Aging with Stroke: Using Functional Electrical Stimulation as a Neuromodulatory Intervention Supplement

Background: Stroke is a leading cause of long-term disability among older adults, characterized by impaired walking, balance dysfunction, and increased fall risk. Conventional clinic-based rehabilitation targets volitional balance but does not adequately address reactive balance, the rapid compensatory responses that are necessary to prevent falls. Functional Electrical Stimulation (FES) is a neuromodulatory adjunct that can improve muscular activation and cortical engagement, but its translation into scalable, home- or community-based paradigms remains limited. Objective: This dissertation contains research studies including proof-of-concept, Stage-I feasibility and pilots and randomized controlled trials feasibility that examined neurophysiological mechanisms, and clinical efficacy of FES-integrated rehabilitation interventions for improving volitional and reactive balance control among aging adults with stroke and high mobility decline. Methods: Three interrelated studies were conducted. Study 1 assessed the feasibility and initial effects of a smartphone-based multicomponent home exercise program (SETS) combined with FES in OAwS. Study 2 compared two supervision models, front-loaded and distributed, within the home-based SETS paradigm to establish optimal therapist engagement structures. Study 3 investigated the immediate effects of synchronizing FES with reactive balance responses during unpredicted gait slips. It was followed by a randomized controlled trial, REACT+FES, to examine the effect of FES-assisted perturbation training on biomechanical, cortical, and clinical outcomes. Throughout the studies, functional mobility, reactive stability, limb support, cortical spectral power (EEG), motivation, usability, and adherence were among the variables measured. Results: Home-based SETS integrated with FES were feasible, safe, and well accepted, demonstrating high adherence (~84%) and clinically meaningful gains in walking speed, balance, and strength, with improvements exceeding established MCIDs. Distributed supervision resulted in greater gains in functional strength (30STS) and mobility (TUG) compared with front-loaded models, underlining the impact of timing of therapist contact on motor learning. In the laboratory, single-session, time-locked FES to paretic quadriceps during slip perturbation reduced induced falls by over 50%, while increasing vertical limb support, reactive stability, and compensatory step efficiency. These findings were corroborated by the REACT+FES clinical trial, showing increased cortical beta desynchronization, reduced perturbation-evoked potentials (N1), and improved post-slip stability, mobility, and balance confidence as compared to conventional training. Collectively, these findings establish FES as an effective neuromodulatory adjunct capable of enhancing both volitional and reactive balance rehabilitation post-stroke. With the integration of digital health delivery, optimal supervision design, and cortical biomarkers, this work contributes to and extends a precision neurorehabilitation framework that improves motor learning, reduces fall risk, and supports scalable home-based implementation for OAwS.

Author dc:creator

• Rudri Purohit (23292118)

• Older Adults with Stroke

Statement dc:rights

• In Copyright
• Open Access after 2028-01-01

DOI dc:identifier

https://doi.org/10.25417/uic.31451857.v1

OAI identifier oai:identifier

oai:figshare.com:article/31451857