The Challenges of Implementing Functional Electrical Stimulation Cycling in a Patient with Hemiparesis following Stroke: A Case Report

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.