Improve motor, sensory and cognitive recovery of hand and arm function after stroke

Does it sometimes happen that after lying down for a while, the nerves in the arm are stressed and you can't feel the arm, you can't feel its position and size, it doesn't feel like it belongs in your own body
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If this continues for years, the representation of the upper extremities in the brain is chronically distorted

Stroke patients report a variety of symptoms, such as the inability to show their arms
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They also reported symptoms such as inability to control the muscles of the arm and hand, inability to precisely adjust grip strength when holding objects, and difficulty perceiving the arm and hand in general

Left untreated, deficits in sensory and physical representation may lead patients to perceive the affected limb as shorter, less sensitive, less responsive, and eventually even "forget" about it
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Stroke is the leading cause of disability in adults in the European Union, according to a 2020 study, and Covid-19 has made the situation worse
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Since the Covid-19 outbreak, the number of stroke patients requiring long-term assistance and recovery has increased significantly, as has flu-related strokes among young adults

Novel neuromuscular electrical stimulation improves rehabilitation

Now, a consortium of neuroscientists, clinicians and neuroengineers includes EPFL's Cognitive Neuroscience Lab (directed by Olaf Blanke), CHUV's MySpace Lab (directed by Andrea Serino), Villa Beretta Hospital (directed by Franco Molteni), research led by the Translational Neuroengineering Laboratory at EPFL (directed by Silvestro Micera) has shown that carefully tuned electrical stimulation of the neuromuscular system, combined with current rehabilitation practices, holds promise for restoring upper extremity control and implementation in long-term disabled stroke patients
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Details of the neuromuscular electrical stimulation (NMES) protocol they tested on 45 chronic stroke patients were published today in MED

Targets multiple domains of perception, including tactile sensitivity, perceived body size, and the sensation of arm twisting, thereby restoring arm use
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He continued, "Our approach reduces perceptual dissociation in the affected limb, which is why targeted electrical muscle stimulation and individualized treatment for specific deficits in chronic stroke survivors is so important

Motor and somatosensory improvements continued beyond the end of treatment
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Furthermore, the electrical stimulation protocol improved physical representation, i.
e.

Robotic Glove Rehabilitation and Novel NMES Rehabilitation

45 chronic stroke patients received 27 NMES treatments over a 9-week period
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Each session lasts 90 minutes, with 60 minutes including traditional physiotherapy rehabilitation and 30 minutes of adjunctive therapy based on robotic gloves or a custom NMES

Scientists measured each patient's motor performance, sensory ability and body perception before, during and after the nine-week clinical trial
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The performance of patients with NMES improved earlier than with robotic gloves
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At the end of treatment, motor improvement was higher in the partial or complete NMES group compared with gloves alone

The current study focused on chronic stroke patients who had undergone multiple previous interventions and who reached a plateau considered to be improvement
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These results suggest that targeted, intensive interventions, especially through NMES, can further drive recovery
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They also point out that subacute stroke patients, those who have just had a stroke, may also benefit from NMES, although this remains to be tested
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"The challenge for subacute stroke patients lies in more unstable sensory perceptions and physical representations
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If their rapidly changing circumstances are appropriately individualized, they may benefit more from new economic mesas," explains Crema
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A major innovation of this study is that it targets and assesses not only motor recovery but also sensory deficits and physical representations
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"This study shows the importance of multidimensional functional assessment after stroke and paves the way for more effective clinical rehabilitation protocols," said Silvestro Micera
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Scientists are currently working on a new system that can provide finer motor and sensory stimulation, as well as a wider variety of stimuli
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