Does it get survivors 100% recovered while still in the hospital? NO? Then it's NOT GOOD ENOUGH! Why are your stroke medical 'professionals' ok with the tyranny of low expectations? Survivors aren't!
Comparison of Functional Electrical Stimulation Cycle vs. Conservative Rehabilitation on Functional Status and Muscle Features in Stroke Patients
Abstract
Background
Functional Electrical Stimulation (FES) Cycle is used in the rehabilitation of stroke.
Objective
The
aim of this study is to investigate the effects of CR and FES cycle
therapy on the functional status and muscle features in stroke patients
Methods
The
1st Group(n = 15) received only CR for 6 weeks, and the 2nd
Group(n = 15) received FES cycle 3 days a week for 4 weeks in addition
to the CR treatment. Brunnstrom recovery staging(BRS), Fugl-Meyer lower
extremity evaluation(FME); Berg Balance Scale(BBS), Functional
Ambulation Classification(FAC), Barthel Index(BI), Fatigue Severity
Scale(FSS), 6 min walk test(6mWT), knee extensor and knee flexor muscle
strengths(KEMS, KFMS) in both groups were assessed before and after
treatment(6th week). Pennate angle(PA) and rectus femoris muscle
thickness(RFT) were measured.
Results
Significant
improvement was detected in BBS, FAS, BI, FME, 6mWT, KEMS, RFT scores
after intra-group treatment compared to before treatment in both groups.
Only the 2nd Group showed a significant difference in KFMS, FSS, BRS
lower extremity, PA values after treatment compared to before. No
significant superiority of the groups over each other was detected.
Conclusions
CR
and FES Cycle contribute to the improvement(NOT GOOD ENOUGH!)
of the functional status of
the patients, but their superiority over each other was not observed.
Introduction
Stroke is defined as sudden neurological deterioration caused by interruption of blood flow to the brain (Kuriakose & Xiao, 2020).
Loss of lower extremity muscle strength and motor coordination that
develops in hemiplegic patients after stroke are the most common
deficits that cause long-term disability of individuals. The main
factors that cause asymmetric movements and worsening of locomotor
balance in patients are muscle weakness and intermuscular coordination
disorder (Ambrosini et al., 2020).
In addition, in post-stroke patients, daily activities such as
dressing, bathing and toileting are often affected. Therefore, it is
important for patients to receive rehabilitation early. Rehabilitation
practices aim to strengthen the functional independence of people
affected by stroke, participate in social activities and shorten the
time to return to work (Corbetta et al., 2015; Patel et al., 2000).
Conservative rehabilitation (CR) exercises include joint range of
motion exercise, progressive resistance strengthening exercises,
stretching exercises to prevent possible contractures, balance
exercises, postural training, mobility and gait training (Lee et al., 2022). Studies have shown that CR contributes to the functional recovery of stroke patients (Son et al., 2014; Wu et al., 2020).
Functional
Electrical Stimulation (FES), which is one of the methods that can be
applied in addition to CR in the treatment of stroke patients, provides
contraction of paralyzed muscle groups and movement in the relevant
joints as a result of electrical stimulation of motor neuron (Lynch & Popovic, 2008).
One of the FES exercise modalities that has become widely used and
researched recently is FES cycle therapy. This device allows people with
or without voluntary leg movement to pedal on a stationary system
combined with an exercise bike. Computer-generated, low-level electrical
pulses are delivered to the leg muscles via transdermal electrodes.
After a full rotation period, the muscles are stimulated in accordance
with the cycling movement by following a sequence that changes according
to the speed and angle of the pedal (Ardıçoğlu, 2016; Peng et al., 2011; van der Scheer et al., 2021).
There
are many studies on motor neuroplasticity that support the role of
goal-oriented active repetitive movement in the training of the paretic
limb to increase motor learning and recovery in the stroke patient group
(Arya et al., 2011; Jones, 2000; Mang et al., 2013).
FES cycle therapy is an effective biofeedback rehabilitation
application that incorporates both repetitive movement and electrical
stimulation mechanism. It is safe to use in stroke patients and is
becoming increasingly common (Alon et al., 2011).
It has been shown that FES applied together with cycling exercise
increases walking speed and improves balance in stroke patients (Shariat et al., 2019).
Previous studies have compared the effectiveness of CR and lower extremity FES applications in stroke patients (Ambrosini et al., 2011; de Sousa et al., 2016; Peri et al., 2016).
It is stated that FES applications are superior to CR applications
alone in terms of balance and motor recovery in stroke patients.
However, in these studies, FES treatment was generally performed by
manually combining stationary cycling with electrical stimulation
application. In FES applications performed in this way, there is no
mechanism to provide instant biofeedback while the patient pedals. At
the same time, the intensity and duration of electrical stimulation
cannot be automatically adjusted according to the patient's pedaling
ability. In current systems, FES and bicycle mechanisms are integrated
and strengthened through computer software. These systems can provide
appropriate responses according to the patient's pedaling ability and
automatically change the resistance according to the patient. It can
also provide visual biofeedback.
In this
study, we aimed to evaluate and compare the effectiveness of CR and the
current lower extremity FES cycle therapy applied in addition to CR in
stroke patients on daily living activities, motor recovery, walking
distance, mobilization, balance, fatigue, muscle strength and its
effects on ultrasonographic muscle properties.
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