Neuromuscular stimulation after stroke: from technology to clinical deployment

Abstract

Since the early 1960s, electrical or neuromuscular electrical stimulation (NMES) has been used to support the rehabilitation of stroke patients. One of the earliest applications of NMES included the use of external muscle stimulation to correct drop-foot after stroke. During the last few decades various clinical applications have been used for the upper and lower limb. Despite a growing body of literature on the use of NMES, its application in stroke is still limited to a few clinical groups that provide dedicated clinical services. Some explanations for the limited use are the sometimes conflicting clinical evidence, the size of the effects or the complicated use of the technology itself. This review points out three directions for future research. First, we need to expand our knowledge on brain plasticity and the use of different electrical stimulation strategies to modulate the neural system. Second, we foresee an increase in therapies combining different training principles, for example, the combination of NMES and robotics or neuromodulating drugs. Finally, with the ever-increasing pressure on healthcare budgets, it is expected that clinical and economic evidence will become more relevant in transferring these interventions to a wider community.

Keywords::

• drop-foot implant
• medical technology assessment
• motor relearning
• neural prostheses
• neuromodulation
• neuromuscular electrical stimulation
• outcomes research
• pain
• stroke

Financial & competing interests disclosure

The authors have no direct relation with any of the companies and/or commercial products mentioned in the manuscript, except for discounts in purchase of devices for clinical and research purposes and small amounts of funding (<€30,000) obtained from Otto Bock (Alexander CH Geurts), Neurocontrol Inc. (Maarten J IJzerman and Gerbert J Renzenbrink) and NESS Ltd (Alexander CH Geurts and Maarten J IJzerman) to carry out independent research on neuroprosthetic and NMES devices. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.