Neuromuscular electrical stimulation restores upper limb sensory-motor functions and body representations in chronic stroke survivors

Andrea Crema; Michela Bassolino; Eleonora Guanziroli; Maria Colombo; Olaf Blanke; Andrea Serino; Silvestro Micera; Franco Molteni

doi:10.1016/j.medj.2021.12.001

Neuromuscular electrical stimulation restores upper limb sensory-motor functions and body representations in chronic stroke survivors

Med. 2022 Jan 14;3(1):58-74.e10. doi: 10.1016/j.medj.2021.12.001. Epub 2022 Jan 7.

Authors

Andrea Crema¹, Michela Bassolino², Eleonora Guanziroli³, Maria Colombo³, Olaf Blanke⁴, Andrea Serino⁵, Silvestro Micera⁶, Franco Molteni³

Affiliations

¹ Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Geneva 1202, Switzerland; AGO Neurotechnologies, sàrl, Geneva 1201, Switzerland. Electronic address: andrea.crema@epfl.ch.
² Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, School of Life Science, Swiss Federal Institute of Technology (EPFL), Geneva 1202, Switzerland; Institute of Health, School of Health Sciences, HES-SO Valais-Wallis, Sion 1950, Switzerland; Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), MySpace Lab, Lausanne 1011, Switzerland.
³ Villa Beretta Rehabilitation Center, Valduce Hospital Como, Costa Masnaga 23845, Italy.
⁴ Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, School of Life Science, Swiss Federal Institute of Technology (EPFL), Geneva 1202, Switzerland; Department of Clinical Neuroscience, University of Geneva Medical School, Geneva 1211, Switzerland.
⁵ Institute of Health, School of Health Sciences, HES-SO Valais-Wallis, Sion 1950, Switzerland; Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), MySpace Lab, Lausanne 1011, Switzerland.
⁶ Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Geneva 1202, Switzerland; The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pontedera 56025, Italy.

PMID: 35590144
DOI: 10.1016/j.medj.2021.12.001

Abstract

Background: A conventional treatment outcome is suboptimal for sensory impairments in stroke patients. Novel approaches based on electrical stimulation or robotics are proposed as an adjuvant for rehabilitation, though their efficacy for motor, sensory, and body representation recovery have not been tested.

Methods: Sixty chronic stroke patients with unilateral motor deficits were included in a pseudo-randomized open-label multi-arm control trial (ClinicalTrials.gov: NCT03349138). We tested the effects of a robotic glove (GloReha [GR]) and a new neuromuscular electrical stimulation system (Helping Hand [HH]) and compared them with conventional treatment (CT) in restoring motor and sensory functions and the affected limb perception. HH was designed to concurrently deliver peripheral motor activation and enhanced cutaneous sensation. Patients were split in four dose-matched groups: CT, GR, HH, and GRHH (receiving 50% GR and 50% HH). Assessments were performed at inclusion, halfway, end of treatment (week 9), and follow-up (week 13).

Findings: HH provided an earlier benefit, quantified by the Motricity Index (MI), than GR. At the end of the treatment, the amelioration was higher in groups GRHH and HH and extended to somatosensory functions. These benefits persisted at the follow-up. GRHH and HH also improved the perceived dimensions and altered feeling toward the affected limb. Interestingly, the reduction of altered feelings correlated with MI improvements and depended on the amount of HH.

Conclusions: We suggest that HH concurrently stimulates sensory and motor systems by generating an enhanced cutaneous sensation, coherent in location with the elicited motor recruitment, leading to ameliorated sensorimotor functions and bodily perceptions in stroke patients.

Funding: This work was supported by a Foundation advised by CARIGEST, by Fondazione CARIPLO, by the SNSF NCCR Robotics, and by the Bertarelli Foundation.

Keywords: Translation to patients; embodiment; neuromuscular electrical stimulation; neuroprosthetics; sensory processing; stroke.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Body Image
Electric Stimulation
Humans
Recovery of Function / physiology
Sensation
Stroke Rehabilitation* / methods
Stroke* / therapy
Survivors
Upper Extremity

Associated data

ClinicalTrials.gov/NCT03349138