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Electrically Induced Recovery of Gait Components for Older Patients with Chronic Stroke

Daly, Janis J. PhD; Ruff, Robert L. MD, PhD

American Journal of Physical Medicine & Rehabilitation: July-August 2000 - Volume 79 - Issue 4 - p 349-360
Research Article: Chronic Stroke

Objective: To compare the gains for chronic stroke patients in volitional gait pattern attained from treatment with functional neuromuscular stimulation (FNS) and intramuscular electrodes (IM) with gains attained using conventional therapy, including treatment with FNS using surface electrodes (surface-stim).

Design: This single-subject research design consisted of a series of two subjects. Three months of conventional therapy and surface-stim were followed by treatment using the FNS-IM system. Two stroke patients had cerebrovascular accident 1 or 4 yr before the study and ambulated with a cane. Interventions consisted of 3 months of conventional exercise and gait training including surface-stim, followed by 7-14 months of treatment with the FNS-IM system. Treatments occurred up to 3 times/wk for 1-hr sessions and a home program. Outcome measures consisted of six kinematic gait components, as measured by a six-camera video-based data-acquisition system. Coordination of isolated joint movement was measured according to the Fugl-Meyer scale.

Results: Both subjects improved during conventional therapy to some degree. During FNS-IM treatment, gains were made beyond those attained during conventional therapy. Statistically significant differences were found between conventional and FNS-IM therapy.

Conclusions: For these two subjects, gains in volitional control of gait were made during conventional treatment (including surface-stim); for these two subjects during FNS-IM treatment, additional gains were made in volitional gait pattern, beyond those attained during conventional therapy.

From the Department of Physical Therapy (JJD), Walsh University, N. Canton, Ohio; Motion Studies Laboratory, Research Service (JJD), and Neurology Service (RLR), VA Medical Center, Cleveland, Ohio; and Neurology Department (RLR), Case Western Reserve University, Cleveland, Ohio.

Reprints: All correspondence and requests for reprints should be addressed to: Janis J. Daly, PhD, Motion Studies Laboratory, Research Service (151-w), V.A. Medical Center, 10701 E Boulevard, Cleveland, OH 44106.

Disclosures: This research was supported by The Rehabilitation and Research Development Service, Department of Veterans Affairs, Grant B678-RA.

Presented, in part, at the Physical Medicine and Rehabilitation National Conference, Seattle, Washington, November 1998.

© 2000 Lippincott Williams & Wilkins, Inc.