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Mirror therapy combined with neuromuscular electrical stimulation for poststroke lower extremity motor function recovery: a systematic review and meta-analysis.

ABSTRACT: The combination of mirror therapy (MT) and neuromuscular electrical stimulation (NMES) has been devised as an intervention method in stroke rehabilitation; however, few studies have investigated its efficacy in lower extremity motor function recovery. In this systematic review and meta-analysis, we examined the effectiveness of combined MT and NMES therapy in improving poststroke walking speed, spasticity, balance and other gait parameters. Randomized controlled trials (RCTs) were selected from PubMed, Cochrane Library, EMBASE, and Scopus databases. In total, six RCTs which involving 181 participants were included. Our findings indicate that MT combined with NMES elicits greater improvement relative to control group in walking speed (SMD = 0.67, 95% confidence interval [CI] 0.26-1.07, P = 0.001), Berg Balance Scale (SMD = 0.72; 95% CI 0.31-1.13; P = 0.0007), cadence (SMD = 0.59, 95% CI 0.02-1.16, P = 0.04), step length (SMD = 0.94, 95% CI 0.35-1.53, P = 0.002), and stride length (SMD = 0.95, 95% CI 0.36-1.54, P = 0.002) but not in modified Ashworth scale (SMD = - 0.40, 95% CI - 1.05 to 0.26, P = 0.23). Our findings suggest that MT combined with NMES may be a suitable supplemental intervention to conventional therapy in stroke survivors.

SUBMITTER: Oh ZH

PROVIDER: S-EPMC10654913 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

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Mirror therapy combined with neuromuscular electrical stimulation for poststroke lower extremity motor function recovery: a systematic review and meta-analysis.

Oh Zhen-Han ZH Liu Chia-Hung CH Hsu Chih-Wei CW Liou Tsan-Hon TH Escorpizo Reuben R Chen Hung-Chou HC

Scientific reports 20231116 1

The combination of mirror therapy (MT) and neuromuscular electrical stimulation (NMES) has been devised as an intervention method in stroke rehabilitation; however, few studies have investigated its efficacy in lower extremity motor function recovery. In this systematic review and meta-analysis, we examined the effectiveness of combined MT and NMES therapy in improving poststroke walking speed, spasticity, balance and other gait parameters. Randomized controlled trials (RCTs) were selected from ...[more]

PMID: 37973838

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Project description:IntroductionNeuromuscular electrical stimulation (NMES) induces neural plasticity of the central nervous system (CNS) and improves motor function in patients with CNS lesions. However, the extended stimulus duration of NMES reduces its clinical applicability. Transcutaneous spinal direct current stimulation (tsDCS), which increases afferent input, may enhance the effects and reduce the stimulus duration of NMES. This study investigated the excitability of the motor cortex, somatosensory cortex, and spinal motor neurons after the combined stimulation of NMES and tsDCS.MethodsAmong the 55 participants in this study, 24 were allocated to experiment 1, 15 to experiment 2, and 16 to experiment 3. They received intervention for 20 min on different days: (1) NMES combined with tsDCS (NMES + tsDCS), (2) NMES combined with sham tsDCS (NMES + sham tsDCS), and (3) sham NMES combined with tsDCS (sham NMES + tsDCS). NMES was delivered to the right common peroneal nerve at 25 Hz with the intensity at 120% of the motor threshold. For tsDCS, the cathodal electrode was positioned on the thoracic 10th-12th vertebral levels, and the anodal electrode was located on the right shoulder. The stimulus intensity was 2.5 mA. In experiment 1, motor evoked potentials (MEPs) and short-latency intracortical inhibition (SICI) were measured by transcranial magnetic stimulation up to 60 min after stimulation. The spinal motor neurons' excitability was assessed by recording the posterior root muscle reflex (PRMR) induced via transcutaneous spinal cord stimulation in experiment 2, and the primary somatosensory cortex excitability was evaluated by recording the somatosensory evoked potentials (SEPs) in experiment 3 up to 15 min after stimulation.ResultsCompared to before the stimulation, NMES + tsDCS significantly increased MEP for 60 min or more, and significantly decreased SICI immediately after. Conversely contrast, the PRMR significantly decreased immediately after, and SEPs were unchanged.DiscussionThese results suggest that simultaneous afferent inputs from different stimulus positions critically induce primary motor cortex plasticity. The combined stimulation of NMES with tsDCS may facilitate the development of a new neurorehabilitation technique.

Project description:IntroductionApproximately 30% of individuals with stroke report unmet lower extremity recovery needs after formal hospital-based rehabilitation programmes have ended. Telerehabilitation can mitigate issues surrounding accessibility of rehabilitation services by providing ongoing support to promote recovery, however, no review exists that is specific to telerehabilitation for lower extremity recovery. This paper describes the protocol of a systematic review and meta-analysis that aims to describe and evaluate the effectiveness of lower extremity-focused telerehabilitation interventions on clinical outcomes poststroke.Methods and analysisA systematic review of relevant electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, Google Scholar, PEDro, PubMed and Cochrane Library) between inception and February 2022 will be undertaken to identify eligible interventional studies published in English that compared telerehabilitation focusing on lower extremity recovery to another intervention or usual care for individuals living in the community with stroke. Clinical outcomes examined will include those related to physical function and impairment, activities and participation that are typically assessed in clinical practice and research. Two reviewers will independently screen results, identify studies to be included for review, extract data and assess risk of bias. Meta-analyses will be performed if sufficient data exist. Sensitivity analyses will be performed by removing studies with low methodological quality, and subgroup analyses will be performed if data allow by stratifying papers based on salient demographic or stroke factors and comparing results. The reporting of the review will follow the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of evidence regarding various outcomes for telerehabilitation for lower extremity recovery poststroke will be assessed according to the Grading of Recommendation, Assessment, Development and Evaluation approach.Ethics and disseminationNo ethical approval or informed consent is needed for this systematic review. The findings of this review will be disseminated via peer-reviewed publications and conference presentations.Prospero registration numberCRD42021246886.

Project description:CONTEXT:Patellofemoral pain (PFP) is a chronic condition that presents with lower extremity muscle weakness, decreased flexibility, subjective functional limitations, pain, and decreased physical activity. Patterned electrical neuromuscular stimulation (PENS) has been shown to affect muscle activation and pain after a single treatment, but its use has not been studied in a rehabilitation trial. OBJECTIVE:To determine the effects of a 4-week impairment-based rehabilitation program using PENS on subjective function, pain, strength, range of motion, and physical activity in individuals with PFP. DESIGN:Randomized controlled trial. SETTING:Laboratory. PATIENTS OR OTHER PARTICIPANTS:A total of 21 patients with PFP (5 males, 16 females; age = 23.4 ± 7.6 years, height = 168.0 ± 7.5 cm, mass = 69.0 ± 19.5 kg). INTERVENTION(S):Participants completed a 4-week supervised rehabilitation program in conjunction with random assignment to receive PENS or sham treatments. MAIN OUTCOME MEASURE(S):Subjective function, pain, strength, range of motion, and physical activity levels were assessed prerehabilitation and postrehabilitation. Subjective function and pain were also assessed at 6 and 12 months postrehabilitation. Repeated-measures analyses of variance and Tukey post hoc testing were conducted with α ≤ .05. We calculated Cohen d effect sizes with 95% confidence intervals. RESULTS:Both groups had statistically and clinically meaningful differences in subjective function, pain, strength, range of motion, and activity level after 4 weeks of impairment-based rehabilitation. Improved subjective function was observed in both groups at 6 and 12 months after the interventions. The PENS group had improvements in current pain for all 3 postrehabilitation times compared with baseline measures. CONCLUSIONS:An impairment-based intervention effectively improved subjective function, pain, strength, range of motion, and physical activity levels in individuals with PFP. Participants who received PENS in addition to the rehabilitation program had improved current pain at 6 and 12 months postrehabilitation compared with baseline scores. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT02441712.

Project description:BackgroundThe mirror neuron system (MNS) plays a key role in the neural mechanism underlying motor learning and neural plasticity. Action observation (AO), action execution (AE), and a combination of both, known as action imitation (AI), are the most commonly used rehabilitation strategies based on MNS. It is possible to enhance the cortical activation area and amplitude by combining traditional neuromuscular electrical stimulation (NMES) with other top-down and active rehabilitation strategies based on the MNS theory.ObjectiveThis study aimed to explore the cortical activation patterns induced by NMES synchronized with rehabilitation strategies based on MNS, namely NMES+AO, NMES+AE, and NMES+AI. In addition, the study aimed to assess the feasibility of these three novel rehabilitative treatments in order to provide insights and evidence for the design, implementation, and application of brain-computer interfaces.MethodsA total of 70 healthy adults were recruited from July 2022 to February 2023, and 66 of them were finally included in the analysis. The cortical activation patterns during NMES+AO, NMES+AE, and NMES+AI were detected using the functional Near-Infrared Spectroscopy (fNIRS) technique. The action to be observed, executed, or imitated was right wrist and hand extension, and two square-shaped NMES electrodes were placed on the right extensor digitorum communis. A block design was adopted to evaluate the activation intensity of the left MNS brain regions.ResultsGeneral linear model results showed that compared with the control condition, the number of channels significantly activated (PFDR < 0.05) in the NMES+AO, NMES+AE, and NMES+AI conditions were 3, 9, and 9, respectively. Region of interest (ROI) analysis showed that 2 ROIs were significantly activated (PFDR < 0.05) in the NMES+AO condition, including BA6 and BA44; 5 ROIs were significantly activated in the NMES+AE condition, including BA6, BA40, BA44, BA45, and BA46; and 6 ROIs were significantly activated in the NMES+AI condition, including BA6, BA7, BA40, BA44, BA45, and BA46.ConclusionThe MNS was activated during neuromuscular electrical stimulation combined with an AO, AE, and AI intervention. The synchronous application of NMES and mirror neuron rehabilitation strategies is feasible in clinical rehabilitation. The fNIRS signal patterns observed in this study could be used to develop brain-computer interface and neurofeedback therapy rehabilitation devices.

Dataset Information

Mirror therapy combined with neuromuscular electrical stimulation for poststroke lower extremity motor function recovery: a systematic review and meta-analysis.

Publications

Mirror therapy combined with neuromuscular electrical stimulation for poststroke lower extremity motor function recovery: a systematic review and meta-analysis.

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