A feasibility study to investigate the effect of functional electrical stimulation and physiotherapy exercise on the quality of gait of people with multiple sclerosis.

OBJECTIVE: To examine the effect of Functional Electrical Stimulation (FES) for dropped foot and hip instability in combination with physiotherapy core stability exercises. METHODS: Twenty-eight people with secondary progressive multiple sclerosis and unilateral dropped foot participated in a randomized crossover trial. Group1 received FES for correction of dropped foot for six weeks with the addition of hip extension for a further six weeks. In weeks 12-18, FES was continued with the addition of eight sessions of core stability physiotherapy with home-based exercise. FES and home-based exercise were continued until weeks 19-24. Group 2 received the same physiotherapy intervention over the first 12 weeks, adding FES in the second 12 weeks. RESULTS: FES improved walking speed and Rivermead Observational Gait Analysis (ROGA) score, whereas physiotherapy did not. Adding gluteal stimulation further improved ROGA score. Both interventions reduced falls, but adding FES to physiotherapy reduced them further. FES had greater impact on Multiple Sclerosis Impact Scale, MSIS-29. CONCLUSION: The intervention was feasible. FES for dropped foot may improve mobility and quality of life and may reduce falls. Adding gluteal stimulation further improved gait quality. Adding physiotherapy may have enhanced the effect of FES, but FES had the dominant effect.

Accelerometer-triggered electrical stimulation for reach and grasp in chronic stroke patients: a pilot study.

BACKGROUND: Electrical stimulation of the upper extremity may reduce impairment in patients following stroke. Stimulation triggered on demand combined with task practice may be an effective means of promoting recovery of function. OBJECTIVE: The authors investigated the feasibility of using accelerometer-controlled electrical stimulation for the elbow, wrist, and finger extensors to enable functional task practice in patients with chronic hemiparesis. METHODS: Following a 4-week baseline, participants received 2 weeks of cyclic stimulation exercise to elbow and forearm extensor muscles, followed by 10 weeks of triggered stimulation to practice functional reaching. Participants were reassessed 12 weeks later as well. Outcome measures were the Action Research Arm Test (ARAT), Modified Ashworth Scale (MAS), Canadian Occupational Performance Measure (COPM), Psychosocial Impact of Assistive Devices Scale (PIADS), and Use of Device Questionnaire (UDQ). RESULTS: Fifteen volunteers who had at least 45° of forward shoulder flexion and could initiate elbow extension and grasp completed the study. The ARAT score improved from 19 to 32 (P = .002); the MAS score for elbow, wrist, and finger flexor spasticity was reduced from 2 each to 1, 0, and 1 (P < .05); the COPM performance and satisfaction scores improved (P = .001); and the PIADS became positive for competence (P = .005), adaptability (P = .008), and self-esteem (P = .008). Gains were maintained 12 weeks later. CONCLUSIONS: Accelerometer-triggered electrical stimulation to augment task training for the hemiplegic arm is feasible and may improve functional ability and quality of life which may be maintained 12 weeks after treatment. A randomized trial design is required to evaluate efficacy and cost benefit.

A pilot study to investigate the feasibility of electrical stimulation to assist gait in Parkinson's disease.

Objectives. This study aims to investigate the effect of functional electrical stimulation (FES) on gait in people with Parkinson's disease. Materials and Methods. Seven subjects with idiopathic Parkinson's disease received single-channel electrical stimulation for eight weeks to the common peroneal nerve to improve heel strike and provide sensory stimulus during the swing phase of gait. Stride length, time, and number of steps to complete a 20-m walk and distance completed in 3 min were assessed. Episodes of freezing and incidence of falls were recorded. Statistical analysis of the walking test data was analyzed using the nonparametric Wilcoxon signed ranks test. Results. An immediate improvement was demonstrated with FES on distance and average stride length during a 3-min walk during the treatment period but not on number of steps and walking speed during a 20-m walk. A training effect was observed for all parameters of gait measured over the eight-week treatment period, which was mostly maintained four weeks after treatment was stopped. Fewer falls and episodes of freezing occurred during the treatment period. The number of falls returned to pretreatment levels when treatment was stopped. Conclusions. This study has shown that FES can improve some parameters of gait over an eight-week period of use with a carryover effect that is maintained without stimulation during that time and an immediate reduction in the frequency of falls. An immediate effect of FES was demonstrated over a 3-min walk but not over a 20-m walk. Improvements in gait largely persisted on reassessment four weeks after stopping use of FES although the frequency of falls returned to pretreatment levels. A larger study is required to support these findings, to understand the mechanisms of the effects of electrical stimulation on gait and to identify those most likely to benefit from it.

A pilot study to investigate the effects of electrical stimulation on recovery of hand function and sensation in subacute stroke patients.

Objectives. 1) To compare the effect of cyclic neuromuscular electrical stimulation (NMES) of the forearm and elbow extensor muscles with passive stretching exercises on hand function and sensation following stroke. 2) To inform sample size for a larger randomized controlled trial (RCT). Materials and Methods. Twenty-two subjects with hemiplegia resulting from a stroke during the previous 12 months were randomly allocated into stimulation (treatment) and exercise (control) groups. Stimulation was applied to the elbow, and forearm extensor muscle groups of the hemiplegic arm for 12 weeks. Subjects in the control group were taught passive stretching exercises for the same period. The primary outcome measure was the Action Research Arm test (ARAT). Sensation was tested using two-point discrimination. Statistical analysis applied nonparametric analysis of covariance (ancova). Results. Statistically significant between-group differences in change in ARAT scores were shown between the two groups after 12 weeks of treatment (p = 0.003) and following 12 further weeks without intervention (p = 0.012). There were no significant differences in sensation. Conclusions. 1) A significant treatment effect of electrical stimulation over passive exercise has been demonstrated in a group of 22 subacute stroke patients, randomized into two equal groups and further work identified which may help to improve recovery of hand function and sensation following stroke. 2) A sample size of 24 subjects in each group has been estimated assuming a two-sided test significance level of 5% with 80% power, primary outcome variability SD = 6.75, a minimum difference of ten ARAT score units, and a 10% dropout rate.

An implantable two channel drop foot stimulator: initial clinical results.

This article reports preliminary results of pilot studies of a new implantable two channel drop foot stimulator. The stimulator consists of an externally worn transmitter inductively coupled to an implanted receiver unit located in the lower leg, lateral and distal to the knee. The receiver is connected to electrodes located under the epineurium of the deep and the superficial peroneal nerves. Stimulation is triggered by detection of heel lift and terminated at heel strike in a manner similar to surface mounted systems. The location of the electrodes allows for a degree of selectivity over the resultant moment about the ankle joint that is not possible with surface stimulation of the common peroneal nerve. The two subjects used the stimulator on a regular basis and showed increases in walking speed of between 10% and 44% when compared to their baseline measurements. Isometric tests have demonstrated that the stimulator allows selective and repeatable stimulation of ankle joint muscles.