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A Novel Neuromuscular Electrical Stimulation Treatment for Recovery of Ankle Dorsiflexion in Chronic Hemiplegia

A Case Series Pilot Study

Knutson, Jayme S., PhD; Chae, John, MD

American Journal of Physical Medicine & Rehabilitation: August 2010 - Volume 89 - Issue 8 - p 672-682
doi: 10.1097/PHM.0b013e3181e29bd7
Case Series: Hemiplegia

Knutson JS, Chae J: A novel neuromuscular electrical stimulation treatment for recovery of ankle dorsiflexion in chronic hemiplegia: A case series pilot study.

Objective: To evaluate the feasibility of improving active ankle dorsiflexion with contralaterally controlled neuromuscular electrical stimulation (CCNMES).

Design: CCNMES dorsiflexes the paretic ankle with a stimulation intensity that is directly proportional to the degree of voluntary dorsiflexion of the unimpaired contralateral ankle, which is detected by an instrumented sock. Three subjects with chronic (>6-mo poststroke) dorsiflexor paresis participated in a 6-wk CCNMES treatment, which consisted of self-administering CCNMES-assisted ankle dorsiflexion exercises at home daily and practicing an ankle motor control task in the research laboratory twice a week.

Results: For subjects 1 and 2, respectively, maximum voluntary ankle dorsiflexion increased by 13 and 17 degrees, ankle movement tracking error decreased by ∼57% and 57%, and lower limb Fugl-Meyer score (maximum score is 34) increased by 4 and 5 points. Subject 3 had no appreciable improvement in these measures. Both subjects 1 and 2 maintained their performance in ankle movement tracking through the 3-mo follow-up; subject 2 also maintained the gains in maximum ankle dorsiflexion and Fugl-Meyer score.

Conclusions: These results suggest that CCNMES may have a positive effect on ankle motor impairment in some stroke survivors. Further investigation of the effect of CCNMES on gait is warranted.

From the Department of Biomedical Engineering (JSK, JC), Case Western Reserve University, Cleveland, Ohio; Department of Physical Medicine and Rehabilitation (JC), MetroHealth Medical Center, Cleveland, Ohio;Department of Physical Medicine and Rehabilitation (JC), Case Western Reserve University, Cleveland, Ohio; and Cleveland Functional Electrical Stimulation Center (JSK, JC), Case Western Reserve University, Cleveland, Ohio

All correspondence and requests for reprints should be addressed to: Jayme S. Knutson, PhD, Cleveland FES Center, MetroHealth Medical Center, 2500 MetroHealth Drive, Hamann S1-105A, Cleveland, OH 44109.

This work was supported by Grant Numbers K12RR023264 and KL2RR024990 from the National Institutes of Health (NIH) National Center for Research Resources (NCRR) and by Grant Number K24HD054600 from the National Institute of Child Health and Human Development (NICHD). The neuromuscular electrical stimulators used in this study were developed by the Technical Development Laboratory of the Cleveland FES Center. Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2010 Lippincott Williams & Wilkins, Inc.