Gait synchronized neuromuscular electrical stimulation to the gluteus medius on a patient with right hemiparesis: a case report.

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.

The use of motor learning and neural plasticity in rehabilitation for ataxic hemiparesis: A case report.

Background and Purpose: Although the principles of neural plasticity for stroke rehabilitation are well established, specific intervention plans for patients with ataxia following a lacunar infarct are not well described. The purpose of this case report is to describe the intervention program for a patient with ataxic hemiparesis based on principles of motor learning and neural plasticity. Case Description: An 83-year-old, socially active male presented to the emergency department with right-sided upper extremity weakness and ataxia. The patient's acute hospital course included 4 days in a stoke unit, followed by 13 days in inpatient rehabilitation. Intervention: A 3-phase graded mobility and coordination plan was used during inpatient rehabilitation. Interventions included function-based training with repeated ambulation, coordination activities for the upper and lower extremities, and strengthening to help the patient achieve his goal of walking "without gait deviations." The concepts of motor learning and neural plasticity were utilized for timing and feedback on patient errors when implementing this novel program. Outcomes: The patient's level of assistance for mobility and activities of daily living improved from minimal assistance to modified independence without use of an assistive device. The Dynamic Gait Index score improved from 16/24 to 20/24 suggesting a decreased fall risk. Discussion: This case report describes a novel intervention strategy for a patient with ataxia following a lacunar stroke. The application of the principles of neural plasticity and motor learning was the foundation for a function-based plan of care.

Tolerance of a standing tilt table protocol by patients an inpatient stroke unit setting: a pilot study.

BACKGROUND AND PURPOSE: To describe and examine physiologic and self-reported indices of tolerance to a standing tilt table protocol (STTP) among patients following an acute stroke. METHODS: We undertook a prospective, observational pilot study of patients admitted to a stroke unit of a single academic medical center. A clinical protocol for the use of the tilt table was developed and applied to subjects in the acute phase following a stroke. The protocol involved a stepwise process to gradually raise the subject into a standing position on the tilt table platform, at 10° intervals from 60° to 90°. Tolerance of the STTP was operationally defined as the ability to sustain 60° or greater of tilt table inclination for a minimum of 5 minutes, without signs or symptoms of intolerance. Specific measures recorded were frequencies of the highest angle achieved, the duration of standing time tolerated, and physiologic response. RESULTS: Thirty-six patients with ischemic or hemorrhagic stroke (22 women and 14 men) aged 24 to 87 (mean age = 62, SD = 16) years participated in a single trial of the STTP. Fifty-three percent of subjects (N = 19) attained 60° or higher on the tilt table, with a mean total standing time of approximately 9 minutes. DISCUSSION AND CONCLUSIONS: This pilot study suggests that the use of a tilt table is well tolerated among patients in the acute stroke phase and may be an effective tool for introducing early upright mobilization to a medically fragile patient population.Video Abstract available (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A35) for more insights from the authors.