Functional electrical stimulation for gait correction in the early recovery phase after ischemic stroke

Introduction. Gait dysfunction is a complication of acute cerebrovascular accidents, which is biomechanically manifested as reduced speed and asymmetry in spatiotemporal and kinematic parameters. These impairments can be corrected using functional electrical stimulation (FES) of muscle contraction; however, the available literature primarily describes its application during the late recovery phase of stroke.

Objective. Evaluation of the potential of multichannel FES for gait recovery in early post-stroke rehabilitation.

Materials and methods. The study included 11 patients (2 females and 9 males) aged 46–66 years in the early recovery period after an ischemic stroke (time since stroke onset was 69.1 ± 52.0 days) and 34 healthy subjects (18 females and 16 males) as a control group. The lower limb muscle strength and tone were assessed using the Medical Research Council Scale for Muscle Strength and the modified Ashworth scale, respectively. Gait function was evaluated using the Dynamic Gait Index, Hauser Ambulation Index, Timed-Up-and-Go test, and 10-Meter Walk test. Gait pattern function (b770), obstacle negotiation (d4551), and short-distance walking (d4500) were also examined. All patients underwent a FES therapy course (mean number of sessions — 10.8). Clinical and biomechanical examinations were performed before and after the FES therapy course. Biomechanical gait analysis was conducted using a Stadis system (Neurosoft, Russia). Statistical analysis was performed using the Statistica 12.0 software.

Results. The conducted clinical evaluation demonstrated a minor yet statistically significant functional improvement in post-treatment testing. An increase in the scores of Dynamic Gait Index and 10-Meter Walk test was observed. A decrease in the values of Hauser Index values and the completion time of Timed- Up-and-Go test, as well as in domains (d770) and (d4500), was noted. Gait function showed improvement. The values of walking speed (p < 0.05), double support time on the paretic side (p < 0.05), and m. gastrocnemius activity on both the paretic and unaffected sides (p < 0.05) increased.

Conclusions. The observed changes in gait function were typical of hemiparesis. During the FES therapy course, the patients showed no negative reactions. The clinical and biomechanical gait functions of patients showed minor but positive changes during the FES therapy course. Among biomechanical parameters, the amplitude of the gastrocnemius muscle course on the paretic side significantly increased, which is one of the FES target parameters. Short courses of multichannel FES can be applied in this patient category; however, their effectiveness is insufficient. Approaches to improving the FES effectiveness require further investigation.

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