Reply to “The effects of functional electrical stimulation on upper extremity function and cortical plasticity in chronic stroke patients”

I appreciate the very important and developed suggestions by Dr. Cecatto for our article (). The proposals on the reasons why EMG-controlled FES (EMG–FES) could shift the brain hemispheric-dominant perfusion in our study provided our study further development and progress. The motor output and corresponding muscle and joint proprioceptive feedback may be tightly coupled and coordinated with movement by EMG–FES. As Dr. Cecatto proposed, these neural reorganisation mechanisms should be explored. The sensory components of large afferent fibre activation, proprioceptive input and increased cognitive sensory attention are all weighted in the direction of spasticity reduction and are thus helpful in the return of voluntary movement and increased function (). Nudo et al. suggest that afferent input associated with repetitive movements facilitates improvement of motor function (). For this reason, motor movement stimulation might be more effective in improving motor control than simple sensory stimulation. This is likely, as electrical stimulation that provokes motor activation is associated with cutaneous, muscle and joint proprioceptive afferent feedback. In another way, the mechanism underlying the EMG-controlled FES therapy is that alternative motor pathways are recruited and activated to assist impaired efferent pathways (). This explanation is based on the sensory–motor integration theory that stipulates that sensory input from movement of an affected limb directly influe...
Source: Clinical Neurophysiology - Category: Neuroscience Authors: Tags: Letters to the Editor Source Type: research