristics have poorer outcomes following surgery. Furthermore, patients, who undergo curative advanced rectal cancer surgery such as pelvic exenteration, are at risk of skeletal muscle loss due to immobility, malnutrition and a post-surgical catabolic state. Neuromuscular electrical stimulation (NMES) may be a feasible adjunctive treatment to help ameliorate these adverse side-effects. Hence, the purpose of this study is to investigate NMES as an adjunctive pre- and post-operative treatment for rectal cancer patients in the radical pelvic surgery setting and to provide early indicative evidence of efficacy in relation to key health outcomes. METHOD: In a phase II, double-blind, randomised controlled study, 58 patients will be recruited and randomised (1:1) to either a treatment (NMES plus standard care) or placebo (sham-NMES plus standard care) group. The intervention will begin 2 weeks pre-operatively and continue for 8 weeks after exenterative surgery. The primary outcome will be change in mean skeletal muscle attenuation, a surrogate marker of myosteatosis. Sarcopenia, quality of life, inflammatory status and cancer specific outcomes will also be assessed. DISCUSSION: This phase II randomised controlled trial will provide important preliminary evidence of the potential for this adjunctive treatment. It will provide guidance on subsequent development of phase 3 studies on the clinical benefit of NMES for rectal cancer patients in the radical pelvic surgery setting. TRIAL REGISTRATION: Protocol version 6.0; 05/06/20. ClinicalTrials.gov NCT04065984 . Registered on 22 August 2019; recruiting.


Subject(s)
Electric Stimulation Therapy , Rectal Neoplasms , Sarcopenia , Bicycling , Electric Stimulation , Electric Stimulation Therapy/adverse effects , Humans , Quality of Life , Rectal Neoplasms/complications , Rectal Neoplasms/surgery , Sarcopenia/diagnosis , Sarcopenia/etiology , Sarcopenia/therapy
9.
J Rehabil Med ; 53(3): jrm00164, 2021 Mar 18.
Article in English | MEDLINE | ID: mdl-33634830

ABSTRACT

The rehabilitation of patients with COVID-19 after prolonged treatment in the intensive care unit is often complex and challenging. Patients may develop a myriad of long-term multiorgan impairments, affecting the respiratory, cardiac, neurological, digestive and musculoskeletal systems. Skeletal muscle dysfunction of respiratory and limb muscles, commonly referred to as intensive care unit acquired weakness, occurs in approximately 40% of all patients admitted to intensive care. The impact on mobility and return to activities of daily living is severe. Furthermore, many patients experience ongoing symptoms of fatigue, weakness and shortness of breath, in what is being described as "long COVID". Neuromuscular electrical stimulation is a technique in which small electrical impulses are applied to skeletal muscle to cause contractions when voluntary muscle contraction is difficult or impossible. Neuromuscular electrical stimulation can prevent muscle atrophy, improve muscle strength and function, maintain blood flow and reduce oedema. This review examines the evidence, current guidelines, and proposed benefits of using neuromuscular electrical stimulation with patients admitted to the intensive care unit. Practical recommendations for using electrical muscle stimulation in patients with COVID-19 are provided, and suggestions for further research are proposed. Evidence suggests NMES may play a role in the weaning of patients from ventilators and can be continued in the post-acute and longer-term phases of recovery. As such, NMES may be a suitable treatment modality to implement within rehabilitation pathways for COVID-19, with consideration of the practical and safety issues highlighted within this review.


Subject(s)
COVID-19/therapy , Electric Stimulation Therapy/methods , COVID-19/rehabilitation , COVID-19/virology , Clinical Trials as Topic , Hospitalization , Humans , Intensive Care Units , Randomized Controlled Trials as Topic , SARS-CoV-2/isolation & purification
10.
Spinal Cord Ser Cases ; 6(1): 24, 2020 04 21.
Article in English | MEDLINE | ID: mdl-32317626

ABSTRACT

INTRODUCTION: Sexual functioning is a high priority for people with a spinal cord injury (SCI) yet this area has received little attention. Two SCI case reports are presented which suggests there may be greater potential for the recovery of sexual functioning than previously recognised. CASE PRESENTATION: A 74-year-old SCI male (AIS D, C5/C6) and a 36-year-old SCI male (AIS A, T4/T5) were treated for neurogenic bowel using 6 weeks of abdominal FES (ABFES) (40 Hz, 300 µ pulse width (current typically 30-60 MA) simultaneously delivered (8 s contraction with 2 s ramps and 3 s off period) from both channels). The 74-year-old AIS D, C5/C6 participant reported improved strength and duration of erectile function after using ABFES for 3 weeks. The 36-year-old AIS A, T4/T5 participant reported improvements in ejaculatory function and urine flow. Both reported a reduction in time required for bowel management. DISCUSSION: The findings could be attributed to an improved vascularisation of the abdominal area, an improved body image and self-esteem, direct innervation of nerves involved in parasympathetic pathways or innervation of the T11/T1 area implicated in the alternative psychogenic pathway. Both participants reported they had not used ABFES during sexual activity suggesting a therapeutic effect from the treatment.


Subject(s)
Abdominal Muscles/physiology , Electric Stimulation Therapy/methods , Penile Erection/physiology , Spinal Cord Injuries/therapy , Abdominal Muscles/innervation , Adult , Aged , Cervical Vertebrae/injuries , Electric Stimulation Therapy/trends , Humans , Male , Spinal Cord Injuries/physiopathology , Thoracic Vertebrae/injuries , Treatment Outcome
11.
Neurodegener Dis Manag ; 9(2): 83-89, 2019 04.
Article in English | MEDLINE | ID: mdl-30998082

ABSTRACT

Aim: Functional constipation is common in multiple sclerosis (MS) and first line treatments are frequently ineffective. The current study explored the use of abdominal functional electrical stimulation (ABFES) for treating constipation in MS. Patients/methods: 20 people with MS and constipation (ROME IV criteria). The patient assessment of constipation-related quality of life questionnaire was administered at baseline and after 6 weeks of ABFES treatment alongside semi-structured interviews. Results: All patient assessment of constipation-related quality of life subscales were significant: satisfaction (p = 0.003), psychosocial discomfort (p = 0.008), physical discomfort (p = 0.001) and worries and concerns (p = 0.003). A long-term therapeutic effect, reduction in laxative use and improved sexual functioning were also reported. Conclusion: ABFES provides a potential alternative treatment intervention for people with MS and constipation.


Subject(s)
Abdominal Muscles , Colonic Diseases, Functional/therapy , Constipation/therapy , Electric Stimulation Therapy , Multiple Sclerosis/complications , Outcome Assessment, Health Care , Adult , Colonic Diseases, Functional/etiology , Constipation/etiology , Electric Stimulation Therapy/methods , Female , Humans , Male , Middle Aged , Quality of Life
12.
Int J MS Care ; 20(5): 224-230, 2018.
Article in English | MEDLINE | ID: mdl-30374252

ABSTRACT

BACKGROUND: Few studies have examined the long-term consequences of using peroneal nerve functional electrical stimulation (FES) for people with multiple sclerosis (MS). This study examines orthotic effects on a longitudinal cohort and explores additional benefits of FES on self-reported measures such as joint pain. METHODS: One hundred forty-five people with foot drop and MS were included (mean age, 52 [range, 28-74] years). Orthotic effects, unassisted walking speed, and clinically important differences (ie, ≥0.05 and ≥0.10 m/s) were derived from walking speed over 10 m. Visual analogue scales examined joint pain, walking effort, trips, confidence, and quality of life. Measures were taken on day 1, after 6 months, and at 2, 3, 4, and 5 years. RESULTS: A significant difference was found overall for walking with FES compared with walking without FES for the 5-year period (P < .001). Despite a significant decline in overall unassisted walking speed at baseline (0.58 m/s) compared with 5 years later (0.46 m/s) (P < .001), participants achieved an orthotic effect with (0.52 m/s) versus without (0.46 m/s) FES after 5 years (P < .001). A significant decrease in joint pain was found after 6 months compared with day 1 (P = .004), which was maintained after 5 years (P < .001). CONCLUSIONS: Despite progression of MS, long-term users of FES still benefit from an orthotic effect after using FES for 5 years. The study highlights the need for further work to assess the perceived benefits of FES regarding the experience of joint pain.

13.
J Spinal Cord Med ; 41(3): 361-366, 2018 05.
Article in English | MEDLINE | ID: mdl-29108487

ABSTRACT

CONTEXT/OBJECTIVE: The study aimed to investigate the presence of a training effect for rehabilitation of walking function in motor-incomplete spinal cord injury (SCI) through daily use of functional electrical stimulation (FES). SETTING: A specialist FES outpatient centre. PARTICIPANTS: Thirty-five participants (mean age 53, SD 15, range 18-80; mean years since diagnosis 9, range 5 months - 39 years) with drop foot and motor-incomplete SCI (T12 or higher, ASIA Impairment Scale C and D) able to ambulate 10 metres with the use of a walking stick or frame. INTERVENTIONS: FES of the peroneal nerve, glutei and hamstrings as clinically indicated over six months in the community. OUTCOME MEASURES: The data was analysed for a training effect (difference between unassisted ten metre walking speed at baseline and after six months) and orthotic effects (difference between walking speed with and without FES) initially on day one and after six months. The data was further analysed for a minimum clinically important difference (MCID) (>0.06 m/s). RESULTS: A clinically meaningful, significant change was observed for initial orthotic effect (0.13m/s, CI: 0.04-0.17, P = 0.013), total orthotic effect (0.11m/s, CI: 0.04-0.18, P = 0.017) and training effect (0.09m/s, CI: 0.02-0.16, P = 0.025). CONCLUSION: The results suggest that daily independent use of FES may produce clinically meaningful changes in walking speed which are significant for motor-incomplete SCI. Further research exploring the mechanism for the presence of a training effect may be beneficial in targeting therapies for future rehabilitation.


Subject(s)
Exercise Therapy/methods , Neurological Rehabilitation/methods , Spinal Cord Injuries/rehabilitation , Transcutaneous Electric Nerve Stimulation/methods , Walking Speed , Adolescent , Adult , Aged , Aged, 80 and over , Exercise Therapy/instrumentation , Female , Humans , Male , Middle Aged , Muscle, Skeletal/innervation , Muscle, Skeletal/physiopathology , Orthotic Devices , Peroneal Nerve/physiopathology , Spinal Cord Injuries/pathology
14.
Neurodegener Dis Manag ; 7(4): 253-259, 2017 08.
Article in English | MEDLINE | ID: mdl-28853641

ABSTRACT

Previously, it was believed that exercise-related activity was likely to lead to the symptoms of multiple sclerosis (MS) becoming worse. More recently, it has been acknowledged that the consequences of not exercising are detrimental and may exacerbate symptoms of MS. In addition, it has been recognized that some of the disability that occurs after MS is likely to be due to deconditioning from a reduction in physical activity. The current paper will explore the potential role of functional electrical stimulation of the peroneal nerve, for facilitating neurorehabilitation, through increasing mobility and overcoming barriers to accessing exercise. The paper will also examine the impact of using exercise-related activity to manage the symptoms of MS along with the potential neuroprotective effects.


Subject(s)
Electric Stimulation Therapy , Exercise Therapy , Multiple Sclerosis/rehabilitation , Combined Modality Therapy , Humans , Multiple Sclerosis/physiopathology , Neurological Rehabilitation
15.
J Rehabil Med ; 49(2): 113-119, 2017 Jan 31.
Article in English | MEDLINE | ID: mdl-28102429

ABSTRACT

OBJECTIVE: To examine the evidence for a training effect on the lower limb of functional electrical stimulation. DESIGN: Cohort study. PATIENTS: A total of 133 patients >6 months post-stroke. METHODS: Training and orthotic effects were determined from walking speed over 10 m, associated minimal and substantial clinically important differences (i.e. >0.05 and >0.10 m/s), and Functional Ambulation Category (FAC), ranging from household walking to independent walking in the community. RESULTS: An overall significant (p < 0.01) training effect was found that was not a clinically important difference (0.02 m/s); however, "community" FAC (≥ 0.8 m/s) and "most limited community walkers" FAC (0.4-0.58 m/s), but not "household walkers" (< 0.4 m/s), benefitted from a clinically important difference. A highly significant (p< 0.001), substantial clinically important orthotic effect (0.10 m/s) was found. In terms of overall improvement of one or more FACs, 23% achieved this due to a training effect, compared with 43% due to an orthotic effect. CONCLUSION: The findings suggest that functional electrical stimulation provides a training effect in those who are less impaired. Further work, which optimizes the use of the device for restoration of function, rather than as an orthotic device, will provide greater clarity on the effectiveness of functional electrical stimulation for eliciting a training effect.


Subject(s)
Electric Stimulation Therapy/methods , Gait Disorders, Neurologic/physiopathology , Orthotic Devices/statistics & numerical data , Peroneal Nerve/physiopathology , Stroke Rehabilitation/methods , Stroke/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cohort Studies , Female , Humans , Male , Middle Aged , Walkers , Young Adult
16.
Arch Phys Med Rehabil ; 96(4): 667-72, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25499688

ABSTRACT

OBJECTIVE: To determine the effectiveness of functional electrical stimulation (FES) on drop foot in patients with multiple sclerosis (MS), using data from standard clinical practice. DESIGN: Case series with a consecutive sample of FES users collected between 2008 and 2013. SETTING: Specialist FES center at a district general hospital. PARTICIPANTS: Patients with MS who have drop foot (N=187) (117 women, 70 men; mean age, 55y [range, 27-80y]; mean duration since diagnosis, 11.7y [range, 1-56y]). A total of 166 patients were still using FES after 20 weeks, with 153 patients completing the follow-up measures. INTERVENTIONS: FES of the common peroneal nerve (178 unilateral, 9 bilateral FES users). MAIN OUTCOME MEASURES: Clinically meaningful changes (ie, >.05m/s and >0.1m/s) and functional walking category derived from 10-m walking speed. RESULTS: An increase in walking speed was found to be highly significant (P<.001), both initially where a minimum clinically meaningful change was observed (.07m/s) and after 20 weeks with a substantial clinically meaningful change (.11m/s). After 20 weeks, treatment responders displayed a 27% average improvement in their walking speed. No significant training effect was found. Overall functional walking category was maintained or improved in 95% of treatment responders. CONCLUSIONS: FES of the dorsiflexors is a well-accepted intervention that enables clinically meaningful changes in walking speed, leading to a preserved or an increased functional walking category.


Subject(s)
Electric Stimulation Therapy/methods , Gait Disorders, Neurologic/rehabilitation , Multiple Sclerosis/rehabilitation , Peroneal Nerve , Walking , Adult , Aged , Aged, 80 and over , Female , Gait , Gait Disorders, Neurologic/etiology , Humans , Male , Middle Aged , Multiple Sclerosis/complications , Physical Therapy Modalities
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