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Functional electrical stimulation is a technique to produce functional movements after paralysis. Electrical discharges are applied to a person’s muscles making them contract in a sequence that allows performing tasks such as grasping a key, holding a toothbrush, standing, and walking. The technology was developed in the sixties, during which initial clinical use started, emphasizing its potential as an assistive device. Since then, functional electrical stimulation has evolved into an important therapeutic intervention that clinicians can use to help individuals who have had a stroke or a spinal cord injury regain their ability to stand, walk, reach, and grasp. With an expected growth in the aging population, it is likely that this technology will undergo important changes to increase its efficacy as well as its widespread adoption. We present here a series of functional electrical stimulation systems to illustrate the fundamentals of the technology and its applications. Most of the concepts continue to be in use today by modern day devices. A brief description of the potential future of the technology is presented, including its integration with brain–computer interfaces and wearable (garment) technology.

Neurological conditions like hemiplegia following stroke or tetraplegia following spinal cord injury, result in a massive compromise in motor function. Each of the two conditions can leave individuals dependent on caregivers for the rest of their lives. Once medically stable, rehabilitation is the main stay of treatment. This article will address rehabilitation of upper extremity function. It is long known that moving the affected limb is crucial to recovery following any kind of injury. Overtime, it has also been established that just moving the affected extremities does not suffice, and that the movements have to involve patient’s participation, be as close to physiologic movements as possible, and should ideally stimulate the entire neuromuscular circuitry involved in producing the desired movement. For over four decades now, functional electrical stimulation (FES) is being used to either replace or retrain function. The FES therapy discussed in this article has been used to retrain upper extremity function for over 15 years. Published data of pilot studies and randomized control trials show beyond doubt that FES therapy produces transformational changes in arm and hand function. There are specific principles of the FES therapy as applied in our studies i.e. stimulation is applied using surface stimulation electrodes, there is minimum to virtually no pain during application, each session lasts no more than 45-60 min, the technology is quite robust and can make up for specificity to a certain extent, and fine motor function like two finger precision grip can be trained (i.e. thumb and index finger tip to tip pinch). The FES therapy protocols can be successfully applied to individuals with paralysis resulting from stroke or spinal cord injury.

Previous evidence indicated that interventions with combined neuromuscular electrical stimulation (NMES) and voluntary muscle contractions could have superior effects on corticospinal excitability when the produced total force is larger than each single intervention. However, it is unclear whether the superior effects exist when the produced force is matched between the interventions. Ten able-bodied individuals performed three intervention sessions on separate days: (i) NMES–tibialis anterior (TA) stimulation; (ii) NMES+VOL–TA stimulation combined with voluntary ankle dorsiflexion; (iii) VOL–voluntary ankle dorsiflexion. Each intervention was exerted at the same total output of 20% of maximal force and applied intermittently (5 s ON / 19 s OFF) for 16 min. Motor evoked potentials (MEP) of the right TA and soleus muscles and maximum motor response (M max ) of the common peroneal nerve were assessed: before, during, and for 30 min after each intervention. Additionally, the ankle dorsiflexion force-matching task was evaluated before and after each intervention. Consequently, the TA MEP/M max during NMES+VOL and VOL sessions were significantly facilitated immediately after the interventions started until the interventions were over. Compared to NMES, larger facilitation was observed during NMES+VOL and VOL sessions, but no difference was found between them. Motor control was not affected by any interventions. Although superior combined effects were not shown compared to voluntary contractions alone, low-level voluntary contractions combined with NMES resulted in facilitated corticospinal excitability compared to NMES alone. This suggests that the voluntary drive could improve the effects of NMES even during low-level contractions, even if motor control is not affected.

Background Post-concussion syndrome is a challenging condition to manage for even the most experienced chronic pain experts. Patients’ presentations are heterogeneous with symptoms spanning physical, cognitive and emotional domains. The symptoms reported are often non-specific, making it difficult for health professionals to prescribe effective rehabilitation. The aim of the present study was to examine the effectiveness of a customized rehabilitation program based on subgroup determination following a standardized clinical exam in adults with post-concussion syndrome. Methods A total of 16 adults (mean age ± SD, 38.3 ± 12.5 years) with post-concussion syndrome participated in a 6-week rehabilitation program. Participants were recruited from external community concussion clinics around the greater Toronto area, Canada. Participants underwent a comprehensive standardized clinical exam to subgroup the ostensible symptom generators into either autonomic, cervical or vestibulo-ocular. Customized rehabilitation was then prescribed based on their subgroupings. The primary outcome measure was the Rivermead Post-Concussion Questionnaire (RPQ). Secondary outcome measures included the Patient Health Questionnaire-9 (PHQ-9), the Neck Disability Index (NDI), and exercise tolerance as assessed via the Buffalo Concussion Treadmill Test (BCTT). Results Following 6 weeks of customized rehabilitation, participants on average experienced a significant and clinically meaningful change with respect to the RPQ-3 and RPQ-13 ( p  < 0.001). We also observed a significant change in all secondary outcome measures including a reduction in PHQ-9 ( p  < 0.01), NDI ( p  < 0.001) and exercise tolerance, expressed as heart rate threshold ( p  < 0.001). Conclusion The standardized exam was feasible and useful in assisting the clinician in prescribing effective rehabilitation. The 6-week customized rehabilitation program demonstrated significant changes in patient-reported persistent post-concussion symptoms and exercise tolerance. The implementation of a customized program based on a standardized exam performed to subgroup the ostensible symptom generators may be key to successful management in this population.

Electromyography (EMG) is the resulting electrical signal from muscle activity, commonly used as a proxy for users’ intent in voluntary control of prosthetic devices. EMG signals are recorded with gold standard Ag/AgCl gel electrodes, though there are limitations in continuous use applications, with potential skin irritations and discomfort. Alternative dry solid metallic electrodes also face long-term usability and comfort challenges due to their inflexible and non-breathable structures. This is critical when the anatomy of the targeted body region is variable (e.g., residual limbs of individuals with amputation), and conformal contact is essential. In this study, textile electrodes were developed, and their performance in recording EMG signals was compared to gel electrodes. Additionally, to assess the reusability and robustness of the textile electrodes, the effect of 30 consumer washes was investigated. Comparisons were made between the signal-to-noise ratio (SNR), with no statistically significant difference, and with the power spectral density (PSD), showing a high correlation. Subsequently, a fully textile sleeve was fabricated covering the forearm, with 14 textile electrodes. For three individuals, an artificial neural network model was trained, capturing the EMG of 7 distinct finger movements. The personalized models were then used to successfully control a myoelectric prosthetic hand.

Background The escalating impact of diabetes and its complications, including diabetic foot ulcers (DFUs), presents global challenges in quality of life, economics, and resources, affecting around half a billion people. DFU healing is hindered by hyperglycemia-related issues and diverse diabetes-related physiological changes, necessitating ongoing personalized care. Artificial intelligence and clinical research strive to address these challenges by facilitating early detection and efficient treatments despite resource constraints. This study establishes a standardized framework for DFU data collection, introducing a dedicated case report form, a comprehensive dataset named Zivot with patient population clinical feature breakdowns and a baseline for DFU detection using this dataset and a UNet architecture. Results Following this protocol, we created the Zivot dataset consisting of 269 patients with active DFUs, and about 3700 RGB images and corresponding thermal and depth maps for the DFUs. The effectiveness of collecting a consistent and clean dataset was demonstrated using a bounding box prediction deep learning network that was constructed with EfficientNet as the feature extractor and UNet architecture. The network was trained on the Zivot dataset, and the evaluation metrics showed promising values of 0.79 and 0.86 for F1-score and mAP segmentation metrics. Conclusions This work and the Zivot database offer a foundation for further exploration of holistic and multimodal approaches to DFU research.

Delivering short trains of electric pulses to the muscles and nerves can elicit action potentials resulting in muscle contractions. When the stimulations are sequenced to generate functional movements, such as grasping or walking, the application is referred to as functional electrical stimulation (FES). Implications of the motor and sensory recruitment of muscles using FES go beyond simple contraction of muscles. Evidence suggests that FES can induce short- and long-term neurophysiological changes in the central nervous system by varying the stimulation parameters and delivery methods. By taking advantage of this, FES has been used to restore voluntary movement in individuals with neurological injuries with a technique called FES therapy (FEST). However, long-lasting cortical re-organization (neuroplasticity) depends on the ability to synchronize the descending (voluntary) commands and the successful execution of the intended task using a FES. Brain-computer interface (BCI) technologies offer a way to synchronize cortical commands and movements generated by FES, which can be advantageous for inducing neuroplasticity. Therefore, the aim of this review paper is to discuss the neurophysiological mechanisms of electrical stimulation of muscles and nerves and how BCI-controlled FES can be used in rehabilitation to improve motor function.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) produces an electrophysiological signature called evoked resonant neural activity (ERNA); a high-frequency oscillation that has been linked to treatment efficacy. However, the single-neuron and synaptic bases of ERNA are unsubstantiated. This study proposes that ERNA is a subcortical neuronal circuit signature of DBS-mediated engagement of the basal ganglia indirect pathway network. In people with Parkinson’s disease, we: (i) showed that each peak of the ERNA waveform is associated with temporally-locked neuronal inhibition in the STN; (ii) characterized the temporal dynamics of ERNA; (iii) identified a putative mesocircuit architecture, embedded with empirically-derived synaptic dynamics, that is necessary for the emergence of ERNA in silico; (iv) localized ERNA to the dorsal STN in electrophysiological and normative anatomical space; (v) used patient-wise hotspot locations to assess spatial relevance of ERNA with respect to DBS outcome; and (vi) characterized the local fiber activation profile associated with the derived group-level ERNA hotspot. Subthalamic deep brain stimulation produces evoked resonant neural activity (ERNA) which has been linked to therapeutic benefit. Using a multimodal approach, the authors propose that ERNA reflects activation of the basal ganglia indirect pathway network.

Background There is growing public policy and research interest in the development and use of various technologies for managing violence in healthcare settings to protect the health and well-being of patients and workers. However, little research exists on the impact of technologies on violence prevention, and in particular in the context of rehabilitation settings. Our study addresses this gap by exploring the perceptions and experiences of rehabilitation professionals regarding how technologies are used (or not) for violence prevention, and their perceptions regarding their efficacy and impact. Methods This was a descriptive qualitative study with 10 diverse professionals (e.g., physical therapy, occupational therapy, recreation therapy, nursing) who worked across inpatient and outpatient settings in one rehabilitation hospital. Data collection consisted of semi-structured interviews with all participants. A conventional approach to content analysis was used to identify key themes. Results We found that participants used three types of technologies for violence prevention: an electronic patient flagging system, fixed and portable emergency alarms, and cameras. All of these were perceived by participants as being largely ineffective for violence prevention due to poor design features, malfunction, limited resources, and incompatibility with the culture of care. Our analysis further suggests that professionals’ perception that these technologies would not prevent violence may be linked to their focus on individual patients, with a corresponding lack of attention to structural factors, including the culture of care and the organizational and physical environment. Conclusions Our findings suggest an urgent need for greater consideration of structural factors in efforts to develop effective interventions for violence prevention in rehabilitation settings, including the design and implementation of new technologies.