Why Electrical Stimulation Fails After Stroke and How to Fix It

NeuroRehab Team
Tuesday, January 13th, 2026

Stroke stands as the fifth leading cause of death in the United States and leaves many survivors with long-term disability. Electrical stimulation offers these patients a way to recover. The numbers paint a stark picture – 5.5 million deaths and 116.4 million disability-adjusted life-years worldwide came from stroke in 2016. Most survivors face upper limb hemiparesis, and 55-75% of patients still struggle with arm function even after 3-6 months of therapy.

Research shows promise that electrical sensory inputs combined with regular therapy can improve peak torque dorsiflexion. But the real-life application of neuromuscular electrical stimulation doesn’t meet expectations. Studies have showed that this stimulation can trigger neural reconstruction and lead to better behavioral performance. The adoption rates tell a different story – only 45% of therapists use electrical stimulation regularly.

A big gap exists between what electrical stimulation therapy promises and what it delivers to stroke patients. These devices keep getting better technically, but their success often gets held back by poor training and other barriers.

This piece looks at why many electrical stimulation methods don’t give the best results and shows how to fix these issues to help stroke survivors recover better. Everyone involved in stroke rehabilitation needs to understand these limitations and ways to improve.

Why electrical stimulation is used in stroke rehabilitation

Stroke patients face major challenges when they try to regain independence due to motor impairments. Electrical stimulation plays a vital role in their recovery. This intervention targets specific deficits and works alongside the body’s natural healing processes.

Understanding motor impairment after stroke

Stroke damages brain regions that control movement. This damage leads to upper limb hemiparesis—weakness or inability to move one side of the body—affecting most survivors. 55-75% of stroke patients still show defective arm function even after 3-6 months of rehabilitation ^[1]. Only 5% of patients with complete paralysis get back full arm function, and 30-66% never regain proper use of their affected arm ^[2].

Post-stroke weakness has severe impacts. Patients often have just 45% of normal lower limb strength when they leave inpatient rehabilitation ^[1]. The brain can’t send proper electrical signals through neural pathways to muscles. This leads to muscles that can’t contract normally, which limits daily activities.

The body recovers motor function in predictable stages. Patients first show flaccidity, then develop abnormal movement patterns and synergies. Many people reach a plateau in their recovery around 12 months after stroke. Research shows improvement remains possible even in chronic stages with the right interventions ^[3].

Goals of electrical stimulation therapy

Electrical stimulation therapy helps restore lost motor functions so patients can return to their daily lives ^[1]. The treatment targets neuroplasticity—the brain’s ability to form new neural connections. Electrical stimulation activates damaged parts of the brain in stroke patients, which can speed up recovery ^[1].

The treatment also helps maintain muscle integrity. Muscles become weak and shrink without regular contraction. Electrical stimulation fights this process by:

Decreasing the risk of fractures through increased muscle mass
Improving blood circulation to affected areas
Preventing muscle atrophy from disuse
Building strength in weakened muscles ^[1]

Clinical studies back up these benefits. Research shows electrical stimulation substantially improves motor function and daily activities while reducing long-term disability ^[2]. Patients who combine electrical stimulation with physical therapy show better results than those who only exercise ^[1].

Common types of electrical stimulation used

Stroke patients benefit from several forms of electrical stimulation therapy during rehabilitation:

Neuromuscular Electrical Stimulation (NMES) sends electrical impulses to muscles that mimic normal nervous system signals. This helps strengthen paralyzed or weakened limbs and encourages motor recovery ^[1].

Functional Electrical Stimulation (FES) works as a specialized form of NMES that combines electrical stimulation with functional movements. FES can help lift the foot during walking to reduce foot drop or assist fingers to grasp objects ^[1]. The Clinical Practice Guideline for Stroke Rehabilitation in Korea strongly recommends FES to improve gait function in stroke patients with foot drop ^[3].

Transcutaneous Electrical Nerve Stimulation (TENS) focuses on pain management rather than muscle contraction. It sends impulses to nerve cells that block pain signals from reaching the brain ^[1]. TENS also boosts sensorimotor function in chronic stroke patients ^[4].

Interferential Current (IFC) works like TENS for pain reduction but uses a different frequency that many patients find more comfortable ^[1].

FES systems come in two main categories:

Open-loop FES systems use preprogrammed patterns that patients can’t control to start muscle activation
Closed-loop FES systems use patient feedback and include brain-computer interface (BCI) controlled and electromyogram (EMG) controlled systems ^[1]

Studies show closed-loop systems produce better results. These systems use patient intention and effort, and active participation through feedback loops can improve recovery outcomes ^[1].

The 3 most common types of electrical stimulation for stroke patients

FES systems for stroke rehabilitation come in three main types. Each type has unique features that affect how well they work in clinical settings. Knowing how these systems work is vital to help patients with motor impairments recover better.

Open-loop FES systems

Open-loop FES offers the simplest way to use electrical stimulation for stroke patients. These systems run on preset patterns that patients cannot adjust through feedback ^[5]. The therapist controls electrical stimulation to specific muscles using fixed settings like intensity, duration, and ON/OFF cycles ^[3].

Medical environments still commonly use these simple open-loop systems ^[6]. Products like Parastep I (Sigmedics, Inc.) and RehaStim (Hasomed Inc.) are examples that just need users to press buttons for control ^[6].

Research confirms that open-loop FES helps upper limb stroke recovery. To name just one example, Nakipoglu Yuzer et al. showed that open-loop FES reduces wrist flexor spasticity ^[3]. Another study by Meadmore et al. found a 4.4-point improvement in clinical tests when they combined basic hardware with advanced FES controllers ^[3].

These systems do have drawbacks. Movement control is less precise because they rely on manual input to start stimulation ^[3]. Research shows that manual FES systems lead to a mean difference of 5.6 in Fugl-Meyer Assessment scores (95% CI: 3.77-7.5, P < 0.001) ^[3].

BCI-controlled FES systems

BCI-controlled FES systems mark a big step forward in stroke rehabilitation technology. These systems read patients’ brainwaves to detect movement intention and trigger electrical stimulation ^[1].

A typical BCI-FES system has three key parts: a BCI unit that analyzes brain activity, a BCI-FES interface assembly, and an FES module for muscle stimulation ^[1]. Many systems also use virtual reality to get more patient participation ^[3].

Therapy sessions work like this: patients imagine doing a movement they see in virtual reality. This mental activity creates specific EEG signals for the BCI unit to process ^[3]. The BCI-FES interface then sends commands to control FES stimulation settings ^[3].

Multiple studies prove BCI-FES systems work well. A review of 290 patients from 10 RCTs showed a moderate effect size in upper limb function recovery (SMD = 0.50, 95% CI: 0.26-0.73, P < 0.0001) ^[1]. BCI-FES training helped both subacute (SMD = 0.56, 95% CI: 0.25-0.87, P = 0.0004) and chronic stroke patients (SMD = 0.42, 95% CI: 0.05-0.78, P = 0.02) ^[1].

BCI-FES systems give feedback through muscle stimulation, which is vital for promoting brain reorganization ^[1]. This sensory feedback makes BCI-FES different from other rehabilitation methods.

EMG-controlled FES systems

EMG-controlled FES systems make up the third major type. These systems use the patient’s muscle activity to control stimulation. Unlike open-loop systems, EMG-controlled FES actively uses patient effort in rehabilitation ^[3].

This category has two main approaches:

EMG-triggered FES – Uses EMG signals as switches to start stimulation at certain muscle activity levels ^[3]
EMG-controlled FES – Controls both the timing and strength of stimulation based on real-time EMG signals ^[3]

Research shows the second approach works better. Shindo et al. found that EMG-controlled FES helped finger extension more than other methods ^[3]. The MeCFES system, developed by Thorsen’s team, showed great improvement in upper limb function on the Action Research Arm Test ^[3].

EMG-controlled FES systems show the best results among all FES types. Studies reveal these systems lead to a mean difference of 14.14 in Fugl-Meyer Assessment scores (95% CI: 11.72-16.6, P < 0.001) and 11.9 in Action Research Arm Test scores (95% CI: 8.8-14.9, P < 0.001) ^[3].

These systems work so well because patients stay active throughout therapy. This creates a direct link between effort and help. Yes, it is true that “cells that fire together wire together,” as Hebb’s principle states. The brain and physical activities working together during rehabilitation leads to better recovery of impaired motor function ^[3].

Why electrical stimulation often fails in real-world settings

Research shows promise, but electrical stimulation for stroke patients doesn’t work well in ground clinical settings. Several roadblocks keep these technologies from reaching their full potential. This creates a gap between lab success and actual implementation.

Lack of patient engagement

Getting patients to participate remains one of the biggest hurdles in electrical stimulation therapy. Studies show poor clinical acceptability of neuromuscular electrical stimulation (NMES). Patients rarely stick to their unsupervised sessions ^[7]. Discomfort during electrically evoked contractions is a major limiting factor. A patient’s gender, skin-fold thickness, and coping style affect how they experience this discomfort ^[7].

Better technology might improve exercise delivery, but many patients still find it hard to keep up with their sessions. Older adults need extra psychological, social, and physical support to participate fully in electrical stimulation programs ^[7]. Therapists can alleviate discomfort by using larger electrodes, but engagement issues often continue whatever technical adjustments they make.

Inadequate therapist training

A therapist’s expertise plays a crucial role in how well electrical stimulation therapy works, but many have knowledge gaps. Many therapists doubt whether electrical stimulation helps during different stroke recovery phases: 56% during acute stages, 23% during early subacute stages, 17% during late subacute stages, and 21% during chronic stages ^[1]. They remain skeptical even though growing evidence supports its benefits, especially in acute and subacute rehabilitation periods.

Many therapists also lack confidence in customizing treatments. About 13% never adjust stimulation intensity for individual patients, while 14% aren’t sure about their adjustments ^[1]. They feel even less confident about changing stimulation frequency, pulse duration, and pulse shape. Extra specialized training boosts usage rates (85% vs. 44%), but entry-level education programs don’t give therapists the skills they need ^[1].

Limited access to devices

Device availability often creates bottlenecks, even with knowledgeable therapists and willing patients. Most clinics don’t have enough equipment to loan devices to patients for home use ^[1]. This forces all treatments to happen in clinical settings. Such restrictions limit how often and how long patients can receive therapy, which reduces potential benefits from consistent stimulation.

Device access and usage rates go hand in hand. Therapists who have access to devices use them much more often (80%) compared to those without (44%) ^[8]. Time constraints sometimes make things worse, though most therapists say they have enough time for electrical stimulation therapy.

Overreliance on passive stimulation

Half of all therapists still use passive stimulation techniques ^[1], which lack solid evidence of effectiveness. These approaches don’t ask patients to actively participate during stimulation. This misses chances to strengthen neural connections through simultaneous intention and movement.

Active engagement methods like EMG-triggered or position-triggered electrical stimulation show better results. Simple improvements could help – like asking patients to focus mentally on moving their stimulated limb during therapy. This helps reinforce brain-muscle connections.

Electrical stimulation technology keeps advancing, but these practical challenges keep many stroke patients from getting the most out of this valuable rehabilitation tool. Solving these issues needs a comprehensive approach that includes better device design, therapist education, clinical protocols, and patient support systems.

Clinical limitations in current research and trials

Research on electrical stimulation for stroke patients has major problems with methods that make it hard to trust the results. These scientific shortcomings create big hurdles to wider use of technologies that could help patients.

Small sample sizes

Studies on electrical stimulation therapy don’t have enough participants. Brain stimulation research works with a mean total sample size of just 22.2 ± 24.9 subjects ^[9]. The numbers look even worse – only 8.04% of 435 data sets had 50 or more participants ^[9].

Having too few participants leads to serious problems:

Scientists might miss real effects
Results become less reliable
Effects appear larger than they really are (known as “winner’s curse”)

Scientists estimate that one in three claimed discoveries in electrical brain stimulation research is wrong ^[9]. Small studies often fall prey to problems like “vibration of effects,” publication bias, and cherry-picked data analysis ^[9].

Lack of follow-up data

Stroke rehabilitation research lacks detailed long-term tracking of how patients do. Swedish healthcare, like many countries, only monitors patients for three months after their stroke without any coordinated support for later recovery ^[10].

This missing information creates several issues:

Studies have to leave out patients they can’t track over time, losing about 10% of follow-up data in some cases ^[4]. Patient follow-up care isn’t fair – those with early supported discharge get automatic follow-up while others wait a long time ^[10].

The most worrying fact shows that patients who skip their neurology follow-ups after stroke have much higher death rates (12.9%) than those who attend regularly ^[2]. Yet detailed tracking remains uncommon despite everyone knowing how important regular medical check-ups are.

No neuroplasticity validation

Electrical stimulation therapy wants to rewire the brain, but few studies check if this actually happens. Only two studies in the review showed real proof of neuroplasticity (p < 0.05) ^[11].

Most researchers just assume the brain has changed when they see better movement, without checking what’s happening in the brain. Some teams look at indirect signs like BDNF levels in blood or motor evoked potentials (MEP) ^[12], but they all do it differently.

Inconsistent outcome measures

The biggest problem might be how differently researchers measure success. Out of 51 studies, only 29 clearly stated what they were measuring ^[13]. The focus varied widely – 80% looked at impairment, 75% checked activity levels, and just one study looked at quality of life ^[13].

Researchers used many different tools without much standardization. For measuring impairment alone, they used eight different stroke scales ^[13]. The Barthel Index appeared in 27 studies but had seven different ways of defining good outcomes ^[13].

Test timing ranged from one day to a full year after treatment ^[13]. This makes it impossible to compare studies properly. In Ghana, only 47.6% of physiotherapists use standard measures for stroke patients ^[14]. This shows how hard it is to implement consistent practices worldwide.

These method problems make it hard to create solid guidelines for electrical stimulation therapy. Scientists need to fix these basic research issues before electrical stimulation can reach its full potential in stroke recovery.

Barriers to effective implementation in therapy

The best electrical stimulation technologies run into practical roadblocks in real-life therapy settings. Therapists face challenges at every level – from individual to team, organization to guidelines. These obstacles make it hard to deliver the best possible care.

Time constraints in clinical settings

Time pressure stands out as the biggest hurdle in delivering electrical stimulation to stroke patients. Therapists say the perceived lengthy set-up time clashes with their packed schedules and short sessions ^[3]. The problem gets worse when they handle multiple patients. One therapist put it simply: “Due to higher number of patients, time is limited” ^[15].

Healthcare institutions’ time restrictions affect how therapists handle different clinical needs. This issue shows up not just in acute care but throughout stroke rehabilitation ^[16]. A physiotherapist explained it this way: “If I might have ten new patients that day, I’ve not only got to do the new patients but then I’ve got to do that as well and don’t have that amount of time really” ^[17].

Uncertainty in device settings

Therapists often struggle to select and adjust parameters. Studies show higher levels of therapist uncertainty with custom stimulation parameters compared to preset protocols ^[1]. The numbers tell the story:

13% of therapists don’t customize stimulation intensity for patients
14% express uncertainty about their parameter adjustments
Parameter adjustment uncertainty rises for stimulation frequency, pulse duration, and pulse shape ^[1]

This uncertainty shows up in daily practice as therapists question themselves: “You don’t know whether you’ve got it in the right place… you just doubt yourself, don’t you, or if you’re doing it right or not?” ^[17]. Another called parameter setting “finicky” with big day-to-day changes across patients ^[3].

Low confidence in effectiveness

Beyond technical doubts, many therapists question whether electrical stimulation works. The doubt varies by stroke stage:

56% during the acute stage
23% during early subacute stage
17% during late subacute stage
21% during chronic stage ^[1]

This knowledge gap seems striking, given the growing evidence that supports electrical stimulation’s benefits in acute and subacute stages ^[1]. One therapist admitted: “I don’t have enough experience with that equipment or how it’s working because I don’t seem to ever be able to do it right every time I try” ^[17].

Mismatch between guidelines and practice

Clinical guidelines recommend electrical stimulation, yet actual usage remains low. A survey of nearly 300 physical therapists found most “never” or “rarely” used functional electrical stimulation despite these recommendations ^[3].

Organizational processes create this gap in part. Limited training, education, and protocols discourage guideline use ^[16]. Beyond individual factors, institutions often lack access to devices and equipment loan programs, which widens the divide between best practice and reality ^[1].

The gap grows larger in settings where treatment approaches clash with new evidence. Some therapists worry about wrong movement patterns: “I don’t want to be feeding the wrong pattern of movement for 30 minutes twice a day” ^[17]. This concern actually goes against evidence showing benefits from consistent stimulation.

What actually works: evidence-backed strategies

Research shows that some evidence-backed approaches work better than others when it comes to electrical stimulation for stroke patients. These approaches work best when they involve active participation, up-to-the-minute feedback, and purposeful movement.

Combining FES with task-specific training

Task-oriented therapy combined with functional electrical stimulation works better than conventional therapy alone. This method, called FES therapy (FEST), creates more neuroplastic effects compared to non-functional motor rehabilitation ^[18]. Patients perform goal-directed functional tasks while getting electrical stimulation support.

Therapists have found that high-dose task-specific training works best with more than 100 repetitions per session to encourage brain plasticity ^[19]. Time constraints mean clinicians want to maximize repetitions in 15-minute sessions. Tasks must stay meaningful and goal-oriented to address each patient’s functional needs.

Studies by Popovic and team showed that FES therapy with pushbutton control worked better than regular occupational therapy. This was true for both spinal cord injury and stroke upper limb rehabilitation during 8-week treatments ^[18]. Long-term results tell an even better story – patients who got functional electrical stimulation kept improving during follow-ups. Those who received cyclic stimulation showed little change ^[19].

Using closed-loop systems for better feedback

Closed-loop FES systems work better than open-loop alternatives right now. Traditional open-loop systems use preset stimulation patterns whatever the patient does. Closed-loop systems adjust therapy based on body feedback continuously ^[20]. This adaptive approach helps patients with various neurological conditions.

The numbers back up closed-loop stimulation’s effectiveness. EMG-controlled FES systems lead the pack. They improve Fugl-Meyer Assessment scores by 14.14 points (95% CI: 11.72-16.6, P < 0.001) and Action Research Arm Test scores by 11.9 points (95% CI: 8.8-14.9, P < 0.001) ^[6].

Closed-loop systems offer precise therapy by fine-tuning stimulation to match each patient’s needs. One researcher put it this way: “The device is listening to the neurons of the spinal cord. It is interacting with the living nerve structure and this makes it much more effective” ^[21].

Incorporating patient intention and effort

Patient participation ended up being the key to successful electrical stimulation therapy. Systems that match electrical stimulation with motor intention help rewire the brain more effectively ^[18]. Neural reorganization works best when intended movement and assisted motion happen together.

EMG-controlled FES shows this principle at work. The system analyzes muscle activity and adjusts stimulation based on what muscles need. Patients can control their muscle contractions themselves, which helps them learn motor skills and recover lost function faster ^[6].

Brain-computer interfaces provide another way to drive stimulation through intention. These systems detect motor imagery (MI) through EEG signals, which “activates the neural circuits involved in actual movements and could induce functional redistribution of neuronal circuits through neural plasticity” ^[6].

Emerging solutions to improve outcomes

New technological breakthroughs are revolutionizing electrical stimulation in stroke rehabilitation. These advances tackle many issues that previously limited treatment success.

Hybrid systems with robotics or VR

Engineers have developed promising hybrid devices that combine robotic assistance with electrical stimulation. These systems work in three different ways: Side-by-Side (different joints, same task), Overlapped (same joint, independent control), and Cooperative (single control loop for both components). Research shows hybrid approaches can cut knee motor torque by 48% during swing phase without affecting movement accuracy ^[22]. These integrated systems work better than traditional exoskeletons alone in usability, user experience, and acceptance ^[22]. The cooperative controller stands out by combining impedance control for motors with model-free functional electrical stimulation using Iterative Learning Control ^[22]. A recent breakthrough combines a four-degrees-of-freedom exoskeleton with an eight-channel neuroprosthesis to help neurological patients walk ^[22].

Subthreshold stimulation for energy efficiency

Subthreshold electrical stimulation (STES) uses much less current than traditional methods. This technique needs only 30% of motor threshold current, which cuts power use to 9% of conventional stimulation ^[23]. STES affects tissue only within 100 micrometers of the stimulation site, which protects non-targeted brain regions ^[23]. STES strengthens synaptic connections and boosts functional recovery after stroke when combined with physical exercise or motor training ^[23]. Studies reveal STES triggers neural reconstruction, shown by increased neurite expression in stimulated areas ^[24]. This method delivers two key benefits: better clinical outcomes and longer battery life for implantable devices ^[23].

How to fix the system: practical recommendations

Stroke patients need systematic changes at multiple levels of the rehabilitation ecosystem to benefit from electrical stimulation. The gap between lab success and clinical results shows we just need practical solutions.

Standardize therapist training programs

A well-laid-out education forms the foundation of effective FES implementation. Entry-level programs don’t provide enough training for many clinicians, which shows we just need complete, multi-tier training systems ^[7]. The best approaches combine theory basics, hands-on practice, observation, supervised work, and solo implementation with ongoing support ^[7]. This step-by-step program helps therapists stay confident with devices they rarely use and prevents their skills from getting rusty ^[7].

Improve access to modern FES devices

Advanced FES technology’s high costs create major barriers for many patients, especially in areas with limited resources ^[25]. Manufacturers should focus on streamlined production and budget-friendly materials without reducing therapeutic value ^[25]. Better reimbursement policies would help make these devices part of standard treatment plans ^[25].

Design patient-centered therapy protocols

User-friendly controls let patients adjust settings and modify therapy as needed ^[25]. Home-based options with up to 10 programmable activities per device help extend therapy beyond the clinic ^[26]. Teaching patients and caregivers simple adjustments while keeping safety features intact helps maintain clinical standards ^[26].

Encourage long-term follow-up and data collection

Quality measurements create the foundation for ongoing improvements ^[27]. Reporting requirements like those used by Stroke Centers help create accountability and evidence-based improvements ^[27].

Conclusion

Electrical stimulation therapy shows great promise in stroke rehabilitation, but a big gap exists between clinical research and real-life implementation that limits its success. Research supports its power to improve neuroplasticity and motor function, yet several roadblocks stand in the way of better patient outcomes.

Systems that use patient feedback and intention work better than traditional open-loop methods, without doubt. EMG-controlled FES has shown remarkable gains in standard assessments. Passive stimulation without active participation fails to create meaningful changes, even though many still use it.

Several key issues reduce how well electrical stimulation works. Therapists remain unsure about choosing parameters and question if it works, despite clear evidence supporting it. Time limits in clinics, poor training, and hard-to-get devices make things worse. Small study sizes and different ways of measuring results make it hard to create standard treatment plans.

The solution needs a complete approach. Therapists just need detailed training programs that help them feel confident with devices and settings. Healthcare systems should make modern FES devices more available and create patient-focused plans that people will stick to. Above all, rehabilitation must focus on active participation by combining electrical stimulation with specific tasks that strengthen intention and effort.

New technology brings hope for better solutions. Systems that mix robotics with electrical stimulation, flexible electronics you can wear easily, and energy-saving subthreshold stimulation could fix current problems. Notwithstanding that, these breakthroughs must come with systematic changes in training, access, and clinical methods.

Making electrical stimulation therapy work in practice needs dedication from everyone involved in rehabilitation. While big challenges remain, fixing these barriers and using proven methods will help stroke survivors recover better. This work to bridge the gap offers a great way to improve recovery and life quality for millions of stroke patients worldwide.

Key Takeaways

Despite promising research, electrical stimulation for stroke patients often fails due to implementation barriers, inadequate training, and overreliance on passive approaches. Here’s what actually works:

• Active engagement is crucial: EMG-controlled systems that incorporate patient intention show 14.14-point improvements in motor assessments versus passive stimulation approaches.

• Combine stimulation with task-specific training: Functional electrical stimulation paired with goal-directed activities exceeding 100 repetitions per session optimally promotes neuroplasticity.

• Closed-loop systems outperform open-loop: Real-time feedback systems that adjust to patient responses deliver superior outcomes compared to preprogrammed stimulation patterns.

• Address the training gap: 56% of therapists doubt effectiveness during acute stroke phases, highlighting the need for standardized education programs and parameter selection confidence.

• Focus on implementation barriers: Time constraints, device access limitations, and therapist uncertainty—not technology limitations—are the primary obstacles to successful outcomes.

The key to success lies not in developing new technologies, but in fixing the systematic implementation failures that prevent existing evidence-based approaches from reaching their full potential in clinical practice.

References

[1] – https://pmc.ncbi.nlm.nih.gov/articles/PMC12488299/
[2] – https://www.ahajournals.org/doi/10.1161/str.56.suppl_1.WP162
[3] – https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1001123/full
[4] – https://pmc.ncbi.nlm.nih.gov/articles/PMC10280879/
[5] – https://pmc.ncbi.nlm.nih.gov/articles/PMC7856293/
[6] – https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1272992/full
[7] – https://pmc.ncbi.nlm.nih.gov/articles/PMC9909018/
[8] – https://onlinelibrary.wiley.com/doi/abs/10.1155/np/4697720
[9] – https://pmc.ncbi.nlm.nih.gov/articles/PMC7610509/
[10] – https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223338
[11] – https://pubmed.ncbi.nlm.nih.gov/37732768/
[12] – https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2018.00388/full
[13] – https://www.ahajournals.org/doi/10.1161/01.str.31.6.1429
[14] – https://onlinelibrary.wiley.com/doi/10.1155/2020/9259017
[15] – https://www.nature.com/articles/s41598-025-16738-3
[16] – https://pmc.ncbi.nlm.nih.gov/articles/PMC10041573/
[17] – https://journals.sagepub.com/doi/10.1177/03080226211008706
[18] – https://www.medrxiv.org/content/10.1101/2024.01.18.24301486v1.full-text
[19] – https://www.occupationaltherapy.com/articles/stroke-electrical-stimulation-and-therapy-5700
[20] – https://www.sciencedirect.com/science/article/pii/S1878747923008802
[21] – https://consultqd.clevelandclinic.org/closed-loop-spinal-cord-stimulation-proving-more-effective-at-relieving-pain
[22] – https://www.nature.com/articles/s41467-025-63474-3
[23] – https://www.nature.com/articles/s41598-021-93354-x
[24] – https://pubmed.ncbi.nlm.nih.gov/34234199/
[25] – https://www.medicaltechoutlook.com/news/advancing-recovery-through-functional-electrical-stimulation-technology-nwid-4051.html
[26] – https://restorative-therapies.com/2025/04/18/elevating-neurorehabilitation-with-task-specific-fes-how-the-xcite2-therapy-system-transforms-clinical-practice/
[27] – https://lern.la.gov/lern-stroke-system/stroke-data-collection/