Skip to main content

Functional Electrical Stimulation and Its Use During Cycling for the Rehabilitation of Individuals with Stroke

  • Chapter
  • First Online:

Part of the book series: Biosystems & Biorobotics ((BIOSYSROB,volume 19))

Abstract

Stroke disease involves an increasing number of subjects due to the aging population. In clinical practice‚ the presence of widely accessible rehabilitative interventions to facilitate the patients’ motor recovery‚ especially in the early stages after injury when wider improvement can be gained‚ is crucial to reduce social and economical costs. The functional electrical stimulation (FES) has been investigated as a tool to promote locomotion ability in stroke patients. Particular attention was given to FES delivered during cycling‚ which is recognized as a safe and widely accessible way to provide a FES-based rehabilitative intervention in the most impaired subjects. In this chapter the neurophysiological basis of FES and its potential correlates to facilitate the long-term reorganization at both cortical and spinal level have been discussed. A discussion on clinical evidence and possible future direction is also proposed.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, Elkind MSV, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS, Kleindorfer DO, Lee JM, Moseley ME, Peterson ED, Turan TN, Valderrama AL, Vinters HV. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American heart association/American stroke association. Stroke. 2013;44(7):2064–89.

    Article  Google Scholar 

  2. WHO. The atlas of heart disease and stroke. 2004.

    Google Scholar 

  3. Fattore G, Torbica A, Susi A, Giovanni A, Benelli G, Gozzo M, Toso V. The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study. BMC Neurol. 2012;12(1):137.

    Article  Google Scholar 

  4. Bonita R, Beaglehole R, Bonita R, Beaglehole R. Recovery of motor function after stroke. Stroke. 1988;19:1497–500.

    Article  Google Scholar 

  5. Brown JA. Recovery of motor function after stroke. Prog Brain Res. 2006;157:223–8.

    Article  Google Scholar 

  6. Ward NS. Neural plasticity and recovery of function. Prog Brain Res. 2005;150:527–35.

    Article  Google Scholar 

  7. Peckham PH, Knutson JS. Functional electrical stimulation for neuromuscular applications. Annu Rev Biomed Eng. 2005;7:327–60.

    Article  Google Scholar 

  8. Ambrosini E, Ferrante S, Ferrigno G, Molteni F, Pedrocchi A. Cycling induced by electrical stimulation improves muscle activation and symmetry during pedaling in hemiparetic patients. IEEE Trans Neural Syst Rehabil Eng. 2012;20(3):320–30.

    Article  Google Scholar 

  9. Ambrosini E, Ferrante S, Pedrocchi A, Ferrigno G, Molteni F. Cycling induced by electrical stimulation improves motor recovery in postacute hemiparetic patients: a randomized controlled trial. Stroke. 2011;42(4):1068–73.

    Article  Google Scholar 

  10. Ferrante S, Pedrocchi A, Ferrigno G, Molteni F. Cycling induced by functional electrical stimulation improves the muscular strength and the motor control of individuals with post-acute stroke. Europa Medicophysica-SIMFER 2007 Award Winner. Eur J Phys Rehabil Med. 2008;44(2):159–67.

    Google Scholar 

  11. Kafri M, Laufer Y. Therapeutic effects of functional electrical stimulation on gait in individuals post-stroke. Ann Biomed Eng. 2015;43(2):451–66.

    Article  Google Scholar 

  12. Gater DR, Dolbow D, Tsui B, Gorgey AS. Functional electrical stimulation therapies after spinal cord injury. NeuroRehabilitation. 2011;28(3):231–48.

    Google Scholar 

  13. Barrett CL, Mann GE, Taylor PN, Strike P. A randomized trial to investigate the effects of functional electrical stimulation and therapeutic exercise on walking performance for people with multiple sclerosis. Multiple Sclerosis J. 2009;15(4):493–504.

    Article  Google Scholar 

  14. Peri E, Ambrosini E, Pedrocchi A, Pagliano E, Riva D, Baranello G, Arnoldi MT, Foscan M, Corlatti A, Marchi A, Ferrigno G, Ferrante S. Volitional cycling augmented by functional electrical stimulation in hemiparetic adolescents: a case series study. J Autom Control. 2013;21(1):37–42.

    Article  Google Scholar 

  15. Trevisi E, Gualdi S, De Conti C, Salghetti A, Martinuzzi A, Pedrocchi A, Ferrante S. Cycling induced by functional electrical stimulation in children affected by cerebral palsy: case report. Eur J Phys Rehabil Med. 2012;48(1):135–45.

    Google Scholar 

  16. Singer B. Functional electrical stimulation of the extremities in the neurological patient: a review. Aust J Physiotherapy. 1987;33(1):33–42.

    Article  MathSciNet  Google Scholar 

  17. Harvey RL. Improving poststroke recovery: Neuroplasticity and task-oriented training. Curr Treat Options Cardiovasc Med. 2009;11(3):251–9.

    Article  Google Scholar 

  18. Brown DA, Nagpal S, Chi S. Limb-loaded cycling program for locomotor intervention following stroke. Phys Ther. 2005;85(2):159–68.

    Google Scholar 

  19. Ferrante S, Ambrosini E, Ravelli P, Guanziroli E, Molteni F, Ferrigno G, Pedrocchi A. A biofeedback cycling training to improve locomotion: a case series study based on gait pattern classification of 153 chronic stroke patients. J Neuroeng Rehabil. 2011;8(1):47.

    Article  Google Scholar 

  20. Burnfield JM, Shu Y, Buster T, Taylor A. Similarity of joint kinematics and muscle demands between elliptical training and walking: implications for practice. Phys Ther. 2010;90(2):289–305.

    Article  Google Scholar 

  21. Grill WM, Mortimer JT. Stimulus waveforms for selective neural stimulation. IEEE Eng Med Biol Mag. 1995;14(4):375–85.

    Article  Google Scholar 

  22. McNeal DR. Analysis of a model for excitation of myelinated nerve. IEEE Trans Biomed Eng. 1976;BME-23(4):329–337.

    Google Scholar 

  23. Kandel ER, Schwartz JH, Jessell TM. Principles of neural science 4th ed. New York: McGraw-Hill, Health Professions Division. 2000.

    Google Scholar 

  24. Knaflitz M, Merletti R, De Luca CJ. Inference of motor unit recruitment order in voluntary and electrically elicited contractions. J Appl Physiol. 1990;68(4):1657–67.

    Article  Google Scholar 

  25. Farina D, Blanchietti A, Pozzo M, Merletti R. M-wave properties during progressive motor unit activation by transcutaneous stimulation. J Appl Physiol. 2004;97(2):545–55.

    Article  Google Scholar 

  26. Mortimer JT. Comprehensive physiology. Hoboken, NJ, USA: Wiley; 2011.

    Google Scholar 

  27. Bickel CS, Gregory CM, Dean JC. Motor unit recruitment during neuromuscular electrical stimulation: a critical appraisal. Eur J Appl Physiol. 2011;111(10):2399–407.

    Article  Google Scholar 

  28. Ambrosini E, Ferrante S, Pedrocchi A. Design of myocontrolled neuroprosthesis: tricks and pitfalls. Appl Challenges Adv Electromyogr Signal Process. IGI Global, 2014;275–303.

    Google Scholar 

  29. Sheffler LR, Chae J. Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve. 2007;35(5):562–90.

    Article  Google Scholar 

  30. Smith GV, Alon G, Roys SR, Gullapalli RP. Functional MRI determination of a dose-response relationship to lower extremity neuromuscular electrical stimulation in healthy subjects. Exp Brain Res. 2003;150(1):33–9.

    Article  Google Scholar 

  31. Francis S, Lin X, Aboushoushah S, White TP, Phillips M, Bowtell R, Constantinescu CS. fMRI analysis of active, passive and electrically stimulated ankle dorsiflexion. Neuroimage. 2009;44(2):469–79.

    Article  Google Scholar 

  32. Krakauer JW. Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol. 2006;19(1):84–90.

    Article  Google Scholar 

  33. Rushton DN. Functional electrical Stimulation and rehabilitation—an hypothesis. Med Eng Phys. 2003;25:75–8.

    Article  Google Scholar 

  34. Barsi GI, Popovic DB, Tarkka IM, Sinkjær T, Grey MJ. Cortical excitability changes following grasping exercise augmented with electrical stimulation. Exp Brain Res. 2008;191(1):57–66.

    Article  Google Scholar 

  35. Iftime-Nielsen SD, Christensen MS, Vingborg RJ, Sinkjær T, Roepstorff A, Grey MJ. Interaction of electrical stimulation and voluntary hand movement in SII and the cerebellum during simulated therapeutic functional electrical stimulation in healthy adults. Hum Brain Mapp. 2012;33(1):40–9.

    Article  Google Scholar 

  36. Gandolla M, Ferrante S, Molteni F, Guanziroli E, Frattini T, Martegani A, Ferrigno G, Friston K, Pedrocchi A, Ward NS. Re-thinking the role of motor cortex: context-sensitive motor outputs? Neuroimage. 2014;91:366–74.

    Article  Google Scholar 

  37. Gandolla M, Ward NS, Molteni F, Guanziroli E, Ferrigno G, Pedrocchi A. The neural correlates of long-term carryover following functional electrical stimulation for stroke. 2016; (2016).

    Google Scholar 

  38. Pomeroy VM, King L, Pollock A, Baily-Hallam A, Langhorne P. Electrostimulation for promoting recovery of movement or functional ability after stroke. Cochrane Database Syst Rev. 2006; (2).

    Google Scholar 

  39. Kluding PM, Dunning K, O’Dell MW, Wu SS, Ginosian J, Feld J, McBride K. Foot drop stimulation versus ankle foot orthosis after stroke: 30-week outcomes. Stroke. 2013;44(6):1660–9.

    Article  Google Scholar 

  40. Liberson WT, Holmquest HJ, Scot D, Dow M. Functional electrotherapy: stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients. Arch Phys Med Rehabil. 1961;42:101–5.

    Google Scholar 

  41. Bogataj U, Gros N, Kljajic M, Acimovic R, Malezic M. The rehabilitation of gait in patients with hemiplegia: a comparison between conventional therapy and multichannel functional electrical stimulation therapy. Phys Ther. 1995;75(6):490–502.

    Article  Google Scholar 

  42. Fields RW. Electromyographically triggered electric muscle stimulation for chronic hemiplegia. Arch Phys Med Rehabil. 1987;68(7):407–14.

    Google Scholar 

  43. Cozean CD, Pease WS, Hubbell SL. Biofeedback and functional electric stimulation in stroke rehabilitation. Arch Phys Med Rehabil. 1988;69(6):401–5.

    Google Scholar 

  44. Mazzocchio R, Meunier S, Ferrante S, Molteni F, Cohen LG. Cycling, a tool for locomotor recovery after motor lesions? NeuroRehabilitation. 2008;23(1):67–80.

    Google Scholar 

  45. Meunier S, Kwon J, Russmann H, Ravindran S, Mazzocchio R, Cohen L. Spinal use-dependent plasticity of synaptic transmission in humans after a single cycling session. J Physiol. 2007;579(Pt 2):375–88.

    Article  Google Scholar 

  46. Katz-Leurer M, Sender I, Keren O, Dvir Z. The influence of early cycling training on balance in stroke patients at the subacute stage. Results of a preliminary trial. Clin Rehabil. 2006;20(5):398–405.

    Article  Google Scholar 

  47. Alon G, Conroy VM, Donner TW. Intensive training of subjects with chronic hemiparesis on a motorized cycle combined with functional electrical stimulation (FES): a feasibility and safety study. Physiother. Res. Int. 2011;16(2):81–91.

    Article  Google Scholar 

  48. del-Ama AJ, Koutsou AD, Moreno JC, delos-Reyes A, Gil-Agudo N, Pons JL. Review of hybrid exoskeletons to restore gait following spinal cord injury. J Rehabil Res Dev. 2012;49(4):497.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elisabetta Peri .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Peri, E., Guanziroli, E., Ferrante, S., Pedrocchi, A., Molteni, F. (2018). Functional Electrical Stimulation and Its Use During Cycling for the Rehabilitation of Individuals with Stroke. In: Sandrini, G., Homberg, V., Saltuari, L., Smania, N., Pedrocchi, A. (eds) Advanced Technologies for the Rehabilitation of Gait and Balance Disorders. Biosystems & Biorobotics, vol 19. Springer, Cham. https://doi.org/10.1007/978-3-319-72736-3_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-72736-3_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-72735-6

  • Online ISBN: 978-3-319-72736-3

  • eBook Packages: EngineeringEngineering (R0)

Publish with us

Policies and ethics