In recent years, our understanding of motor
learning, neuroplasticity and functional recovery after the occurrence of brain
lesion has grown significantly. New findings in basic neuroscience have
provided an impetus for research in motor rehabilitation. Several prospective
studies have shown that repeated motor practice and motor activity in a real
world environment have a favorable effect on motor recovery in stroke patients.
Electrical stimulation can be applied in a variety of ways to the hemiparetic upper
extremity following a stroke.
In particular, electromyography (EMG)- triggered
electrical muscle stimulation improves the motor function of the hemiparetic
arm and hand. Triggered electrical stimulation is reported to be more effective
than non-triggered electrical stimulation in facilitating upper extremity motor
recovery after stroke. EMG-controlled functional electrical stimulation (FES)
induces greater muscle contraction by electrical stimulation that is in
proportion to voluntary integrated EMG signals. EMG-controlled FES and motor
point block for antagonist muscles have been applied as a new hybrid FES
therapy in an outpatient rehabilitation clinic for patients with stroke with
good result. Daily EMG-controlled FES home-program therapy with novel equipment
has been shown to effectively improve wrist, finger extension, and shoulder
flexion.
Combined modulation of voluntary movement, proprioceptive sensory
feedback, and electrical stimulation might play an important role in improving
impaired sensory-motor integration by EMG-controlled FES therapy. A
multi-channel near-infrared spectroscopy (NIRS) studies in which the hemoglobin
levels in the brain were non-invasively and dynamically measured during
functional activity found that the cerebral blood flow in the injured
sensory-motor cortex area is greater during a EMG-controlled FES session than
during simple active movement or simple electrical stimulation. Nevertheless,
evidence-based strategies for FES rehabilitation are more and more available,
particularly for patients suffering from hemiparesis.
International Journal of Physical Medicine & Rehabilitation
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