Functional Electrical Stimulation of Ankle Plantarflexor and Dorsiflexor Muscles: Effects on Poststroke Gait

In the 11 years since this came out, has a stroke protocol been published AND distributed  to ALL 10 million yearly stroke survivors? If not, THEN THERE IS COMPLETE FUCKING INCOMPETENCY IN TENS OF THOUSANDS OF STROKE DOCTORS AND THERAPISTS. Do you prefer your incompetency NOT KNOWING OR NOT DOING? Your Hobson's choice. Until we start writing and updating protocols stroke rehab will never move forward. Guidelines are useless because they leave leeway for the survivor to be blamed for not recovering. This is so obvious, IS EVERYONE IN STROKE LEADERSHIP COMPLETELY STUPID?

Functional Electrical Stimulation of Ankle Plantarflexor and Dorsiflexor Muscles: Effects on Poststroke Gait

 Stroke
. 2009 December ; 40(12): 3821–3827. doi:10.1161/STROKEAHA.109.5603
Trisha M. Kesar, PT, PhD 1,
Ramu Perumal, PhD 2,
Darcy S. Reisman, PT, PhD 1,2,
 AngelaJancosko, PT 2,
Katherine S. Rudolph, PT, PhD 1,2,
Jill S Higginson, PhD 2,3, and
Stuart A.Binder-Macleod, PT, PhD 1,2
1 Department of Physical Therapy, University of Delaware, Newark, DE
2 Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE
3 Department of Mechanical Engineering, University of Delaware, Newark, DE

 Abstract

Background and Purpose—
Functional electrical stimulation (FES) is a popular post-stroke gait rehabilitation intervention. Although stroke causes multi-joint gait deficits, FES is commonly used only for the correction of swing phase foot drop. Ankle plantar flexor muscles play an important role during gait. The aim of the current study is to test the immediate effects of delivering FES to both ankle plantar flexors and dorsiflexors on post-stroke gait.
Methods—
Gait analysis was performed as subjects (N=13) with chronic post-stroke hemiparesis walked at their self-selected walking speeds during walking with and without FES.
Results—
Compared to delivering FES to only the ankle dorsiflexor muscles during the swing phase,delivering FES to both the paretic ankle plantarflexors during terminal stance and dorsiflexors during swing phase provided the advantage of greater swing phase knee flexion, greater ankle plantar flexion angle at toe-off, and greater forward propulsion. Although FES of both the dorsi- and plantar flexor muscles improved swing phase ankle dorsiflexion compared to no FES, the improvement was less than that observed by stimulating the dorsiflexors alone, suggesting the need to further optimize stimulation parameters and timing for the dorsiflexor muscles during gait.
Conclusions—
In contrast to the typical FES approach of only stimulating ankle dorsiflexor muscles during the swing phase, delivering FES to both the plantar- and dorsiflexor muscles can help to correct post-stroke gait deficits at multiple joints (ankle and knee) during both the swing and stance phases of gait. Our study shows the feasibility and advantages of stimulating the ankle plantar flexors during FES for post-stroke gait.