Halawani Alhussain, Aljabri Ammar, Bahathiq Dena M, Morya Roaa E, Alghamdi Saeed, Makkawi Seraj
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
Front Neurol. 2024 Feb 21;15:1340248. doi: 10.3389/fneur.2024.1340248. eCollection 2024.
Limb paresis following a stroke is a common sequela that can impact patients' quality of life. Many rehabilitation strategies targeting the restoration of motor function exist. This systematic review and meta-analysis aim to evaluate the effects of contralaterally controlled functional electrical stimulation (CCFES) as a modality for limb rehabilitation. Unlike conventional neuromuscular electrical simulation (NMES), the contra-laterality in CCFES is achieved by two methods a bend angle sensor or an electromyographic bridge (EMGB) method, both of which targets signals from the unaffected limb.
This review study was performed following the preferred reporting item for systematic review and meta-analysis (PRISMA) guidelines. Records that met the inclusion criteria were extracted from the following databases: Medline, Embase, and Cochrane Register of Controlled Trials (CENTRAL). Additional articles were also retrieved from clinicaltrials.gov and China/Asia on Demand (CAOD). Only randomized controlled studies (RCTs) were included.
Sixteen RCTs met the inclusion criteria, and 14 of which were included in the quantitative analysis (meta-analysis). The results of the analysis show that when compared to conventional NMES, CCFES displayed a better improvement in the upper extremity Fugl-Meyer assessment (UEFMA) (SMD = 0.41, 95% CI: 0.21, 0.62, -value <0.0001, = 15%, GRADE: moderate), box and blocks test (BBT) (SMD = 0.48, 95% CI: 0.10, 0.86, -value = 0.01, = 0%, GRADE: very low), modified Barthel index (mBI) (SMD = 0.44, 95% CI: 0.16, 0.71, -value = 0.002, = 0%, GRADE: moderate), active range of motion (AROM) (SMD = 0.61, 95% CI: 0.29, 0.94, -value = 0.0002, = 23%, GRADE: moderate), and surface electromyography (sEMG) scores (SMD = 0.52, 95% CI: 0.14, 0.90, -value = 0.008, = 0%, GRADE: low). The results of the subgroup analysis for the type of sensor used in CCFES shows that an EMGB (SMD = 0.58, 95% CI: 0.33, 0.84, -value <0.00001, = 7%) is more effective than a bend angle sensor (SMD = 0.17, 95% CI: -0.12, 0.45, -value = 0.25, = 0%).
The results of this study provide strong evidence that shows CCFES being a better electrical stimulation modality compared to conventional NMES. This could be explained by the fact that CCFES is bilateral in nature which offers a platform for better neuroplasticity following a stroke. There is still a need for high-quality studies with a standardized approach comparing CCFES to other treatment modalities.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=342670, identifier CRD42022342670.
中风后肢体麻痹是一种常见的后遗症，会影响患者的生活质量。目前存在许多旨在恢复运动功能的康复策略。本系统评价和荟萃分析旨在评估对侧控制功能性电刺激（CCFES）作为肢体康复方式的效果。与传统的神经肌肉电刺激（NMES）不同，CCFES的对侧性通过两种方法实现，即弯角传感器或肌电图桥接（EMGB）方法，这两种方法均针对未受影响肢体的信号。
本综述研究按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。从以下数据库中提取符合纳入标准的记录：医学文献数据库（Medline）、荷兰医学文摘数据库（Embase）和Cochrane对照试验注册中心（CENTRAL）。还从美国国立医学图书馆临床试验数据库（clinicaltrials.gov）和按需提供的中国/亚洲文献（CAOD）中检索了其他文章。仅纳入随机对照试验（RCT）。
16项RCT符合纳入标准，其中14项纳入定量分析（荟萃分析）。分析结果表明，与传统NMES相比，CCFES在上肢Fugl-Meyer评估（UEFMA）（标准化均数差[SMD]=0.41，95%置信区间[CI]：0.21，0.62，P值<0.0001，I²=15%，推荐分级：中等）、箱块测试（BBT）（SMD=0.48，95%CI：0.10，0.86，P值=0.01，I²=0%，推荐分级：极低）、改良Barthel指数（mBI）（SMD=0.44，95%CI：0.16，0.71，P值=0.002，I²=0%，推荐分级：中等）、主动活动范围（AROM）（SMD=0.61，95%CI：0.29，0.9
