Individualized electrostimulation using a wearable electro suit in a mixed cohort of stroke and spinal cord injury with spasticity: Clinical outcomes and qualitative feedback (Preprint)

BACKGROUND Various forms of electrical stimulation have been integrated into the multimodal management of spasticity; however, high-frequency electrical stimulation can potentially induce muscle fatigue. As an alternative approach, the Exopulse Mollii® suit (EMS) is a multi-channel full-body garment that delivers low frequency (20Hz) low amplitude (20V) sub-threshold sensory stimulation aimed at reducing spasticity. OBJECTIVE Primarily, we examined the effects of a single session of EMS on spasticity in seven participants with chronic stroke or spinal cord injury (SCI) and assessed the impact on gait and ambulatory function. User perceptions of usability and acceptability were also evaluated. METHODS Participants wore EMS for 60 minutes, combined with standardised light activities in blocks of 15 minutes alternating with 15-minute rest breaks. RESULTS Based on Modified Tardieu Scale and surface electromyography signals, improvements in spasticity were only observed in two participants. However, four participants demonstrated faster walking speeds. Improvements in Five Times Sit to Stand Test (5xSTS) and step test were noted in three and four participants respectively. Improved gait patterns were observed after use of EMS, particularly in SCI participants. Spatiotemporal gait parameters revealed improvements in gait symmetry in six participants. Qualitative feedback based on NATU quest returned positive results in three participants. Overall outcomes, defined as meeting the individualised goals of each participant, were positive in four. CONCLUSIONS EMS is effective in improving dynamic balance, motor control and gait quality. Additionally, self- administration of EMS at home is feasible for patients with spasticity. To our best knowledge, this is the first report of the effects of EMS in participants with SCI and the first to report spatiotemporal gait parameters with use of EMS.