Fuck, fuck, fuck. More studies, NOT a protocol created to help recovery. Damn it all, survivors want results from studies not just kicking the can down the road.
Gait Rehabilitation Using Functional Electrical Stimulation Induces Changes in Ankle Muscle Coordination in Stroke Survivors: A Preliminary Study
- 1Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV, United States
- 2Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
- 3Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, United States
Background: Previous studies have
demonstrated that post-stroke gait rehabilitation combining functional
electrical stimulation (FES) applied to the ankle muscles during fast
treadmill walking (FastFES) improves gait biomechanics and clinical
walking function. However, there is considerable inter-individual
variability in response to FastFES. Although FastFES aims to sculpt
ankle muscle coordination, whether changes in ankle muscle activity
underlie observed gait improvements is unknown. The aim of this study
was to investigate three cases illustrating how FastFES modulates ankle
muscle recruitment during walking.
Methods: We conducted a preliminary
case series study on three individuals (53–70 y; 2 M; 35–60 months
post-stroke; 19–22 lower extremity Fugl-Meyer) who participated in 18
sessions of FastFES (3 sessions/week; ClinicalTrials.gov: NCT01668602).
Clinical walking function (speed, 6-min walk test, and Timed-Up-and-Go
test), gait biomechanics (paretic propulsion and ankle angle at
initial-contact), and plantarflexor (soleus)/dorsiflexor (tibialis
anterior) muscle recruitment were assessed pre- and post-FastFES while
walking without stimulation.
Results:Two participants (R1, R2) were
categorized as responders based on improvements in clinical walking
function. Consistent with heterogeneity of clinical and biomechanical
changes commonly observed following gait rehabilitation, how muscle
activity was altered with FastFES differed between responders. R1
exhibited improved plantarflexor recruitment during stance accompanied
by increased paretic propulsion. R2 exhibited improved dorsiflexor
recruitment during swing accompanied by improved paretic ankle angle at
initial-contact. In contrast, the third participant (NR1), classified as
a non-responder, demonstrated increased ankle muscle activity during
inappropriate phases of the gait cycle. Across all participants, there
was a positive relationship between increased walking speeds after
FastFES and reduced SOL/TA muscle coactivation.
Conclusion:Our preliminary case series
study is the first to demonstrate that improvements in ankle
plantarflexor and dorsiflexor muscle recruitment (muscles targeted by
FastFES) accompanied improvements in gait biomechanics and walking
function following FastFES in individuals post-stroke. Our results also
suggest that inducing more appropriate (i.e., reduced) ankle
plantar/dorsi-flexor muscle coactivation may be an important
neuromuscular mechanism underlying improvements in gait function after
FastFES training, suggesting that pre-treatment ankle muscle status
could be used for inclusion into FastFES. The findings of this
case-series study, albeit preliminary, provide the rationale and
foundations for larger-sample studies using similar methodology.
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