Improved ankle and knee control with a dual-channel functional electrical stimulation system in chronic hemiplegia A case report (original) (raw)
Related papers
Archives of Physical …, 2010
Objective: To determine whether functional electrical stimulation (FES) timed to activate the dorsiflexors and plantar flexors during gait improves the walking of adults with hemiplegia. Design: Randomized crossover trial. Setting: Outpatient rehabilitation clinic. Participants: Adults with hemiplegia (Nϭ28) with a mean age Ϯ SD of 60Ϯ10.9 years and 4.9Ϯ3.8 years postincident. Interventions: Intervention "A" included 3 months of wearing the FES system, which activated automatically during walking for 6 to 8h/d, 7d/wk, plus walking 1h/d, 6d/wk. Intervention "B" included 3 months of walking 1h/d, 6d/wk without FES. Of the 28 patients who completed the study, 15 were randomly assigned to group A-B, 13 to group B-A. Crossover occurred at 3 months. Main Outcome Measures: Variables were measured at pretreatment, 3 months, and 6 months. Three primary outcomes were selected a priori and included 2 functional variables, the 6-minute walk test and the Emory Functional Ambulatory Profile, and 1 participation variable, the Stroke Impact Scale. Secondary impairment measures included muscle strength and spasticity. Assessments were done without electrical stimulation. Results: In phase 1, patients who received treatment A (A-B group) showed improvement compared with patients who received treatment B (B-A group) on the 6-minute walk test (Pϭ.02), Emory Functional Ambulatory Profile (Pϭ.08), and Stroke Impact Scale (Pϭ.03). In phase 2, the A-B group maintained improvement in all 3 primary outcomes even without FES. Both groups improved significantly on all primary outcome measures, comparing 6-month to initial measures (PՅ.05). Conclusions: An FES system that stimulates dorsiflexors and plantar flexors similar to the timing of typical adult gait, combined with daily walking, can improve the walking ability of adults with hemiplegia.
Annals of rehabilitation medicine, 2014
To evaluate the effects of functional electrical stimulation (FES) to ankle dorsiflexor (DF) and ankle plantarflexor (PF) on kinematic and kinetic parameters of hemiplegic gait. Fourteen post-stroke hemiplegic patients were considered in this study. Electrical stimulation was delivered to ankle DF during the swing phase and ankle PF during the stance phase via single foot switch. Kinematic and kinetic data were collected using a computerized motion analysis system with force plate. Data of no stimulation (NS), DF stimulation only (DS), DF and PF stimulation (DPS) group were compared among each other. Peak ankle dorsiflexion angle during swing phase is significantly greater in DS group (-1.55°±9.10°) and DPS group (-2.23°±9.64°), compared with NS group (-6.71°±11.73°) (p<0.05), although there was no statistically significant difference between DS and DPS groups. Ankle plantarflexion angle at toe-off did not show significant differences among NS, DS, and DPS groups. Peak knee flexi...
Journal of Rehabilitation Medicine
Objective: Impaired ankle dorsiflexion in hemiparesis may be treated with ankle-foot orthosis or functional electrical stimulation. Semi-implanted selective functional electrical stimulation uses independent stimulations of deep and superficial peroneal nerves. The aim of this study was to compare gait kinematics using ankle-foot orthosis or semi-implanted selective functional electrical stimulation over 6 months in hemiparesis.Methods: Subjects with chronic hemiparesis, randomized into ankle-foot orthosis or semi-implanted selective functional electrical stimulation groups, underwent comfortable gait analysis without and with device OFF and ON, before, and 3 and 6 months after treatment onset. The effects of condition, visit and group on gait kinematics (analysis of variance; ANOVA) were analysed.Results: A total of 27 subjects were included (ankle-foot orthosis, n = 13; semi-implanted selective functional electrical stimulation, n = 14). The only between-group difference in change...
Stroke, 2009
Background and Purpose-Functional electrical stimulation (FES) is a popular post-stroke gait rehabilitation intervention. Although stroke causes multi-joint gait deficits, FES is commonly used only for the correction of swing phase foot drop. Ankle plantarflexor muscles play an important role during gait. The aim of the current study is to test the immediate effects of delivering FES to both ankle plantarflexors and dorsiflexors on post-stroke gait.
Journal of Electromyography and Kinesiology, 2013
Sixteen subjects (aged 54.2 ± 14.1 years) with hemiparesis (7.9 ± 7.1 years since diagnosis) demonstrating a foot-drop and hamstrings muscle weakness were fitted with a dual-channel functional electrical stimulation (FES) system activating the dorsiflexors and hamstrings muscles. Measurements of gait performance were collected after a conditioning period of 6 weeks, during which the subjects used the system throughout the day. Gait was assessed with and without the dual-channel FES system, as well as with peroneal stimulation alone. Outcomes included lower limb kinematics and the step length taken with the non-paretic leg. Results with the dual-channel FES indicate that in the subgroup of subjects who demonstrated reduced hip extension but no knee hyperextension (n = 9), hamstrings FES increased hip extension during terminal stance without affecting the knee. Similarly, in the subgroup of subjects who demonstrated knee hyperextension but no limitation in hip extension (n = 7), FES restrained knee hyperextension without having an impact on hip movement. Additionally, step length was increased in all subjects. The peroneal FES had a positive effect only on the ankle. The results suggest that dualchannel FES for the dorsiflexors and hamstrings muscles may affect lower limb control beyond that which can be attributed to peroneal stimulation alone.
Effects of functional electrical stimulation in rehabilitation with hemiparesis patients
Bosnian journal of basic medical sciences / Udruženje basičnih mediciniskih znanosti = Association of Basic Medical Sciences, 2009
Cerebrovascular accident is a focal neurological deficiency occurring suddenly and lasting for more than 24 hours. The purpose of our work is to determine the role of the functional electrical simulation (FES) in the rehabilitation of patients with hemiparesis, which occurred as a consequence of a cerebrovascular accident. This study includes the analysis of two groups of 40 patients with hemiparesis (20 patients with deep hemiparesis and 20 patients with light hemiparesis), a control group which was only treated with kinesiotherapy and a tested group which was treated with kinesiotherapy and functional electrical stimulation. Both groups of patients were analyzed in respect to their sex and age. Additional analysis of the walking function was completed in accordance with the BI and RAP index. The analysis of the basic demographical data demonstrated that there is no significant difference between the control and tested group. The patients of both groups are equal in respect of age ...
https://www.ijhsr.org/IJHSR\_Vol.13\_Issue.3\_March2023/IJHSR-Abstract32.html, 2023
Stroke is the primary cause of impairment in the motor function and gait of adults. In patients with hemiplegia due to stroke, they may experience muscle stiffness, spasms, pain, and spasticity in the affected limb(s). This may lead to abnormal positioning of the affected side, making it difficult to perform daily activities and increasing the risk of them developing muscle contractures, osteoarthritis, and muscle atrophy. Spasticity is one of the most common impairments that takes place after stroke, and may lead to impaired function and harmful effects including: pain, muscle contractures, poor skin hygiene, difficulty with voluntary movements, and problems with gait. Major deficit in hemiplegic gait is the plantar-flexed position the foot and extension of the knee, throughout the swing phase of the gait cycle. Foot clearance and stability issues can lead to fall risk, while abnormal joint kinematics can lead to joint damage During rehabilitation, most prescribed AFOs are Solid ankle foot orthosis (AFO) and Articulated AFO; however, no study is done on Articulated Dorsiflexion Assist TRAFO effect in persons with hemiplegia in India. Solid ankle foot orthosis provides knee stability; eliminate excessive plantar flexion by limiting the normal ankle motion which compromises the normal gait pattern. Hence knee stability is achieved by blocking the available motion at the ankle joint. The Dorsiflexion Assisting Articulated AFO aids in ankle dorsiflexion and control the hyperextension of the knee without blocking motion at the ankle joint. Tone Reducing AFO helps to reduce muscle tone by means of stretching of muscle which inhibits reflex pattern. Combination of Articulated Dorsiflexion Assist and Tone Reducing Feature will help to achieve biomechanically efficient gait pattern in persons with hemiplegia. The results of this study will help the clinicians for the prescription of correct design of AFO in Rehabilitation of persons with hemiplegia and guiding future research studies on this subject, which is still incompletely defined in the literature.