Functional Electrical Stimulation Therapy for Retraining Reaching and Grasping After Spinal Cord Injury and Stroke

Frontiers in Neuroscience, 2020 · DOI: 10.3389/fnins.2020.00718 · Published: July 9, 2020

Simple Explanation

Functional electrical stimulation (FES) is used to retrain upper extremity function after neurological conditions like stroke or spinal cord injury. The therapy involves moving the affected limb with patient's participation, stimulating the neuromuscular circuitry to produce the desired movement. FES therapy uses surface stimulation electrodes with minimal pain during application, with each session lasting 45–60 min, and can train fine motor function like two-finger precision grip.

Study Duration

8–14 weeks

Participants

Approximately 150 spinal cord injury and 50 stroke patients

Evidence Level

Pilot studies and randomized control trials

Key Findings

1
FES therapy can produce significant changes in arm and hand function, as shown in pilot studies and randomized control trials.
2
Patients showed reduced dependency on caregivers and some even became independent in their activities of daily living after 8–14 weeks of therapy.
3
In stroke patients, FES therapy focuses on hand opening and relaxing the fingers, while in spinal cord injury patients, it focuses on finger flexion and grasping tasks.

Research Summary

This article details how transcutaneous multichannel FES therapy for the upper extremity can be applied in clinical trials and practice for individuals with spinal cord injury or stroke. The FES system used in their laboratory is a surface stimulation system with up to 4 stimulation channels that can produce gross motor function as well as precision grips. Short duration FES therapy combined with conventional occupational therapy and physiotherapy has the ability to produce positive changes in these patients.

Practical Implications

Clinical Practice

Physiotherapists and occupational therapists can use the detailed methodology provided to apply transcutaneous multichannel FES therapy in clinical practice.

Future Research

The evidence presented merits conducting more comprehensive clinical trials with FES therapy, especially in cervical complete spinal cord injury patients.

Technology Development

New FES systems are being developed specifically for FES therapy, addressing previous limitations in access and delivery, enhancing its potential uptake in clinical settings.

Study Limitations

1
Limb muscles must be accessible for electrode placement.
2
There should not be a major degree of lower motor neuron injury or nerve-root damage of the stimulated muscle.
3
Patient has to be cognitively able to follow the instructions and actively participate in the therapy process.

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