Whole-Body Adaptive Functional Electrical Stimulation Kinesitherapy Can Promote the Restoring of Physiological Muscle Synergies for Neurological Patients

Overview

Journal Sensors (Basel)

Publisher MDPI

Specialty Biotechnology

Date 2022 Feb 26

PMID 35214345

Authors

Alessandro Scano

Robert Mihai Mira

Guido Gabbrielli

Franco Molteni

Viktor Terekhov

Affiliations

Soon will be listed here.

Abstract

Background: Neurological diseases and traumas are major factors that may reduce motor functionality. Functional electrical stimulation is a technique that helps regain motor function, assisting patients in daily life activities and in rehabilitation practices. In this study, we evaluated the efficacy of a treatment based on whole-body Adaptive Functional Electrical Stimulation Kinesitherapy (AFESK™) with the use of muscle synergies, a well-established method for evaluation of motor coordination. The evaluation is performed on retrospectively gathered data of neurological patients executing whole-body movements before and after AFESK-based treatments.

Methods: Twenty-four chronic neurologic patients and 9 healthy subjects were recruited in this study. The patient group was further subdivided in 3 subgroups: hemiplegic, tetraplegic and paraplegic. All patients underwent two acquisition sessions: before treatment and after a FES based rehabilitation treatment at the VIKTOR Physio Lab. Patients followed whole-body exercise protocols tailored to their needs. The control group of healthy subjects performed all movements in a single session and provided reference data for evaluating patients' performance. sEMG was recorded on relevant muscles and muscle synergies were extracted for each patient's EMG data and then compared to the ones extracted from the healthy volunteers. To evaluate the effect of the treatment, the motricity index was measured and patients' extracted synergies were compared to the control group before and after treatment.

Results: After the treatment, patients' motricity index increased for many of the screened body segments. Muscle synergies were more similar to those of healthy people. Globally, the normalized synergy similarity in respect to the control group was 0.50 before the treatment and 0.60 after ( < 0.001), with improvements for each subgroup of patients.

Conclusions: AFESK treatment induced favorable changes in muscle activation patterns in chronic neurologic patients, partially restoring muscular patterns similar to healthy people. The evaluation of the synergic relationships of muscle activity when performing test exercises allows to assess the results of rehabilitation measures in patients with impaired locomotor functions.

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References

Driver J, Noesselt T . Multisensory interplay reveals crossmodal influences on 'sensory-specific' brain regions, neural responses, and judgments. Neuron. 2008; 57(1):11-23. PMC: 2427054. DOI: 10.1016/j.neuron.2007.12.013. View

Dujovic S, Malesevic J, Malesevic N, Vidakovic A, Bijelic G, Keller T . Novel multi-pad functional electrical stimulation in stroke patients: A single-blind randomized study. NeuroRehabilitation. 2017; 41(4):791-800. DOI: 10.3233/NRE-172153. View

dAvella A, Fernandez L, Portone A, Lacquaniti F . Modulation of phasic and tonic muscle synergies with reaching direction and speed. J Neurophysiol. 2008; 100(3):1433-54. DOI: 10.1152/jn.01377.2007. View

Molteni F, Gasperini G, Cannaviello G, Guanziroli E . Exoskeleton and End-Effector Robots for Upper and Lower Limbs Rehabilitation: Narrative Review. PM R. 2018; 10(9 Suppl 2):S174-S188. DOI: 10.1016/j.pmrj.2018.06.005. View

Mazzoleni S, Battini E, Rustici A, Stampacchia G . An integrated gait rehabilitation training based on Functional Electrical Stimulation cycling and overground robotic exoskeleton in complete spinal cord injury patients: Preliminary results. IEEE Int Conf Rehabil Robot. 2017; 2017:289-293. DOI: 10.1109/ICORR.2017.8009261. View

McCabe J, Monkiewicz M, Holcomb J, Pundik S, Daly J . Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2014; 96(6):981-90. DOI: 10.1016/j.apmr.2014.10.022. View

Filipovic A, Kleinoder H, Dormann U, Mester J . Electromyostimulation--a systematic review of the effects of different electromyostimulation methods on selected strength parameters in trained and elite athletes. J Strength Cond Res. 2011; 26(9):2600-14. DOI: 10.1519/JSC.0b013e31823f2cd1. View

Hofstoetter U, Krenn M, Danner S, Hofer C, Kern H, McKay W . Augmentation of Voluntary Locomotor Activity by Transcutaneous Spinal Cord Stimulation in Motor-Incomplete Spinal Cord-Injured Individuals. Artif Organs. 2015; 39(10):E176-86. DOI: 10.1111/aor.12615. View

Popovic M, Thrasher T, Adams M, Takes V, Zivanovic V, Tonack M . Functional electrical therapy: retraining grasping in spinal cord injury. Spinal Cord. 2005; 44(3):143-51. DOI: 10.1038/sj.sc.3101822. View

10.

Jones S, Man W, Gao W, Higginson I, Wilcock A, Maddocks M . Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev. 2016; 10:CD009419. PMC: 6464134. DOI: 10.1002/14651858.CD009419.pub3. View

11.

Dayan E, Cohen L . Neuroplasticity subserving motor skill learning. Neuron. 2011; 72(3):443-54. PMC: 3217208. DOI: 10.1016/j.neuron.2011.10.008. View

12.

He K, Liang Y, Abdollahi F, Bittmann M, Kording K, Wei K . The Statistical Determinants of the Speed of Motor Learning. PLoS Comput Biol. 2016; 12(9):e1005023. PMC: 5015831. DOI: 10.1371/journal.pcbi.1005023. View

13.

Muceli S, Boye A, dAvella A, Farina D . Identifying representative synergy matrices for describing muscular activation patterns during multidirectional reaching in the horizontal plane. J Neurophysiol. 2010; 103(3):1532-42. DOI: 10.1152/jn.00559.2009. View

14.

Cooke S, Bliss T . Plasticity in the human central nervous system. Brain. 2006; 129(Pt 7):1659-73. DOI: 10.1093/brain/awl082. View

15.

Doyon J, Benali H . Reorganization and plasticity in the adult brain during learning of motor skills. Curr Opin Neurobiol. 2005; 15(2):161-7. DOI: 10.1016/j.conb.2005.03.004. View

16.

Clark D, Ting L, Zajac F, Neptune R, Kautz S . Merging of healthy motor modules predicts reduced locomotor performance and muscle coordination complexity post-stroke. J Neurophysiol. 2009; 103(2):844-57. PMC: 2822696. DOI: 10.1152/jn.00825.2009. View

17.

Steele K, Rozumalski A, Schwartz M . Muscle synergies and complexity of neuromuscular control during gait in cerebral palsy. Dev Med Child Neurol. 2015; 57(12):1176-82. PMC: 4683117. DOI: 10.1111/dmcn.12826. View

18.

Dominici N, Ivanenko Y, Cappellini G, dAvella A, Mondi V, Cicchese M . Locomotor primitives in newborn babies and their development. Science. 2011; 334(6058):997-9. DOI: 10.1126/science.1210617. View

19.

Karhu J, Tesche C . Simultaneous early processing of sensory input in human primary (SI) and secondary (SII) somatosensory cortices. J Neurophysiol. 1999; 81(5):2017-25. DOI: 10.1152/jn.1999.81.5.2017. View

20.

Brambilla C, Pirovano I, Mira R, Rizzo G, Scano A, Mastropietro A . Combined Use of EMG and EEG Techniques for Neuromotor Assessment in Rehabilitative Applications: A Systematic Review. Sensors (Basel). 2021; 21(21). PMC: 8588321. DOI: 10.3390/s21217014. View