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Contralaterally Controlled Neuromuscular Electrical Stimulation for Recovery of Ankle Dorsiflexion: A Pilot Randomized Controlled Trial In Patients With Chronic Post-Stroke Hemiplegia

Knutson, Jayme S. PhD; Hansen, Kristine PT; Nagy, Jennifer PT; Bailey, Stephanie N. BSE; Gunzler, Douglas D. PhD; Sheffler, Lynne R. MD; Chae, John MD

American Journal of Physical Medicine & Rehabilitation: August 2013 - Volume 92 - Issue 8 - p 656–665
doi: 10.1097/PHM.0b013e31829b4c16
Original Research Articles

Objective The aim of this study was to compare the effects of contralaterally controlled neuromuscular electrical stimulation (CCNMES) vs. cyclic neuromuscular electrical stimulation (NMES) on lower extremity impairment, functional ambulation, and gait characteristics.

Design Twenty-six survivors of stroke with chronic (≥6 mos) foot drop during ambulation were randomly assigned to 6 wks of CCNMES or cyclic NMES. Both groups had ten sessions per week of self-administered home application of either CCNMES or cyclic NMES plus two sessions per week of gait training with a physical therapist. Primary outcomes included lower extremity Fugl-Meyer score, modified Emory Functional Ambulation Profile, and gait velocity. Assessments were made at pretreatment and posttreatment and at 1 and 3 mos after treatment.

Results There were no significant differences between the groups in the outcome trajectories for any of the measures. With data from both groups pooled, there were significant but modest and sustained improvements in the Fugl-Meyer score and the modified Emory Functional Ambulation Profile but not in gait velocity.

Conclusions The results support the hypothesis that gait training combined with either CCNMES or cyclic NMES reduces lower extremity impairment and functional ambulation but do not support the hypothesis that CCNMES is more effective than cyclic NMES in patients with chronic post-stroke hemiplegia.

From the Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio (JSK, LRS, JC); Cleveland Functional Electrical Stimulation Center, Ohio (JSK, LRS, JC); Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute of Ohio, MetroHealth Medical Center, Cleveland (JSK, KH, JN, LRS, JC); Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio (SNB); and Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, Ohio (DDG).

All correspondence and requests for reprints should be addressed to: Jayme S. Knutson, PhD, Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute of Ohio, 4229 Pearl Rd, Suite N527, Cleveland, OH 44109.

Supported by funds from the National Institutes of Health (NIH) National Institute of Child Health and Human Development (NICHD) grant number R21HD061593 and the NIH National Center for Research Resources (NCRR) Clinical and Translational Science Collaborative of Cleveland grant number UL1RR024989. The stimulators used in this study were developed and provided by the Technical Development Laboratory of the Cleveland FES Center and are limited by federal law to investigational use. Jayme S. Knutson, PhD, and John Chae, MD, are coinventors on the contralaterally controlled neuromuscular electrical stimulation patent assigned to Case Western Reserve University, Patent 8,165,685: System and Method for Therapeutic Neuromuscular Electrical Stimulation. Financial disclosure statements have been obtained, and no other conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2013 by Lippincott Williams & Wilkins