INTRODUCTION:

Stroke is a primary cause of death and disability, and the costs of post-stroke care are high. The
overall burden of stroke has remained high despite declining age-standardized death rates and
prevalence over time, according to data from the 2015 version of the Global Burden of Diseases,
Injuries, and Risk Factors Study (GBD). (Johnson et al., 2016; GBD 2016 Stroke Collaborators,
2019). Effective rehabilitation following a stroke is crucial to mitigating this financial impact and
enhancing patient 27 comes. Post- stroke, patients often experience temporary paralysis on one
side of their body, a condition known as hemiplegia, where one side of the body experiences
temporary paralysis. Rehabilitation therapy that incorporates repetitive and function-specific
tasks is essential for the gradual recovery of strength and movement in the affected side
(Mehrholz et al., 2018). By maximizing the patient's independence despite their impairments and
lowering the likelihood of developing secondary complications, post-stroke rehabilitation
improves patient outcomes. An interdisciplinary team with experience in the rehabilitation
process provides post-stroke rehabilitation. It can be easier for patients to transition from
inpatient rehabilitation to their home environment if early discharge planning is done. It is
challenging to predict post-stroke outcomes with precision due to the variability and complexity
of stroke recovery; however, the significance of early interventions and continuous outpatient
rehabilitation cannot be overstated. (Journal / South African Medical Journal / Vol. 109 No. 2
(2019)). Modern non-implanted devices such as trans cranial direct current stimulation (tDCS)
and transcutaneous electrical nerve stimulation (TENS) apply electrical stimulation to the head
an21 skin, respectively, using electrode pads (Lefaucheur et al., 2017; Bennett et al., 2011).

After a stroke, people use functional electrical stimulation (FES) to their lower extremity (LE)
muscles as a training modality or as an alternative to mechanical orthotic devices during gait.
Advancements in technology that enhance the practicability, accessibility, and efficacy of FES
systems as orthotic and training aids underscore the possibility of FES in helping stroke
survivors restore their left hemisphere function. The therapeutic benefits of LE FES on post-
stroke subjects’ motor performance when stimulation is not used. (Therapeutic Effects of
Functional Electrical Stimulation on Gait in Individuals Post-Stroke Published: 15 October 2014
Volume 43, pages 451–466, (2015)). These FES devices have shown promising results in
improving mobility and functional independence, which is crucial for stroke patients. According
to the World Health Organization, assistive technologies are pivotal in helping individuals with
disabilities live independently and participate actively in their communities (WHO, 2018). The
National Health Service (NHS) in the UK has also highlighted the need for ongoing
improvements in device design to address these concerns and ensure better rehabilitation
outcomes (NHS-UK, 2019). Factors such as the features and composition of stimulation
wavefor26, protocol design, electrode size, and current densities play a critical role in
determining the safety and effectiveness of these devices (Johnson et al., 2012).

A technique for producing artificial muscle contractions is electrical stimulation, which uses
low-energy electrical pulses. Functional electrical stimulation (FES) is the term for an
intervention that uses electrical stimulation to facilitate functional movements like grasping and
walking. In other words, a user would interact with the device every time they needed to produce
a desired outcome. Recently, therapies to retrain voluntary motor skills like grasping, reaching,
and walking have been delivered using FES technology. The name "FES therapy" or "FET"
refers to the use of FES as a short-term therapy in this embodiment, with the goal being the
restoration of voluntary function rather than a lifetime dependence on the FES device. To put it
another way, FET is a temporary solution that helps the patient's central nervous system regain
the ability to perform damaged functions rather than leaving them permanently dependent on
neuroprosthetics. (Milos R. Popovic , Kei Masani , and Silvestro Micera). The National Health Service
(NHS) in the UK has also highlighted the need for ongoing improvements in device design to
address these concerns and ensure better rehabilitation outcomes (NHS-UK, 2019). Factors such
as the features and composition of stimulation wavefor26, protocol design, electrode size, and
current densities play a critical role in determining the safety and effectiveness of these devices
(Johnson et al., 2012).

Recent advancements in the field underscore the need for innovative approaches to
rehabilitation. Newer studies have demonstrated that integrating intelligent control systems with
FES devices could $24 ificantly enhance rehabilitation outcomes. For instance, the development
of hybrid brain- computer interface (BCI)-controlled FES systems has shown promise in
improving motor recovery and functional performance in stroke patients (Lu et al., 2023).
Similarly, advancements in wearable FES devices with real-time feedback mechanisms have
been reported to improve patient gagement and treatment efficacy (Chae & Yu, 2024).
Furthermore, the integration of advanced machine learning algorithms into FES systems has
been shown to optimize therapy by personalizing stimulation parameters based on real-time
patieng data (Zhang et al., 2024).

The primary goal of this project is to create an intelligent Functional Electrical Stimulation (FES)
device that uses hand and voice gesture controls to make patient rehabilitation easier and more
efficient. By incorporating intelligent control mechanisms, this system is intended to address the
shortcomings of conventional FES devices and allow users to regulate their therapy with the least
amount of physical exertion. The device is designed to primarily serve people with paraplegia
and other neuromuscular illnesses, who frequently struggle with prolonged immobility, by
emphasizing easy-to-use, real-time adjustments.
If the design proves successful, a small-scale, portable prototype may be expanded for wider
clinical application. In addition to providing a more user-friendly interface, the incorporation of
voice commands and hand gestures is in line with current technology trends toward adaptive
rehabilitation devices that provide real-time treatment personalization. For patients who are
confined to beds or chairs for prolonged periods of time, this degree of personalization is
essential because it enables more constant and focused therapeutic approaches. Additionally, the
study intends to improve therapeutic outcomes and lessen the long-term load on caregivers by
addressing the difficulty of maintaining patients who are unable to walk independently.