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Debeuf R, De Vlieger D, Defour A, Feyen K, Guida S, Cuypers L, Firouzi M, Tassenoy A, Swinnen E, Beckwée D, Leemans L. Electrotherapy in stroke rehabilitation can improve lower limb muscle characteristics: a systematic review and meta-analysis. Disabil Rehabil 2024:1-17. [PMID: 38557249 DOI: 10.1080/09638288.2024.2334444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This review assesses the effect of electrotherapy (e.g. functional electrical stimulation (FES), motor and sensor therapeutic electrical stimulation (TES)) on muscle strength and skeletal muscle characteristics in individuals post-stroke compared to conventional or sham therapy. METHODS A systematic literature search was conducted in MEDLINE, SCOPUS, and Web of Science, focusing on randomized controlled trials investigating the effect of electrotherapy. Data of interest was extracted from eligible studies, and risk of bias was assessed. RESULTS In total, 23 studies (933 people post-stroke) were included, of which 17, which mainly focus on patients in a chronic stage of stroke recovery and the implementation of FES, were incorporated in the meta-analysis. A significant increase in muscle strength was found favoring electrotherapy over conventional therapy (SMD 0.63, 95% CI 0.34-0.91, I2 = 37%, p = 0.07) and over sham therapy (SMD 0.44, 95% CI 0.20-0.68, I2 = 38%, p = 0.08). Three studies investigated the effect on muscle thickness and found a significant increase in favor of electrostimulation when compared to conventional therapy (MD 0.11 cm, 95% CI 0.06-0.16, I2 = 0%, p = 0.50). CONCLUSION Current evidence suggests electrotherapy in combination with physiotherapy has positive effects on lower limb muscle strength and skeletal muscle characteristics in patients recovering from stroke.
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Affiliation(s)
- Ruben Debeuf
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Daan De Vlieger
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Arne Defour
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Karen Feyen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefania Guida
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Lotte Cuypers
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mahyar Firouzi
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Brain, Body and Cognition, Department of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - An Tassenoy
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - David Beckwée
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Lynn Leemans
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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Perez N, Morales C, Reyes A, Cruickshank T, Penailillo L. Effects of eccentric strength training on motor function in individuals with stroke: a scoping review. Top Stroke Rehabil 2024:1-14. [PMID: 38507234 DOI: 10.1080/10749357.2024.2330040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/09/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Preliminary evidence suggests that eccentric strength training (ECC) improves muscle strength and postural control in individuals with stroke; however, the evidence about the effects of ECC in people living with stroke has not been systematically analyzed. OBJECTIVE To determine the effects of ECC, compared to other exercise modalities (i.e., concentric training), on motor function in individuals with stroke. METHODS This scoping review was performed according to PRISMA extension for scoping reviews. Until March 2023, a comprehensive search of studies using ECC intervention to improve motor functions in individuals with stroke was performed. Study designs included were randomized and non-randomized controlled trials and quasi-experimental studies using MEDLINE, Web of Science, Rehabilitation & Sports Medicine, PEDro, and OTSeeker databases. Two independent reviewers selected articles based on title and abstract and extracted relevant information from the eligible studies. The results were qualitatively synthesized, and the critical appraisal was performed using the Rob 2.0 and Robins-I tools. RESULTS Ten studies, with 257 individuals, were analyzed. ECC revealed positive effects on muscle strength, muscular activity, balance, gait speed, and functionality, mainly compared with concentric training, physical therapy, and daily routine. No significant adverse events were reported during ECC. The critical appraisal of individual articles ranged from some to high concern. CONCLUSION ECC had a greater and positive effect on motor function in individuals with stroke than other exercise modalities. However, the limited number of studies, variability of outcomes, and the risk of bias produced a low certainty of evidence.
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Affiliation(s)
- Natalia Perez
- Carrera de Kinesiologia, Universidad Central de Chile, Santiago, Chile
| | - Cristian Morales
- Departamento de Biología - Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Alvaro Reyes
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Travis Cruickshank
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Luis Penailillo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
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Purohit R, Varas-Diaz G, Bhatt T. Functional electrical stimulation to enhance reactive balance among people with hemiparetic stroke. Exp Brain Res 2024; 242:559-570. [PMID: 38214733 DOI: 10.1007/s00221-023-06729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/23/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Individuals with stroke demonstrate a twofold higher fall incidence compared to healthy counterparts, potentially associated with deficits in reactive balance control, which is crucial for regaining balance from unpredictable perturbations to the body. Moreover, people with higher stroke-related motor impairment exhibit greater falls and cannot recover balance during higher perturbation intensities. Thus, they might need supplemental agents for fall prevention or even to be included in a perturbation-based protocol. Functional electrical stimulation is a widely used clinical modality for improving gait performance; however, it remains unknown whether it can enhance or interfere with reactive balance control. METHODS We recruited twelve ambulatory participants with hemiparetic stroke (61.48 ± 6.77 years) and moderate-to-high motor impairment (Chedoke-McMaster Stroke Leg Assessment ≤ 4/7). Each participant experienced 4 unpredicted paretic gait-slips, with and without functional electrical stimulation (provided 50-500 ms after perturbation) in random order. The paretic quadriceps muscle group was chosen to receive electrical stimulation, considering the role of support limb knee extensors for preventing limb-collapse. Outcomes including primary (laboratory falls), secondary (reactive stability, vertical limb support) and tertiary (compensatory step length, step initiation, execution time) measures were compared between the two conditions. RESULTS Participants demonstrated fewer falls, higher reactive stability, and higher vertical limb support (p < 0.05) following gait-slips with functional electrical stimulation compared to those without. This was accompanied by reduced step initiation time and a longer compensatory step (p < 0.05). CONCLUSION The application of functional electrical stimulation to paretic quadriceps following gait-slips reduced laboratory fall incidence with enhanced reactive balance outcomes among people with higher stroke-related motor impairment. Our results lay the preliminary groundwork for understanding the instantaneous neuromodulatory effect of functional electrical stimulation in preventing gait-slip falls, future studies could test its therapeutic effect on reactive balance. Clinical registry number: NCT04957355.
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Affiliation(s)
- Rudri Purohit
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor Street, Chicago, IL, 60612, USA
- Ph.D. Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor Street, Chicago, IL, 60612, USA
| | - Gonzalo Varas-Diaz
- Carrera de Kinesiología, Departamento Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor Street, Chicago, IL, 60612, USA.
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Shin HE, Kim M, Lee D, Jang JY, Soh Y, Yun DH, Kim S, Yang J, Kim MK, Lee H, Won CW. Therapeutic effects of functional electrical stimulation on physical performance and muscle strength in post-stroke older adults: a review. Ann Geriatr Med Res 2022; 26:16-24. [PMID: 35313099 PMCID: PMC8984173 DOI: 10.4235/agmr.22.0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/15/2022] [Indexed: 11/09/2022] Open
Abstract
Stroke-related disabilities cause poor physical performance, especially among older adults, and can lead to sarcopenia. Functional electrical stimulation (FES) has been used to improve physical performance in individuals with neurological disorders and increase muscle mass and strength to counteract muscle atrophy. This review covers the principles, underlying mechanisms, and therapeutic effects of FES on physical performance and skeletal muscle function in post-stroke older adults. We found that FES restored weakened dorsiflexor and hip abductor strength during the swing and stance phases of gait, respectively, to help support weight-bearing and upright posture and facilitate static and dynamic balance in this population. FES may also be effective in improving muscle mass and strength to prevent muscle atrophy. However, previous studies on this topic in post-stroke older adults are scarce, and further studies are needed to confirm this supposition.
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Affiliation(s)
- Hyung Eun Shin
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, East-West Medical Research Institute, Kyung Hee University College of Medicine, Seoul, Korea
| | - Daehyun Lee
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jae Young Jang
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, Korea
| | - Yunsoo Soh
- Department of Physical Medicine & Rehabilitation Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dong Hwan Yun
- Department of Physical Medicine & Rehabilitation Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jisoo Yang
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Maeng Kyu Kim
- Sports Medicine Lab., Department of Physical Education, Kyungpook National University, Daegu, Korea
| | | | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, Kyung Hee University College of Medicine, Seoul, Korea
- Corresponding Authors: Chang Won Won, MD, PhD Department of Family Medicine, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea E-mail:
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Hu C, Wang T, Leung KWC, Li L, Tong RKY. Muscle Electrical Impedance Properties and Activation Alteration After Functional Electrical Stimulation-Assisted Cycling Training for Chronic Stroke Survivors: A Longitudinal Pilot Study. Front Neurol 2022; 12:746263. [PMID: 34975713 PMCID: PMC8716001 DOI: 10.3389/fneur.2021.746263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
Electrical impedance myography (EIM) is a sensitive assessment for neuromuscular diseases to detect muscle inherent properties, whereas surface electromyography (sEMG) is a common technique for monitoring muscle activation. However, the application of EIM in detecting training effects on stroke survivors is relatively few. This study aimed to evaluate the muscle inherent properties and muscle activation alteration after functional electrical stimulation (FES)-assisted cycling training to chronic stroke survivors. Fifteen people with chronic stroke were recruited for 20 sessions of FES-assisted cycling training (40 min/session, 3–5 sessions/week). The periodically stimulated and assessed muscle groups were quadriceps (QC), tibialis anterior (TA), hamstrings (HS), and medial head of gastrocnemius (MG) on the paretic lower extremity. EIM parameters [resistance (R), reactance (X), phase angle (θ), and anisotropy ratio (AR)], clinical scales (Fugl-Meyer Lower Extremity (FMA-LE), Berg Balance Scale (BBS), and 6-min walking test (6MWT)] and sEMG parameters [including root-mean square (RMS) and co-contraction index (CI) value] were collected and computed before and after the training. Linear correlation analysis was conducted between EIM and clinical scales as well as between sEMG and clinical scales. The results showed that motor function of the lower extremity, balance, and walking performance of subjects improved after the training. After training, θ value of TA (P = 0.014) and MG (P = 0.017) significantly increased, and AR of X (P = 0.004) value and AR of θ value (P = 0.041) significantly increased on TA. The RMS value of TA decreased (P = 0.022) and a significant reduction of CI was revealed on TA/MG muscle pair (P < 0.001). Significant correlation was found between EIM and clinical assessments (AR of X value of TA and FMA-LE: r = 0.54, P = 0.046; X value of TA and BBS score: 0.628, P = 0.016), and between sEMG and clinical scores (RMS of TA and BBS score: r = −0.582, P = 0.029). This study demonstrated that FES-assisted cycling training improved lower limb function by developing coordinated muscle activation and facilitating an orderly myofiber arrangement. The current study also indicated that EIM can jointly evaluate lower extremity function alteration with sEMG after rehabilitation training. Clinical Trail Registration: The study was registered on the Clinical Trial Registry (trial registration number: NCT 03208439, https://clinicaltrials.gov/ct2/show/NCT03208439).
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Affiliation(s)
- Chengpeng Hu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tong Wang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kenry W C Leung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| | - Raymond Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
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Varas-Diaz G, Bhatt T. Application of neuromuscular electrical stimulation on the support limb during reactive balance control in persons with stroke: a pilot study. Exp Brain Res 2021; 239:3635-3647. [PMID: 34609544 DOI: 10.1007/s00221-021-06209-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to investigate the effect of the application of neuromuscular electrical stimulation to the quadriceps muscle of the paretic limb during externally induced stance perturbations on reactive balance control and on fall outcomes in people with chronic stroke. Ten participants experienced 12 stance treadmill perturbation trails, 6 forward balance perturbation trials and 6 backward balance perturbation trials. For each perturbation condition, three perturbation trials were delivered synchronized with neuromuscular electrical stimulation applied to the quadriceps of the paretic limb and three perturbation trials were delivered without stimulation. Behavioral outcome measures, such as incidence of laboratory falls and number of compensatory steps, kinematic outcome measures, such as margin of stability and minimum hip high values after the perturbation, step initiation time, step execution time and step length of the stepping leg were analyzed. The application of neuromuscular electrical stimulation on the paretic quadriceps between the range of 50 and 500 ms after stance forward and backward perturbations reduced the laboratory falls incidence (p < 0.05), improved stability values (p < 0.05) and reduced the hip height descent (p < 0.05) compared to the experimental condition in which participants were exposed to stance perturbations without neuromuscular electrical stimulation. Additionally, step initiation time of the recovery step was lower in neuromuscular electrical stimulation condition during the forward balance perturbation protocol. Our results showed that the application of neuromuscular electrical stimulation on the knee extensor muscles of the paretic limb reduces the incidence of laboratory falls, enhances reactive stability control and reduces vertical limb collapse after stance forward and backward perturbations in people with chronic stroke.
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Affiliation(s)
- Gonzalo Varas-Diaz
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W, Taylor Street, Chicago, IL, 60612, USA.,School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W, Taylor Street, Chicago, IL, 60612, USA.
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Warshaw ME, Baltz MJ, Hollman JH. Gait synchronized neuromuscular electrical stimulation to the gluteus medius on a patient with right hemiparesis: a case report. Physiother Theory Pract 2021; 38:3180-3186. [PMID: 34260331 DOI: 10.1080/09593985.2021.1946874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background and Purpose: Although the use of neuromuscular electrical stimulation (NMES) to return gait speed and function in patients poststroke is well documented, the use of NMES to the gluteus medius in patients with hemiparesis is not well described. The purpose of this case report is to describe the use of gait synchronized NMES to the right gluteus medius of a patient with right hemiparesis who had poor hip abduction control during the stance phase of the gait cycle and impaired balance.Case Description: A 72-year-old female presented to the emergency department with right-sided hemiparesis. During her fifteen day stay in in-patient rehabilitation she demonstrated a Trendelenburg gait pattern, indicating the use of functional NMES to the gluteus medius to help improve her hip abduction control during the stance phase of gait.Outcomes: After intervention which included traditional rehabilitation as well as functional NMES, the patient's gait speed increased from 0.22 m/s to 0.69 m/s and her Berg Balance Scale (BBS) increased from a 14/56 to 32/56 over a 14 day period indicating an improvement in dynamic balance and community ambulation.Discussion: This case report outlines the novel use of NMES to the gluteus medius during the stance phase of the gait cycle in a patient with poor hip abductor control.
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Affiliation(s)
- Molly E Warshaw
- Michigan Medicine, Department of Physical Medicine and Rehabilitation, University Hospital, MI, USA
| | - Mathew J Baltz
- Michigan Medicine, Department of Physical Medicine and Rehabilitation, University Hospital, MI, USA
| | - John H Hollman
- Physical Therapy, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
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The Effects of Combining Transcranial Direct Current Stimulation and Gait Training with Functional Electrical Stimulation on Trunk Acceleration During Walking in Patients with Subacute Stroke. J Stroke Cerebrovasc Dis 2021; 30:105635. [PMID: 33517032 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105635] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aimed to investigate whether the combination of transcranial direct current stimulation (tDCS) and gait training with FES affected walking speed and trunk accelerometry-based gait characteristics in patients with subacute stroke, compared with FES or tDCS gait training only. MATERIALS AND METHODS Stroke patients (n = 34; female 15; mean age, 72.5 ± 11.2 years; mean days poststroke, 38.7) with resultant paresis in the lower extremity (mean Fugl-Meyer score, 25.5) were enrolled. Patients were randomly assigned to one of three groups: combined anodal tDCS and gait training with FES (tDCS+FES, n = 11), anodal tDCS with gait training (tDCS, n = 11), or combined sham tDCS and gait training with FES (FES, n = 12). Participants received the intervention for 20 minutes and a 40-minute conventional rehabilitative intervention daily for a week. Patients' walking ability was evaluated using walking speed, harmonic ratio (HR), autocorrelation coefficient (AC), and root mean square (RMS) along each axis using a wearable trunk accelerometer. RESULTS The tDCS+FES group had a significantly greater change in AC in the anteroposterior axis and mediolateral axis than the FES and tDCS groups and FES group, respectively. There were no significant effects on walking speed or other parameters (HR and RMS) among the groups. CONCLUSIONS The combination of anodal tDCS and gait training with FES improved the post-stroke patients' gait regularity than FES gait training intervention only. Thus, combined tDCS and FES gait training, as a novel intervention, could be an important therapeutic tool in improving walking performance.
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Takeda K, Koyama S, Shomoto K, Ushiroyama K, Naoi Y, Nagai T, Sakurai H, Kanada Y, Tanabe S. The effect of gait training with low-intensity neuromuscular electrical stimulation of hip abductor muscles in two patients following surgery for hip fracture: Two case reports. Physiother Theory Pract 2020; 38:1553-1563. [PMID: 33355512 DOI: 10.1080/09593985.2020.1864798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: The rate of force development (RFD) is an indicator of muscle strength. A previous study reported that the RFD of hip abductor muscles was increased by neuromuscular electrical stimulation (NMES) to gluteus medius (GM) during gait in healthy adults. However, the effects for patients following femoral head replacement for hip fracture are unclear.Purpose: The aim of this case report was to investigate the effects of gait training with sub-motor threshold NMES on RFD of hip abductor muscles in two patients following femoral head replacement for hip fracture compared to gait training without NMES.Case description: Two elderly patients following femoral head replacement for hip fracture received both interventions of gait training with sub-motor threshold NMES to GM and without NMES. Intervention phases involved 14 sessions each, for 28 sessions total.Outcomes: The RFD of hip abductor muscles, maximum walking speed, six-minute walk distance (6MWD), Berg Balance Scale, one-leg standing time (OLST), functional independence measure, and Numeric Pain Rating Scale (NPRS) were used as outcome measures. In both patients, RFD, 6MWD, OLST, and NPRS were improved by gait training with NMES compared to without NMES.Conclusion: Our results suggest the potential of NMES as a treatment methodology for these two patients undergoing femoral head replacement for hip fracture.
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Affiliation(s)
- Kazuya Takeda
- Department of Rehabilitation, Kawamura Hospital, Akutami, Japan
| | - Soichiro Koyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Koji Shomoto
- Department of Physical Therapy, Faculty of Health Science, Kio University, Koryo, Japan
| | | | - Yuki Naoi
- Department of Rehabilitation, Kawamura Hospital, Akutami, Japan
| | - Tomoko Nagai
- Department of Rehabilitation, Kawamura Hospital, Akutami, Japan
| | - Hiroaki Sakurai
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yoshikiyo Kanada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
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Chung E, Lee BH, Hwang S. Therapeutic effects of brain-computer interface-controlled functional electrical stimulation training on balance and gait performance for stroke: A pilot randomized controlled trial. Medicine (Baltimore) 2020; 99:e22612. [PMID: 33371056 PMCID: PMC7748200 DOI: 10.1097/md.0000000000022612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Brain-computer interface-controlled functional electrical stimulation (BCI-FES) approaches as new feedback training is increasingly being investigated for its usefulness in improving the health of adults or partially impaired upper extremity function in individuals with stroke. OBJECTIVE To evaluate the effects of BCI-FES on postural control and gait performance in individuals with chronic hemiparetic stroke. METHODS A total of 25 individuals with chronic hemiparetic stroke (13 individuals received BCI-FES and 12 individuals received functional electrical stimulation [FES]). The BCI-FES group received BCI-FES on the tibialis anterior muscle on the more-affected side for 30 minutes per session, 3 times per week for 5 weeks. The FES group received FES using the same methodology for the same periods. This study used the Mann-Whitney test to compare the two groups before and after training. RESULTS After training, gait velocity (mean value, 29.0 to 42.0 cm/s) (P = .002) and cadence (mean value, 65.2 to 78.9 steps/min) (P = .020) were significantly improved after BCI-FES training compared to those (mean value, 23.6 to 27.7 cm/s, and mean value, 59.4 to 65.5 steps/min, respectively) after FES approach. In the less-affected side, step length was significantly increased after BCI-FES (mean value, from 28.0 cm to 34.7 cm) more than that on FES approach (mean value, from 23.4 to 25.4 cm) (P = .031). CONCLUSION The results of the BCI-FES training shows potential advantages on walking abilities in individuals with chronic hemiparetic stroke.
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Affiliation(s)
- Eunjung Chung
- Department of Physical Therapy, Andong Science College, Andong-si
| | - Byoung-Hee Lee
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul
| | - Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan-si, Republic of Korea
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Effect of Functional Electrical Stimulation of the Gluteus Medius during Gait in Patients following a Stroke. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8659845. [PMID: 35721669 PMCID: PMC9201370 DOI: 10.1155/2020/8659845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/12/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022]
Abstract
Many stroke patients rely on cane or ankle-foot orthosis during gait rehabilitation. The purpose of this study was to investigate the immediate effect of functional electrical stimulation (FES) to the gluteus medius (GMed) and tibialis anterior (TA) on gait performance in stroke patients, including those who needed assistive devices. Fourteen stroke patients were enrolled in this study (mean poststroke duration: 194.9 ± 189.6 d; mean age: 72.8 ± 10.7 y). Participants walked 14 m at a comfortable velocity with and without FES to the GMed and TA. After an adaptation period, lower-limb motion was measured using magnetic inertial measurement units attached to the pelvis and the lower limb of the affected side. Motion range of angle of the affected thigh and shank segments in the sagittal plane, motion range of the affected hip and knee extension-flexion angle, step time, and stride time were calculated from inertial measurement units during the middle ten walking strides. Gait velocity, cadence, and stride length were also calculated. These gait indicators, both with and without FES, were compared. Gait velocity was significantly faster with FES (p = 0.035). Similarly, stride length and motion range of the shank of the affected side were significantly greater with FES (stride length: p = 0.018; motion range of the shank: p = 0.026). Meanwhile, cadence showed no significant difference (p = 0.238) in gait with or without FES. Similarly, range of motion of the affected hip joint, knee joint, and thigh did not differ significantly depending on FES condition (p = 0.115‐0.529). FES to the GMed and TA during gait produced an improvement in gait velocity, stride length, and motion range of the shank. Our results will allow therapists to use FES on stroke patients with varying conditions.
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Balance Training with Electromyogram-Triggered Functional Electrical Stimulation in the Rehabilitation of Stroke Patients. Brain Sci 2020; 10:brainsci10020080. [PMID: 32024262 PMCID: PMC7071601 DOI: 10.3390/brainsci10020080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
This study was conducted to investigate the effects of balance training with electromyogram-triggered functional electrical stimulation (EMG-triggered FES) to improve static balance, dynamic balance, and ankle muscle activation in stroke patients. Forty-nine participants (>6 months after stroke) were randomly assigned to the experimental group (n = 25) and the control group (n = 24). The experimental group underwent balance training with EMG-triggered FES for 40 min a day, 5 days a week, for a 6-week period in addition to general rehabilitation. The control group underwent balance training without EMG-triggered FES along with conventional therapy. Outcome measures included static balance ability, dynamic balance ability, and leg muscle activation. The static and dynamic balance abilities were significantly improved after intervention in both groups (p < 0.05), although the experimental group showed considerably greater improvement than the control group (p < 0.05). Leg muscle activation on the affected side resulted in significant improvements in the experimental group (p < 0.05) when compared with baseline but not in the control group. Balance training with EMG-triggered FES is an acceptable and effective intervention to improve the static balance, dynamic balance, and ankle muscle activation in stroke patients.
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The effects of electromyography-triggered neuromuscular electrical stimulation plus tilt sensor functional electrical stimulation training on gait performance in patients with subacute stroke: a randomized controlled pilot trial. Int J Rehabil Res 2019; 42:358-364. [DOI: 10.1097/mrr.0000000000000371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Takeda K, Koyama S, Shomoto K, Ushiroyama K, Naoi Y, Sakurai H, Kanada Y, Tanabe S. Modulation of the rate of force development in hip abductor muscles by neuromuscular electrical stimulation during gait. Somatosens Mot Res 2019; 37:1-5. [DOI: 10.1080/08990220.2019.1693357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kazuya Takeda
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan
| | - Soichiro Koyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Koji Shomoto
- Department of Physical Therapy, Faculty of Health Science, Kio University, Nara, Japan
| | | | - Yuki Naoi
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan
| | - Hiroaki Sakurai
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yoshikiyo Kanada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
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Jung J, Chung Y. The effects of functional electrical stimulation applied to the gluteus medius and tibialis anterior on stair climbing ability in persons with stroke. ACTA ACUST UNITED AC 2018. [DOI: 10.14474/ptrs.2018.7.3.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jewon Jung
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University, Seoul, Republic of Korea
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Dujović SD, Malešević J, Malešević N, Vidaković AS, Bijelić G, Keller T, Konstantinović L. Novel multi-pad functional electrical stimulation in stroke patients: A single-blind randomized study. NeuroRehabilitation 2018; 41:791-800. [PMID: 29254111 DOI: 10.3233/nre-172153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Foot drop is common gait impairment after stroke. Functional electrical stimulation (FES) of the ankle dorsiflexor muscles during the swing phase of gait can help correcting foot drop. OBJECTIVE To evaluate efficacy of additional novel FES system to conventional therapy in facilitating motor recovery in the lower extremities and improving walking ability after stroke. METHODS Sixteen stroke patients were randomly allocated to the FES group (FES therapy plus conventional rehabilitation program) (n = 8), and control group (conventional rehabilitation program) n = 8. FES was delivered for 30 min during gait to induce ankle plantar and dorsiflexion. MAIN OUTCOME MEASURES gait speed using 10 Meter Walk Test (10 MWT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS) and modified Barthel Index (MBI). RESULTS Results showed a significant increase in gait speed in FES group (p < 0.001), higher than the minimal detected change. The FES group showed improvement in functional independence in the activities of daily living, motor recovery and gait performance. CONCLUSIONS The findings suggest that novel FES therapy combined with conventional rehabilitation is more effective on walking speed, mobility of the lower extremity, balance disability and activities of daily living compared to a conventional rehabilitation program only.
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Affiliation(s)
- Suzana Dedijer Dujović
- The University of Belgrade, Serbia and Clinic for rehabilitation "Dr M.Zotovic", Belgrade, Serbia
| | - Jovana Malešević
- The University of Belgrade and Tecnalia Serbia Ltd., Belgrade, Serbia
| | - Nebojša Malešević
- Department of Biomedical Engineering, Lund University, Belgrade, Serbia
| | - Aleksandra S Vidaković
- Faculty of Medicine, University of Belgrade and Clinic for rehabilitation "Dr M.Zotovic", Belgrade, Serbia
| | - Goran Bijelić
- Neurorehabilitation Area at the Health Division of TECNALIA, San Sebastian, Spain
| | - Thierry Keller
- Neurorehabilitation Area at the Health Division of TECNALIA, San Sebastian, Spain
| | - Ljubica Konstantinović
- Faculty of Medicine, University of Belgrade and Clinic for rehabilitation "Dr M.Zotovic", Belgrade, Serbia
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Hong Z, Sui M, Zhuang Z, Liu H, Zheng X, Cai C, Jin D. Effectiveness of Neuromuscular Electrical Stimulation on Lower Limbs of Patients With Hemiplegia After Chronic Stroke: A Systematic Review. Arch Phys Med Rehabil 2018; 99:1011-1022.e1. [DOI: 10.1016/j.apmr.2017.12.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/09/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
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Sota K, Uchiyama Y, Ochi M, Matsumoto S, Hachisuka K, Domen K. Examination of Factors Related to the Effect of Improving Gait Speed With Functional Electrical Stimulation Intervention for Stroke Patients. PM R 2018. [DOI: 10.1016/j.pmrj.2018.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Nussbaum EL, Houghton P, Anthony J, Rennie S, Shay BL, Hoens AM. Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice. Physiother Can 2017; 69:1-76. [PMID: 29162949 PMCID: PMC5683854 DOI: 10.3138/ptc.2015-88] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose: In response to requests from physiotherapists for guidance on optimal stimulation of muscle using neuromuscular electrical stimulation (NMES), a review, synthesis, and extraction of key data from the literature was undertaken by six Canadian physical therapy (PT) educators, clinicians, and researchers in the field of electrophysical agents. The objective was to identify commonly treated conditions for which there was a substantial body of literature from which to draw conclusions regarding the effectiveness of NMES. Included studies had to apply NMES with visible and tetanic muscle contractions. Method: Four electronic databases (CINAHL, Embase, PUBMED, and SCOPUS) were searched for relevant literature published between database inceptions until May 2015. Additional articles were identified from bibliographies of the systematic reviews and from personal collections. Results: The extracted data were synthesized using a consensus process among the authors to provide recommendations for optimal stimulation parameters and application techniques to address muscle impairments associated with the following conditions: stroke (upper or lower extremity; both acute and chronic), anterior cruciate ligament reconstruction, patellofemoral pain syndrome, knee osteoarthritis, and total knee arthroplasty as well as critical illness and advanced disease states. Summaries of key details from each study incorporated into the review were also developed. The final sections of the article outline the recommended terminology for describing practice using electrical currents and provide tips for safe and effective clinical practice using NMES. Conclusion: This article provides physiotherapists with a resource to enable evidence-informed, effective use of NMES for PT practice.
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Affiliation(s)
- Ethne L. Nussbaum
- Department of Physical Therapy, University of Toronto
- Toronto Rehab, University Health Network, Toronto, Ontario
| | - Pamela Houghton
- School of Physical Therapy, University of Western Ontario, London
| | - Joseph Anthony
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Sandy Rennie
- Department of Physical Therapy, University of Toronto
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia
| | - Barbara L. Shay
- Department of Physical Therapy, University of Manitoba, Winnipeg, Manitoba
| | - Alison M. Hoens
- School of Physical Therapy, University of Western Ontario, London
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Meyer AJ, Eskinazi I, Jackson JN, Rao AV, Patten C, Fregly BJ. Muscle Synergies Facilitate Computational Prediction of Subject-Specific Walking Motions. Front Bioeng Biotechnol 2016; 4:77. [PMID: 27790612 PMCID: PMC5061852 DOI: 10.3389/fbioe.2016.00077] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/21/2016] [Indexed: 12/18/2022] Open
Abstract
Researchers have explored a variety of neurorehabilitation approaches to restore normal walking function following a stroke. However, there is currently no objective means for prescribing and implementing treatments that are likely to maximize recovery of walking function for any particular patient. As a first step toward optimizing neurorehabilitation effectiveness, this study develops and evaluates a patient-specific synergy-controlled neuromusculoskeletal simulation framework that can predict walking motions for an individual post-stroke. The main question we addressed was whether driving a subject-specific neuromusculoskeletal model with muscle synergy controls (5 per leg) facilitates generation of accurate walking predictions compared to a model driven by muscle activation controls (35 per leg) or joint torque controls (5 per leg). To explore this question, we developed a subject-specific neuromusculoskeletal model of a single high-functioning hemiparetic subject using instrumented treadmill walking data collected at the subject's self-selected speed of 0.5 m/s. The model included subject-specific representations of lower-body kinematic structure, foot-ground contact behavior, electromyography-driven muscle force generation, and neural control limitations and remaining capabilities. Using direct collocation optimal control and the subject-specific model, we evaluated the ability of the three control approaches to predict the subject's walking kinematics and kinetics at two speeds (0.5 and 0.8 m/s) for which experimental data were available from the subject. We also evaluated whether synergy controls could predict a physically realistic gait period at one speed (1.1 m/s) for which no experimental data were available. All three control approaches predicted the subject's walking kinematics and kinetics (including ground reaction forces) well for the model calibration speed of 0.5 m/s. However, only activation and synergy controls could predict the subject's walking kinematics and kinetics well for the faster non-calibration speed of 0.8 m/s, with synergy controls predicting the new gait period the most accurately. When used to predict how the subject would walk at 1.1 m/s, synergy controls predicted a gait period close to that estimated from the linear relationship between gait speed and stride length. These findings suggest that our neuromusculoskeletal simulation framework may be able to bridge the gap between patient-specific muscle synergy information and resulting functional capabilities and limitations.
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Affiliation(s)
- Andrew J Meyer
- Department of Mechanical and Aerospace Engineering, University of Florida , Gainesville, FL , USA
| | - Ilan Eskinazi
- Department of Mechanical and Aerospace Engineering, University of Florida , Gainesville, FL , USA
| | - Jennifer N Jackson
- Department of Biomedical Engineering, University of Florida , Gainesville, FL , USA
| | - Anil V Rao
- Department of Mechanical and Aerospace Engineering, University of Florida , Gainesville, FL , USA
| | - Carolynn Patten
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA; Neural Control of Movement Lab, Malcom-Randall VA Medical Center, Gainesville, FL, USA
| | - Benjamin J Fregly
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA; Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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Qu H, Xie Y, Liu X, He X, Hao M, Bao Y, Xie Q, Lan N. Development of network-based multichannel neuromuscular electrical stimulation system for stroke rehabilitation. ACTA ACUST UNITED AC 2016; 52:263-78. [PMID: 27149687 DOI: 10.1682/jrrd.2014.10.0227] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 07/07/2015] [Indexed: 11/05/2022]
Abstract
Neuromuscular electrical stimulation (NMES) is a promising assistive technology for stroke rehabilitation. Here we present the design and development of a multimuscle stimulation system as an emerging therapy for people with paretic stroke. A network-based multichannel NMES system was integrated based on dual bus architecture of communication and an H-bridge current regulator with a power booster. The structure of the system was a body area network embedded with multiple stimulators and a communication protocol of controlled area network to transmit muscle stimulation parameter information to individual stimulators. A graphical user interface was designed to allow clinicians to specify temporal patterns and muscle stimulation parameters. We completed and tested a prototype of the hardware and communication software modules of the multichannel NMES system. The prototype system was first verified in nondisabled subjects for safety, and then tested in subjects with stroke for feasibility with assisting multijoint movements. Results showed that synergistic stimulation of multiple muscles in subjects with stroke improved performance of multijoint movements with more natural velocity profiles at elbow and shoulder and reduced acromion excursion due to compensatory trunk rotation. The network-based NMES system may provide an innovative solution that allows more physiological activation of multiple muscles in multijoint task training for patients with stroke.
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Affiliation(s)
- Hongen Qu
- Institute of Rehabilitation Engineering, Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Buesing C, Fisch G, O'Donnell M, Shahidi I, Thomas L, Mummidisetty CK, Williams KJ, Takahashi H, Rymer WZ, Jayaraman A. Effects of a wearable exoskeleton stride management assist system (SMA®) on spatiotemporal gait characteristics in individuals after stroke: a randomized controlled trial. J Neuroeng Rehabil 2015; 12:69. [PMID: 26289955 PMCID: PMC4545867 DOI: 10.1186/s12984-015-0062-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/11/2015] [Indexed: 11/21/2022] Open
Abstract
Background Robots offer an alternative, potentially advantageous method of providing repetitive, high-dosage, and high-intensity training to address the gait impairments caused by stroke. In this study, we compared the effects of the Stride Management Assist (SMA®) System, a new wearable robotic device developed by Honda R&D Corporation, Japan, with functional task specific training (FTST) on spatiotemporal gait parameters in stroke survivors. Methods A single blinded randomized control trial was performed to assess the effect of FTST and task-specific walking training with the SMA® device on spatiotemporal gait parameters. Participants (n = 50) were randomly assigned to FTST or SMA. Subjects in both groups received training 3 times per week for 6–8 weeks for a maximum of 18 training sessions. The GAITRite® system was used to collect data on subjects’ spatiotemporal gait characteristics before training (baseline), at mid-training, post-training, and at a 3-month follow-up. Results After training, significant improvements in gait parameters were observed in both training groups compared to baseline, including an increase in velocity and cadence, a decrease in swing time on the impaired side, a decrease in double support time, an increase in stride length on impaired and non-impaired sides, and an increase in step length on impaired and non-impaired sides. No significant differences were observed between training groups; except for SMA group, step length on the impaired side increased significantly during self-selected walking speed trials and spatial asymmetry decreased significantly during fast-velocity walking trials. Conclusions SMA and FTST interventions provided similar, significant improvements in spatiotemporal gait parameters; however, the SMA group showed additional improvements across more parameters at various time points. These results indicate that the SMA® device could be a useful therapeutic tool to improve spatiotemporal parameters and contribute to improved functional mobility in stroke survivors. Further research is needed to determine the feasibility of using this device in a home setting vs a clinic setting, and whether such home use provides continued benefits. Trial registration This study is registered under the title “Development of walk assist device to improve community ambulation” and can be located in clinicaltrials.gov with the study identifier: NCT01994395.
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Affiliation(s)
- Carolyn Buesing
- Northwestern University Physical Therapy and Human Movement Sciences, 645 N. Michigan Ave, Suite 1100, Chicago, IL, 60611, USA.
| | - Gabriela Fisch
- Northwestern University Physical Therapy and Human Movement Sciences, 645 N. Michigan Ave, Suite 1100, Chicago, IL, 60611, USA.
| | - Megan O'Donnell
- Northwestern University Physical Therapy and Human Movement Sciences, 645 N. Michigan Ave, Suite 1100, Chicago, IL, 60611, USA.
| | - Ida Shahidi
- Northwestern University Physical Therapy and Human Movement Sciences, 645 N. Michigan Ave, Suite 1100, Chicago, IL, 60611, USA.
| | - Lauren Thomas
- Northwestern University Physical Therapy and Human Movement Sciences, 645 N. Michigan Ave, Suite 1100, Chicago, IL, 60611, USA.
| | - Chaithanya K Mummidisetty
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Rehabilitation Institute of Chicago, 345 E. Superior St, Chicago, IL, 60611, USA.
| | - Kenton J Williams
- Honda R&D Americas, Inc, 21001 State Route 739, Raymond, OH, 43067, USA.
| | - Hideaki Takahashi
- Honda R&D Americas, Inc, 21001 State Route 739, Raymond, OH, 43067, USA.
| | - William Zev Rymer
- Director, Research Planning, Rehabilitation Institute of Chicago, 345 E. Superior St, Chicago, IL, 60611, USA.
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Rehabilitation Institute of Chicago, 345 E. Superior St, Chicago, IL, 60611, USA.
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Abstract
This article reviews the most common therapeutic and neuroprosthetic applications of neuromuscular electrical stimulation (NMES) for upper and lower extremity stroke rehabilitation. Fundamental NMES principles and purposes in stroke rehabilitation are explained. NMES modalities used for upper and lower limb rehabilitation are described, and efficacy studies are summarized. The evidence for peripheral and central mechanisms of action is also summarized.
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Cho MK, Kim JH, Chung Y, Hwang S. Treadmill gait training combined with functional electrical stimulation on hip abductor and ankle dorsiflexor muscles for chronic hemiparesis. Gait Posture 2015; 42:73-8. [PMID: 26005188 DOI: 10.1016/j.gaitpost.2015.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to investigate the effects of treadmill training (TT) with functional electrical stimulation (FES) applied to the gluteus medius (GM) and tibialis anterior (TA) muscles on gait and balance performance in individuals with chronic hemiparetic stroke. Thirty-six participants with chronic hemiparesis were recruited to this study and randomly distributed into three groups: TT with FES applied to the GM and TA muscles (TTFES-GM+TA group, 12 patients); TT with FES applied to the TA muscle (TTFES-TA group, 12 patients); and TT only (control group, 12 patients). All participants underwent 20 sessions of TT with a harness (30min five times per week for 4 weeks). They also received regular physical therapy for 1h five times per week for 4 weeks. All participants were assessed before and after training using digital muscle testing, the Medical Research Council (MRC) scale, the 6-min walk test (6MWT), and spatiotemporal parameters. After training, the TTFES-GM+TA group showed significant improvement in hip abductor strength, Berg Balance Scale score, 6MWT result, MRC scale score grade, gait velocity, and cadence compared to the TTFES-TA group and control group. These findings show that TT with FES applied to the GM and TA muscles increased lower limb muscle strength and improved balance and gait capacities. Therefore, TT with FES applied to the GM and TA could be a beneficial intervention in clinical settings for individuals with chronic hemiparetic stroke.
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Affiliation(s)
- Min-Kwon Cho
- Department of Physical Therapy, The Graduate School, Sahmyook University, Republic of Korea
| | - Jung-Hyun Kim
- Department of Physical Therapy, The Graduate School, Sahmyook University, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health Welfare, Sahmyook University, Republic of Korea.
| | - Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Republic of Korea
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