Post-stroke Engagement-sensitive Balance Rehabilitation Under An Adaptive Multi-level Electrotherapy: Clinical Hypothesis and Computational Framework

Stroke is caused due to burst or clot in an artery carrying blood from heart to an area in the brain. This prevents delivery of oxygen and nutrients to neurons thereby causing their death and leading to disability. Since about half of the stroke survivors are left with some degree of disability so innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. Here, the ability of the nervous system to respond to stimuli by reorganizing its structure, function and connections may play an important role which is called neuroplasticity. Beneficial neuroplastic changes can be facilitated early in post-stroke rehabilitation using sensory and motor stimulation towards sensorimotor integration where electrical stimulation of the neural tissue may play an important role. Furthermore, active cortical participation may be required for such sensorimotor integration where volitional effort, detected with electromyogram- (EMG) and electroencephalogram- (EEG) derived biopotentials, may be assisted with non-invasive electrotherapy, such as neuromuscular electrical stimulation (NMES) and noninvasive brain stimulation (NIBS). In this article, we discuss this novel concept for an engagement-sensitive interactive system consisting of a low-cost static posturography system with adaptive response non-invasive electrotherapy technology for post-stroke balance rehabilitation that integrates a multi-level (central and peripheral nervous system) electrotherapy paradigm to assist volitional postural control.