title: The application of precisely controlled functional electrical stimulation to the shoulder, elbow and wrist for upper limb stroke rehabilitation: a feasibility study.
abstract: BACKGROUND
  Functional electrical stimulation (FES) during repetitive practice of everyday tasks can facilitate recovery of upper limb function following stroke. Reduction in impairment is strongly associated with how closely FES assists performance, with advanced iterative learning control (ILC) technology providing precise upper-limb assistance. The aim of this study is to investigate the feasibility of extending ILC technology to control FES of three muscle groups in the upper limb to facilitate functional motor recovery post-stroke.
  
  
  METHODS
  Five stroke participants with established hemiplegia undertook eighteen intervention sessions, each of one hour duration. During each session FES was applied to the anterior deltoid, triceps, and wrist/finger extensors to assist performance of functional tasks with real-objects, including closing a drawer and pressing a light switch. Advanced model-based ILC controllers used kinematic data from previous attempts at each task to update the FES applied to each muscle on the subsequent trial. This produced stimulation profiles that facilitated accurate completion of each task while encouraging voluntary effort by the participant. Kinematic data were collected using a Microsoft Kinect, and mechanical arm support was provided by a SaeboMAS. Participants completed Fugl-Meyer and Action Research Arm Test clinical assessments pre- and post-intervention, as well as FES-unassisted tasks during each intervention session.
  
  
  RESULTS
  Fugl-Meyer and Action Research Arm Test scores both significantly improved from pre- to post-intervention by 4.4 points. Improvements were also found in FES-unassisted performance, and the amount of arm support required to successfully perform the tasks was reduced.
  
  
  CONCLUSIONS
  This feasibility study indicates that technology comprising low-cost hardware fused with advanced FES controllers accurately assists upper limb movement and may reduce upper limb impairments following stroke.
authors: Faculty of Physical Sciences and Engineering, University of Southampton, Southampton, UK. klm@ecs.soton.ac.uk.
authors: Katie L
authors: KL
authors: Meadmore
authors: Timothy A
authors: TA
authors: Exell
authors: Emma
authors: E
authors: Hallewell
authors: Ann-Marie
authors: AM
authors: Hughes
authors: Chris T
authors: CT
authors: Freeman
authors: Mustafa
authors: M
authors: Kutlu
authors: Valerie
authors: V
authors: Benson
authors: Eric
authors: E
authors: Rogers
authors: Jane H
authors: JH
authors: Burridge
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D004550:Elbow / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012782:Shoulder / Q000503:physiopathology; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000503:physiopathology*; D014953:Wrist / Q000503:physiopathology