22 - Electrical stimulation approaches to stroke recovery  pp. 247-258

Electrical stimulation approaches to stroke recovery

By John Chae and Leigh R. Hochberg

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Electrical stimulation can modify the function of peripheral or central nervous system elements. Neuromuscular electrical stimulation (NMES) in stroke rehabilitation provides both therapeutic and functional benefits. NMES produces muscle contractions by directly exciting peripheral motor nerves or motor points. Therapeutic applications may lead to a specific effect that enhances, but does not directly provide, function. Specific NMES therapeutic applications reviewed in this chapter include post-stroke motor relearning and reduction of hemiplegic shoulder pain. The term functional electrical stimulation or FES refers to the use of NMES to directly accomplish functional tasks. Devices that provide FES are also referred to as neuroprostheses, and are also reviewed in this chapter. Specific “functional” or neuroprosthetic applications reviewed in this chapter include upper and lower limb motor movement for activities of daily living (ADL) and mobility, respectively. Finally, the fourth section of this chapter considers a range of emerging electrical stimulation techniques for promoting recovery and repair after stroke, some of which specifically target the central nervous system.

Motor relearning

Basic science and theoretical considerations

Motor relearning is defined as “the recovery of previously learned motor skills that have been lost following localized damage to the central nervous system”. In non-human primate models, goal-oriented, active repetitive movement training of the paretic limb after local damage to the motor cortex shapes subsequent functional reorganization in the adjacent intact cortex, and the undamaged motor cortex plays an important role in motor relearning.

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