I don't care about your minor challenges, your patient has much bigger challenges, mainly you with your 'can't do it attitude'
The Challenges of Implementing Functional Electrical Stimulation Cycling in a Patient with Hemiparesis following Stroke: A Case Report
Sarah Briggs
DPT
Class of 2017
Department of
Physical Therapy & Rehabilitation Science
The University of Iowa
Abstract
Background:
Strokes are the most common cause of severe disability in the United States. Functional
electrical stimulation (FES) cycling may be used as an intervention to decrease disability post-stroke,
though there is conflicting evidence among the existing studies exploring its use. The purpose of this
case study is to describe the use of FES cycling in order to decrease residual disability post-stroke, as
well as the challenges of implementing this intervention in the inpatient rehabilitation setting.
Case
Description:
The patient was a 75 year
-old female who presented to inpatient rehabilitation with a sub-
acute
ischemic right
posterior cerebral artery stroke. The patient demons
trated severe left hemiparesis,
left homonymous hemianopsia resulting in left neglect, as well as impairments in sensation, balance,
and functional mobility. Interventions consisted of use of an FES bicycle at a low dosage, balance
activities, left attenti
on tasks, sensory reeducation,
strengthening, and education.
Outcomes:
The
patient’s length of stay was 24 days. During this period, she demonstrated a 22-point increase in
the
Functional Independence Measure score from initial evaluation to discharge. The
patient also
demonstrated an increase in postural control as demonstrated by a five-point increase in her Postural
Assessment Scale for Stroke score.
Discussion:
Though the patient made significant improvements in
postural control and required much less assistance with mobility, she continued to demonstrate severe
deficits at discharge that prevented her from returning home independently. Patient complexity, time
constraints, scheduling difficulties, and reimbursement issues represented challenges of regular
implementation of FES cycling, resulting in dosage at a level lower than is recommended. While current
research is conflicting, FES cycling at an appropriate volume may be beneficial in reducing disability in
sub-acute stroke survivors.
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