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Review
. 2024 May;35(2):369-382.
doi: 10.1016/j.pmr.2023.06.008. Epub 2023 Aug 21.

Neurostimulation After Stroke

Hala Osman  1 , Ricardo Siu  2 , Nathan S Makowski  3 , Jayme S Knutson  4 , David A Cunningham  5
Affiliations
Review

Neurostimulation After Stroke

Hala Osman et al. Phys Med Rehabil Clin N Am. 2024 May.

Abstract

Neural stimulation technology aids stroke survivors in regaining lost motor functions. This article explores its applications in upper and lower limb stroke rehabilitation. The authors review various methods to target the corticomotor system, including transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and vagus nerve stimulation. In addition, the authors review the use of peripheral neuromuscular electrical stimulation for therapeutic and assistive purposes, including transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, and functional electrical stimulation. For each, the authors examine the potential benefits, limitations, safety considerations, and FDA status.

Keywords: Functional electrical stimulation; Motor impairment; Repetitive transcranial magnetic stimulation; Stroke rehabilitation; Transcranial direct current stimulation; Vagus nerve stimulation.

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Figures

Fig. 1.
Fig. 1.
Neural stimulation targeting the corticomotor system. (A) Repetitive transcranial magnetic stimulation, (B) transcranial direct current stimulation, and (C) implanted vagus nerve stimulation. (Illustration by Emily Imka. © 2023 Cleveland FES Center, Cleveland, OH.)
Fig. 2.
Fig. 2.
Example neural stimulation for the upper limb. Contralaterally controlled functional electrical stimulation (CCFES), an innovative method of applying NMES for the upper limb for individuals poststroke. Traditionally, CCFES has consisted of a kinematic sensor glove, stimulation control unit, surface electrodes, and touchscreen interface. However, a wireless model is currently in development (Synapse Biomedical Inc) which replaces the kinematic sensor glove with an optical sensor worn on the less-affected hand (right hand). The optical sensor records movement of the digits and in turn delivers stimulations to the hemiplegic limbs (left hand) with intensity proportional to the degree of volitional opening of the less–affected hand. A touchscreen interface is used to program the stimulator. The CCFES device enables stroke survivors to practice using their paretic hand to perform tasks in therapy and to self-administer hand opening exercises. (Illustration by Emily Imka. © 2023 Cleveland FES Center, Cleveland, OH.)
Fig. 3.
Fig. 3.
Example of neural stimulation for the lower limb. The L300 Go is an FES system that incorporates 3D motion detection via an adaptive algorithm to precisely detect gait events. It consists of an ergonomic cuff, a control unit, and gait sensor. The L300 Go provides 3D motion detection of gait, multichannel stimulation and includes a mobile application to track user activity. The device delivers electrical stimulation and uses information from a three-axis gyroscope and accelerometer. Individuals’ movement is monitored in all three planes and stimulation is implemented when needed during the gait cycle. The adaptive algorithm accommodates changes in gait dynamics and a high-speed processor deploys stimulation within 10 ms of detecting a valid gait event (with permission; Image courtesy of Bioventus). (Illustration by Emily Imka. © 2023 Cleveland FES Center, Cleveland, OH.)
See this image and copyright information in PMC

References

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