ABSTRACT
PURPOSE: To investigate the feasibility of combining physiotherapy and functional electrical stimulation to improve gait post stroke. METHODS: A parallel group partially single-blinded randomised clinical trial. Adults living at home, less than 6 months post stroke, were randomised to Group A (physiotherapy, n = 10) or Group B (physiotherapy and common peroneal nerve stimulation, n = 10). Assessments were conducted before randomisation (Week 1), after intervention (Week 8) and after 12 weeks follow-up (Week 20). RESULTS: No between group differences were observed. There were statistically significant within group differences after the intervention period in both groups for walking speed and distance walked (without stimulation), Rivermead Mobility Index and Canadian Occupational Performance Measure, maintained at Week 20. There was statistically significant improvement in 10-m walking speed (Group B) when the stimulator was used at Week 8 (p = 0.03, median 0.04 m/s (8%)). Only Group B had statistically significant within group change in Rivermead Visual Gait Analysis (Week 8), maintained at Week 20. CONCLUSIONS: Integrating electrical stimulation and physiotherapy was feasible and improved walking speed. There was no evidence of a training effect compared with physiotherapy alone. One-hundred forty-four participants per group would produce an adequately powered study based on this protocol. Implications for Rehabilitation At the end of the intervention period participants using electrical stimulation to correct dropped foot walked faster. It was feasible for electrical stimulation to be combined with physiotherapy for people less than 6 months post stroke. A larger adequately powered study is required to establish whether there are training effects associated with use of stimulation in this population.
ABSTRACT
The aim of this pilot study was to investigate the feasibility of applying the combination of Dynamic splinting (DS) and Neuromuscular electrical stimulation (NMES) in order to improve wrist and elbow function, and range of motion, in children with upper limb contractures due to Cerebral palsy (CP). Six children aged seven to 16, with contractures at the wrist or elbow, were recruited. Following a 12-week baseline period all participants underwent a 12-week treatment period where DS was used for one hour per day and combined with NMES for the second half of the 1-h treatment. A 12-week follow-up period then ensued. Upper limb function was assessed with the Melbourne assessment, physical disability with the Paediatric Evaluation of Disability Index and the Activity Scale for Kids, and quality of life with the Pediatric Quality of Life Scale. Passive and active range of motion at the wrist and elbow were measured using manual and electrical goniometers. The technique of using combined NMES and DS was demonstrated to be feasible and compliance with the intervention was good. There was an increase in passive elbow extension in two participants treated for elbow contractures, although no accompanying change in upper limb function was demonstrated. Wrist range of movement improved in one participant treated for wrist contracture.
