Enhanced rehabilitation of gait after stroke: a case report of a therapeutic approach using multichannel functional electrical stimulation.

The beneficial effects of using multichannel functional electrical stimulation (MFES) for gait rehabilitation in nonambulatory hemiplegic patients have already been shown. The methodology of application and the results presented were pooled for the whole group of participants, which blurs the exact picture of each particular subject and many vital details are not presented. The purpose of this article is to focus on a single subject from the study and to present all the details of the treatment. The presented subject participated six weeks in the study, first three weeks in MFES therapy and second three weeks in conventional therapy. The effects of each therapy were evaluated by the following measures: temporal-distance parameters of gait, ground reaction forces, goniograms in hip knee and ankle, and assessment of the physical status of the patient according to the Fugl-Meyer evaluation scale. An analysis of the measured parameters showed improved performance of the patient during MFES therapy and stagnation or even slight recession during conventional therapy. The patient achieved independent gait during the three weeks of MFES therapy. At 30 months after the beginning of therapy, the patient was still able to ambulate independently without any significant changes in his gait pattern. The accomplishment was mainly attributed to the avoidance of pathological gait pattern development by using MFES assisted gait training and to the high motivation of the patient to walk and exercise during therapy as well as after he was released to go home.

The rehabilitation of gait in patients with hemiplegia: a comparison between conventional therapy and multichannel functional electrical stimulation therapy.

BACKGROUND AND PURPOSE: Gait rehabilitation in patients with severe hemiplegia requires substantial effort. Preliminary studies indicate potential beneficial effects of using multichannel functional electrical stimulation (MFES) for gait rehabilitation in these patients. In this study, a new method of gait rehabilitation for nonambulatory patients with hemiplegia by means of MFES added to conventional therapy was introduced. The results of the method's application were evaluated by comparing it with conventional therapeutic methods. SUBJECTS: The proposed rehabilitation method was tested on a group of 20 patients with severe hemiplegia secondary to cerebrovascular accident. Subjects were randomly assigned to one of two groups. One group received 3 weeks of MFES followed by 3 weeks of conventional therapy. The other group received 3 weeks of conventional therapy followed by 3 weeks of MFES. METHODS: The effects of each therapeutic method were evaluated by measurements of temporal-distance variables and ground reaction forces and by assessment of each subject's physical status according to the Fugl-Meyer evaluation scale. RESULTS: There was improved performance of the subjects during MFES combined with conventional therapy as compared with conventional therapy alone. CONCLUSION AND DISCUSSION: The superiority of the MFES method as compared with conventional therapy was mainly attributed to the enhanced motor learning accomplished by application of MFES. These results, however, are preliminary, and further research is needed.

Application of a programmable dual-channel adaptive electrical stimulation system for the control and analysis of gait.

A dual-channel electrical stimulation system with a stimulator and a programmer/stride analyzer was designed for clinical rehabilitation of gait and for subsequent daily use as an orthotic aid. The stimulator, with controls to adjust amplitude only (50 mA), adapts chosen stimulation sequences to the walking rate of a patient. Pulse duration (50-500 microseconds), frequency (5-120 Hz), shape (symmetrical biphasic, monophasic), stimulation sequences (16 stride segments) and their cycle (2-12 sec), and right/left foot-switch choices are selected for each patient and programmed into a separate unit. The programming unit also statistically processes the foot-switch data collected by the stimulator. The device was evaluated with regard to the programmable parameters, effectiveness during gait, and feasibility in clinical use. It was applied to 11 stroke patients and 10 brain injury patients during gait, stimulating 22 combinations of peroneal nerve and hamstring, quadriceps, triceps brachii, and gluteus maximus muscles. Forces on both feet, equinovarus, knee extension and hyperextension, elbow flexion, and hip extension were corrected. Selection of the stimulation sequences, their adaptation, range of pulse duration, and valid statistics were verified. Improved forces and joint angles were recorded together with significant changes in the stride time, length, and velocity by the stimulation.

Restoration of gait during two to three weeks of therapy with multichannel electrical stimulation.

Multichannel electrical stimulation was applied in 20 patients with hemiplegia secondary to stroke or head injury using a six-channel microprocessor stimulator-stride analyzer to restore independent gait and to reestablish a normal gait pattern in a two- to three-week therapy period. The therapy was followed up at every session by a stride analyzer incorporated into the stimulator. At the beginning and at the end of the therapy period, each subject's gait was measured with a ground reaction measuring system. Statistical results and observations are presented for the group of 20 subjects, and a detailed description of the results is given for one subject who is representative of the whole group. According to the measured gait characteristics, gait improved significantly in all subjects during the therapy period, resulting in a partly or completely independent gait. The subjects' posture and endurance also improved, and they spontaneously learned how to use a crutch. The measurements and visual assessment of the subjects' progress indicate that the described treatment protocol offers good prospects for faster and more efficient gait rehabilitation in severely impaired patients. To determine the efficacy of gait therapy with multichannel electrical stimulation, a comparative study of conventional therapeutic methods and the method described in this article should be conducted.

Evaluation of gait with multichannel electrical stimulation.

Short, intensive multichannel electrical stimulation therapy was evaluated in 14 hemiplegics after stroke or head injury. The stimulation of the peroneal nerve, soleus, quadriceps, hamstring, gluteus maximus, and triceps brachii muscles with individually preprogrammed sequences was applied by surface electrodes at the beginning of gait rehabilitation. The patients started walking with the support of a therapist, gradually increased the walking distance and all reached independent ambulation with a crutch after an average of 14 stimulation sessions. A portable microprocessor six-channel stimulator/stride analyzer enabled the collection of gait parameters and recording of statistical mean values of stride time, gait symmetry, right and left stance times, and their standard deviations. Without additional equipment, several hundred stimulated strides were measured during each stimulation session.

Preliminary testing of a dual-channel electrical stimulator for correction of gait.

A dual-channel orthotic electrical stimulator was designed for daily use at home by plegic and paretic patients who had completed a hospital rehabilitation program. With two independent channels, two muscle groups can be stimulated in chosen sequences. A microcomputer accommodates the stimulation sequences to the gait cadence of the patient for the stance and swing phase separately.