Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 8:14:1272992.
doi: 10.3389/fneur.2023.1272992. eCollection 2023.

A systematic review on functional electrical stimulation based rehabilitation systems for upper limb post-stroke recovery

Muhammad Ahmed Khan  1   2   3 , Hoda Fares  4 , Hemant Ghayvat  5 , Iris Charlotte Brunner  6 , Sadasivan Puthusserypady  3 , Babak Razavi  1 , Maarten Lansberg  1 , Ada Poon  2 , Kimford Jay Meador  1
Affiliations

A systematic review on functional electrical stimulation based rehabilitation systems for upper limb post-stroke recovery

Muhammad Ahmed Khan et al. Front Neurol. .

Abstract

Background: Stroke is one of the most common neurological conditions that often leads to upper limb motor impairments, significantly affecting individuals' quality of life. Rehabilitation strategies are crucial in facilitating post-stroke recovery and improving functional independence. Functional Electrical Stimulation (FES) systems have emerged as promising upper limb rehabilitation tools, offering innovative neuromuscular reeducation approaches.

Objective: The main objective of this paper is to provide a comprehensive systematic review of the start-of-the-art functional electrical stimulation (FES) systems for upper limb neurorehabilitation in post-stroke therapy. More specifically, this paper aims to review different types of FES systems, their feasibility testing, or randomized control trials (RCT) studies.

Methods: The FES systems classification is based on the involvement of patient feedback within the FES control, which mainly includes "Open-Loop FES Systems" (manually controlled) and "Closed-Loop FES Systems" (brain-computer interface-BCI and electromyography-EMG controlled). Thus, valuable insights are presented into the technological advantages and effectiveness of Manual FES, EEG-FES, and EMG-FES systems.

Results and discussion: The review analyzed 25 studies and found that the use of FES-based rehabilitation systems resulted in favorable outcomes for the stroke recovery of upper limb functional movements, as measured by the FMA (Fugl-Meyer Assessment) (Manually controlled FES: mean difference = 5.6, 95% CI (3.77, 7.5), P < 0.001; BCI-controlled FES: mean difference = 5.37, 95% CI (4.2, 6.6), P < 0.001; EMG-controlled FES: mean difference = 14.14, 95% CI (11.72, 16.6), P < 0.001) and ARAT (Action Research Arm Test) (EMG-controlled FES: mean difference = 11.9, 95% CI (8.8, 14.9), P < 0.001) scores. Furthermore, the shortcomings, clinical considerations, comparison to non-FES systems, design improvements, and possible future implications are also discussed for improving stroke rehabilitation systems and advancing post-stroke recovery. Thus, summarizing the existing literature, this review paper can help researchers identify areas for further investigation. This can lead to formulating research questions and developing new studies aimed at improving FES systems and their outcomes in upper limb rehabilitation.

Keywords: functional electrical stimulation (FES); post-stroke therapy; rehabilitation; stroke; stroke rehabilitation systems; upper limb neurorehabilitation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Types of FES based rehabilitation system for stroke recovery (A) Open-Loop FES System, (B) Closed-Loop FES System (BCI-FES), (C) Closed-Loop FES System (EMG-FES).
Figure 2
Figure 2
PRISMA flow chart of study selection.
Figure 3
Figure 3
Overall representation of BCI-FES neurorehabilitation system (main components: EEG unit for BCI, BCI-FES interface, and FES module. Optional component: VR display/headset).
Figure 4
Figure 4
Overall representation of EMG-FES neurorehabilitation system (main components: EMG sensing unit, EMG-FES interface, and FES module. Optional component: VR display/headset).
See this image and copyright information in PMC

References

    1. Grefkes C, Fink GR. Recovery from stroke: current concepts and future perspectives. Neurological Res Pract. 2:1. 10.1186/s42466-020-00060-6 - DOI - PMC - PubMed
    1. Cramer SC, Wolf SL, Adams HP, Chen D, Dromerick AW, Dunning K, et al. . Stroke recovery and rehabilitation research: issues, opportunities, and the NIH StrokeNet. Stroke. (2017) 48:813–9. 10.1161/STROKEAHA.116.015501 - DOI - PMC - PubMed
    1. Robinson RG, Jorge RE. Post-stroke depression: a review. Am J Psychiatry. (2016) 173:221–31. 10.1176/appi.ajp.2015.15030363 - DOI - PubMed
    1. Khedr EM, Abdelrahman AA, Desoky T, Zaki, Gamea AF. Post-stroke depression: frequency, risk factors, and impact on quality of life among 103 stroke patients—hospital-based study. Egypt J Neurol Psychiat Neurosurg. (2020) 56:1. 10.1186/s41983-020-00199-8 - DOI
    1. Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, et al. . Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. (2019) 18:439–58. 10.1016/S1474-4422(19)30034-1 - DOI - PMC - PubMed

Publication types