Functional Electrostimulation in Patients Affected by the Most Frequent Central Motor Neuron Disorders-A Scoping Review

Post-stroke sequelae, spinal cord injury and multiple sclerosis are the most common and disabling diseases of upper motor neurons. These diseases cause functional limitations and prevent patients from performing activities of daily living. This review aims to identify the potential of functional electrical stimulation (FES) for locomotor rehabilitation and daily use in upper motor neuron diseases. A systematic search was conducted. For the search strategy, MeSH terms such as "stroke", "functional electrical stimulus*" and "FES", "post-stroke", "multiple sclerosis", and "spinal cord injury*" were used. Of the 2228 papers from the raw search results, 14 articles were analyzed after inclusion and exclusion criteria were applied. Only four articles were randomized clinical trials, but with low numbers of participants. RehaMove, Microstim and STIWELL were reported in three independent studies, whereas Odstock was used in four articles. The results of the studies were very heterogeneous, although for lower extremity stimulation (11 out of 14 papers), walking speed was reported only in 6. Berg Balance Scale, Timed Up and Go, Functional Ambulation Category, 6-Minute Walk Test, 10-Meter Walk Test, Fugl-Meyer Assessment, Motricity Index and Action Research Arm Test were reported for functional assessment. For clinical assessment, the Modified Barthel Index, the Rivermead Mobility Index and the Stroke Impact Scale were used. Four studies were spread over 6 months, two investigated the effects of FES during one session, and the other eight were conducted for 3 to 8 weeks. Improvements were reported related to gait speed, functional ambulation, hand agility and range of motion. FES can be considered for large-scale use as a neuroprosthesis in upper neuron motor syndromes, especially in patients with impaired gait patterns. Further research should focus on the duration of the studies and the homogeneity of the reported results and assessment scales, but also on improvements to devices, accessibility and quality of life.