Feasibility and Preliminary Efficacy of Gait Training Assisted by Multichannel Functional Electrical Stimulation in Early Stroke Rehabilitation: A Pilot Randomized Controlled Trial

Background. Many stroke survivors suffer from leg muscle paresis, resulting in asymmetrical gait patterns, negatively affecting balance control and energy cost. Interventions targeting asymmetry early after stroke may enhance recovery of walking. Objective. To determine the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by multichannel functional electrical stimulation (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of gait symmetry and walking capacity in patients starting in the subacute phase after stroke. Methods. Forty inpatient participants (≤31 days after stroke) were randomized to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday. Feasibility was determined by adherence (≥75% sessions) and satisfaction with gait training (score ≥7 out of 10). Primary outcome for efficacy was step length symmetry. Secondary outcomes included other spatiotemporal gait parameters and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect postintervention and at 3-month follow-up. Results. Thirty-seven participants completed the study protocol (19 experimental group participants). Feasibility was confirmed by good adherence (90% of the participants) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome. Conclusions. MFES gait training is feasible early after stroke, but MFES efficacy for improving step length symmetry, other spatiotemporal gait parameters, or walking capacity could not be demonstrated. Trial Registration. Netherlands Trial Register (NTR4762).

Download Full-text

Using a cane for one month does not improve walking or social participation in chronic stroke: An attention-controlled randomized trial

Clinical Rehabilitation ◽

10.1177/02692155211020864 ◽

2021 ◽

pp. 026921552110208

Author(s):

Patrick Roberto Avelino ◽

Lucas Rodrigues Nascimento ◽

Louise Ada ◽

Kênia Kiefer Parreiras de Menezes ◽

Luci Fuscaldi Teixeira-Salmela

Keyword(s):

Randomized Trial ◽

Social Participation ◽

Walking Speed ◽

Single Point ◽

Step Length ◽

Chronic Stroke ◽

Control Group ◽

Walking Capacity ◽

Carry Over ◽

Experimental Group

Objective: To examine the effects of the provision of a cane, delivered to ambulatory people with chronic stroke, for improving walking and social participation. Design: Two-arm, randomized trial. Setting: Community-based. Participants: Ambulatory individuals with chronic stroke. Interventions: The experimental intervention was the provision of a single-point cane during one month. The control group received a placebo intervention. Outcome measures: Walking speed, step length, cadence, walking capacity, and walking confidence were measured without the cane to examine its rehabilitative effect. Walking speed was also measured with the cane for inclusiveness, and social participation was measured for examining carry over effects. Outcomes were measured at baseline, and after one and two months. Results: Fifty individuals were included. In the experimental group, mean age was 69 years (SD 14), and walking speed was 0.58 m/s (SD 0.17). In the control group, mean age was 68 years (SD 13), and walking speed was 0.63 m/s (SD 0.15). When walking without the cane, after one and after two months, there were no between-group differences in any measures. When walking with the cane, after one month, the experimental group walked 0.14 m/s (95% CI 0.05–0.23) faster than the control group and after two months, they were still walking 0.18 m/s (95% CI 0.06–0.30) faster. Conclusion: Use of a cane improved walking speed, only when participants walked with the cane. Use of cane for one month did not improve walking outcomes, when walking without the cane. People with stroke would need to continue to use the cane to maintain any benefits in walking speed.

Download Full-text

Rapid and Long-term Adaptations in Gait Symmetry Following Unilateral Step Training in People With Hemiparesis

Physical Therapy ◽

10.2522/ptj.20080237 ◽

2009 ◽

Vol 89 (5) ◽

pp. 474-483 ◽

Cited By ~ 39

Author(s):

Jennifer H Kahn ◽

T George Hornby

Keyword(s):

Step Length ◽

Control Group ◽

Overground Walking ◽

Gait Symmetry ◽

Gait Parameters ◽

Impaired Limb ◽

Repeated Training ◽

Minute Session

Background and Objective Evidence for specific physical interventions that improve walking symmetry in individuals with hemiparesis poststroke is limited. The aim of this study was to investigate the rapid and prolonged effects of unilateral step training (UST) on step length asymmetry (SLA) in people with hemiparesis. Subjects and Design Eighteen individuals with chronic hemiparesis and substantial SLA during overground walking participated in a single-group, pretest-posttest study. The study consisted of 2 phases, with 10 subjects participating in each phase; 2 subjects participated in both phases. Interventions and Measurements To investigate rapid effects of UST, the participants completed a 20-minute session of UST on a treadmill with their unimpaired limb, with the impaired limb held stationary off the treadmill. Data for spatiotemporal gait parameters during overground walking at self-selected and fastest speeds were collected prior to and following UST, with follow-up measurements at 1 day and 1 week. To investigate the prolonged effects, the participants completed ten 20-minute sessions of UST. Data for spatiotemporal gait parameters were collected prior to training as well as after every third session, with follow-up measurements at 1 and 2 weeks. Results Immediately following UST, SLA tested during fast-paced overground walking improved by up to 13% (49% reduced to a 36% SLA), with changes retained for up to 24 hours. Following 10 sessions of UST, SLA improved significantly, with changes retained for up to 2 weeks. Limitations Despite repeated baseline measurements, the absence of a control group was a limitation. Furthermore, stepping characteristics during UST were not quantified. Conclusion Unilateral step training may improve spatiotemporal patterns in people with substantial gait asymmetry poststroke. Repeated training may be necessary for maintenance of adaptations.

Download Full-text

Immediate effect of orthopedic shoe and functional foot orthosis on center of pressure displacement and gait parameters in juvenile flexible flat foot

Prosthetics and Orthotics International ◽

10.1177/0309364613496111 ◽

2013 ◽

Vol 38 (3) ◽

pp. 218-223 ◽

Cited By ~ 20

Author(s):

Atefeh Aboutorabi ◽

Hassan Saeedi ◽

Mohammad Kamali ◽

Behshid Farahmand ◽

Arezoo Eshraghi ◽

...

Keyword(s):

Walking Speed ◽

Center Of Pressure ◽

Step Length ◽

Control Group ◽

Healthy Children ◽

Flat Foot ◽

Gait Symmetry ◽

Gait Parameters ◽

Walking Velocity ◽

Foot Orthosis

Background:Flat foot in children is a common deformity in which the medial longitudinal arch is reduced or eliminated.Objectives:The objective of this article was to compare flat foot and healthy children on the displacement of the center of pressure and walking parameters in children with two common orthoses (functional foot orthosis and medical shoe).Study design:Comparative study.Methods:This study included 30 children with flat foot and 20 healthy children as a control group. The step length and width, walking velocity, symmetry, and center of pressure (CoP) displacements were recorded and compared for three conditions: functional foot orthosis and regular shoe, a medical shoe and barefoot.Results:The results from the CoP displacements showed that the regular shoe with functional foot orthosis caused a significant decrease in the level of displacement of the CoP in flat foot children. The findings indicated a significant improvement in symmetry of steps and walking speed with the functional foot orthosis in comparison to the medical shoe in flat foot children.Conclusion:The CoP displacement was decreased and the percentage of gait symmetry and walking speed were increased by the use of regular shoes with a functional foot orthosis in comparison to the medical shoes.Clinical relevanceAn orthopaedic shoe can be expensive, and in particular heavy with most children reluctant to wear it. This study focussed on the CoP displacement and selected gait parameters with an orthopaedic shoe and functional foot orthosis, and showed that a combined prescription of a functional foot orthosis and with regular shoes may be a useful alternative for children with moderate flat foot.

Download Full-text

A Robotic System with EMG-Triggered Functional Eletrical Stimulation for Restoring Arm Functions in Stroke Survivors

Neurorehabilitation and Neural Repair ◽

10.1177/1545968321997769 ◽

2021 ◽

pp. 154596832199776

Author(s):

Emilia Ambrosini ◽

Giulio Gasperini ◽

Johannes Zajc ◽

Nancy Immick ◽

Andreas Augsten ◽

...

Keyword(s):

Quality Of Life ◽

Electrical Stimulation ◽

Functional Electrical Stimulation ◽

Robotic Systems ◽

Control Group ◽

Significant Interaction Effect ◽

Quality Of Life Scale ◽

Task Oriented ◽

Experimental Group

Background Robotic systems combined with Functional Electrical Stimulation (FES) showed promising results on upper-limb motor recovery after stroke, but adequately-sized randomized controlled trials (RCTs) are still missing. Objective To evaluate whether arm training supported by RETRAINER, a passive exoskeleton integrated with electromyograph-triggered functional electrical stimulation, is superior to advanced conventional therapy (ACT) of equal intensity in the recovery of arm functions, dexterity, strength, activities of daily living, and quality of life after stroke. Methods A single-blind RCT recruiting 72 patients was conducted. Patients, randomly allocated to 2 groups, were trained for 9 weeks, 3 times per week: the experimental group performed task-oriented exercises assisted by RETRAINER for 30 minutes plus ACT (60 minutes), whereas the control group performed only ACT (90 minutes). Patients were assessed before, soon after, and 1 month after the end of the intervention. Outcome measures were as follows: Action Research Arm Test (ARAT), Motricity Index, Motor Activity Log, Box and Blocks Test (BBT), Stroke Specific Quality of Life Scale (SSQoL), and Muscle Research Council. Results All outcomes but SSQoL significantly improved over time in both groups ( P < .001); a significant interaction effect in favor of the experimental group was found for ARAT and BBT. ARAT showed a between-group change of 11.5 points ( P = .010) at the end of the intervention, which increased to 13.6 points 1 month after. Patients considered RETRAINER moderately usable (System Usability Score of 61.5 ± 22.8). Conclusions Hybrid robotic systems, allowing to perform personalized, intensive, and task-oriented training, with an enriched sensory feedback, was superior to ACT in improving arm functions and dexterity after stroke.

Download Full-text

Neuroprosthesis Peroneal Functional Electrical Stimulation in the Acute Inpatient Rehabilitation Setting: A Case Series

Physical Therapy ◽

10.2522/ptj.20080241 ◽

2009 ◽

Vol 89 (5) ◽

pp. 499-506 ◽

Cited By ~ 17

Author(s):

Kari Dunning ◽

Kristy Black ◽

Andrea Harrison ◽

Keith McBride ◽

Susan Israel

Keyword(s):

Electrical Stimulation ◽

Case Report ◽

Functional Electrical Stimulation ◽

Case Series ◽

Inpatient Rehabilitation ◽

Gait Training ◽

Stroke Recovery ◽

Gait Symmetry ◽

The Difference ◽

Test Distance

Background and Purpose Studies have suggested that peroneal nerve functional electrical stimulation (peroneal FES) during walking improves gait in patients with chronic stroke. The effect of peroneal FES during the acute stages of stroke recovery is not known. The purposes of this case report are: (1) to describe differences between walking with and without a neuroprosthesis during the first few weeks after stroke, (2) to offer a clinical perspective on decision making for the use of peroneal FES during acute rehabilitation, and (3) to determine the feasibility of rehabilitation with peroneal FES neuroprostheses during the acute phases of stroke recovery. Case Description This case report describes 2 patients with different clinical presentations but both receiving inpatient rehabilitation less than 2 weeks after stroke. Each patient received peroneal FES via a neuroprothesis as tolerated while gait training in therapy. Outcomes One patient immediately increased gait speed (128%) and decreased time to perform the Timed “Up & Go” Test (40%) using the neuroprothesis. Both patients immediately increased the 6-Minute Walk Test distance using the neuroprothesis (121% and 101%). The patient who underwent testing with the instrumented walking system also demonstrated improved gait symmetry. After 1 to 3 weeks of using the neuroprothesis, the difference between outcomes with and without the neuroprothesis decreased. Discussion It is possible that peroneal FES delivered through a neuroprosthesis during acute stroke recovery may improve gait outcomes. Research is needed to determine proper duration and timing.

Download Full-text

Efficacy of axial TheraTogs on gait pattern in children with dyskinetic cerebral palsy: a randomized controlled trial

Bulletin of Faculty of Physical Therapy ◽

10.1186/s43161-021-00030-2 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Shamekh Mohamed El-Shamy ◽

Ehab Mohamed Abd El Kafy

Keyword(s):

Cerebral Palsy ◽

Physical Therapy ◽

Muscle Tone ◽

Controlled Trial ◽

Gait Pattern ◽

Controlled Study ◽

Control Group ◽

Randomized Controlled ◽

Gait Parameters ◽

Experimental Group

Abstract Background TheraTogs promotes proprioceptive sense of a child with cerebral palsy and improves abnormal muscle tone, posture alignment, balance, and gait. Therefore, the aim of this study was to investigate the efficacy of TheraTogs orthotic undergarment on gait pattern in children with dyskinetic cerebral palsy. Thirty children with dyskinetic cerebral palsy were selected for this randomized controlled study. They were randomly assigned to (1) an experimental group that received TheraTogs orthotic undergarment (12 h/day, 3 days/week) plus traditional physical therapy for 3 successive months and (2) a control group that received only traditional physical therapy program for the same time period. Gait parameters were measured at baseline and after 3 months of intervention using Pro-Reflex motion analysis. Results Children in both groups showed significant improvements in the gait parameters (P < 0.05), with significantly greater improvements in the experimental group than in the control group. Conclusions The use of TheraTogs may have a positive effect to improve gait pattern in children with dyskinetic cerebral palsy. Trial registration This trial was registered in the ClinicalTrial.gov PRS (NCT03037697).

Download Full-text

Robot-Assisted Gait Training in Patients with Multiple Sclerosis: A Randomized Controlled Crossover Trial

Medicina ◽

10.3390/medicina57070713 ◽

2021 ◽

Vol 57 (7) ◽

pp. 713

Author(s):

Cristiano Sconza ◽

Francesco Negrini ◽

Berardo Di Matteo ◽

Alberto Borboni ◽

Gennaro Boccia ◽

...

Keyword(s):

Crossover Trial ◽

Gait Training ◽

Treatment Session ◽

Control Group ◽

Walk Test ◽

Robot Assisted ◽

Randomized Controlled ◽

Gait Parameters ◽

Before And After

Background and Objectives: Gait disorders represent one of the most disabling aspects in multiple sclerosis (MS) that strongly influence patient quality of life. The improvement of walking ability is a primary goal for rehabilitation treatment. The aim of this study is to evaluate the effectiveness of robot-assisted gait training (RAGT) in association with physiotherapy treatment in patients affected by MS in comparison with ground conventional gait training. Study design: Randomized controlled crossover trial. Materials and Methods: Twenty-seven participants affected by MS with EDSS scores between 3.5 and 7 were enrolled, of whom seventeen completed the study. They received five training sessions per week over five weeks of conventional gait training with (experimental group) or without (control group) the inclusion of RAGT. The patients were prospectively evaluated before and after the first treatment session and, after the crossover phase, before and after the second treatment session. The evaluation was based on the 25-foot walk test (25FW, main outcome), 6 min walk test (6MWT), Tinetti Test, Modified Ashworth Scale, and modified Motricity Index for lower limbs. We also measured disability parameters using Functional Independence Measure and Quality of Life Index, and instrumental kinematic and gait parameters: knee extensor strength, double-time support, step length ratio; 17 patients reached the final evaluation. Results: Both groups significantly improved on gait parameters, motor abilities, and autonomy recovery in daily living activities with generally better results of RAGT over control treatment. In particular, the RAGT group improved more than control group in the 25FW (p = 0.004) and the 6MWT (p = 0.022). Conclusions: RAGT is a valid treatment option that in association with physiotherapy could induce positive effects in MS-correlated gait disorders. Our results showed greater effectiveness in recovering gait speed and resistance than conventional gait training.

Download Full-text

Functional electrical stimulation‐assisted cycle ergometry-based progressive mobility programme for mechanically ventilated patients: randomised controlled trial with 6 months follow-up

Thorax ◽

10.1136/thoraxjnl-2020-215755 ◽

2021 ◽

pp. thoraxjnl-2020-215755

Author(s):

Petr Waldauf ◽

Natália Hrušková ◽

Barbora Blahutova ◽

Jan Gojda ◽

Tomáš Urban ◽

...

Keyword(s):

Electrical Stimulation ◽

Randomised Controlled Trial ◽

Functional Electrical Stimulation ◽

Controlled Trial ◽

Cycle Ergometry ◽

Control Group ◽

Mechanically Ventilated ◽

Icu Discharge ◽

Randomised Controlled

PurposeFunctional electrical stimulation-assisted cycle ergometry (FESCE) enables in-bed leg exercise independently of patients’ volition. We hypothesised that early use of FESCE-based progressive mobility programme improves physical function in survivors of critical care after 6 months.MethodsWe enrolled mechanically ventilated adults estimated to need >7 days of intensive care unit (ICU) stay into an assessor-blinded single centre randomised controlled trial to receive either FESCE-based protocolised or standard rehabilitation that continued up to day 28 or ICU discharge.ResultsWe randomised in 1:1 ratio 150 patients (age 61±15 years, Acute Physiology and Chronic Health Evaluation II 21±7) at a median of 21 (IQR 19–43) hours after admission to ICU. Mean rehabilitation duration of rehabilitation delivered to intervention versus control group was 82 (IQR 66–97) versus 53 (IQR 50–57) min per treatment day, p<0.001. At 6 months 42 (56%) and 46 (61%) patients in interventional and control groups, respectively, were alive and available to follow-up (81.5% of prespecified sample size). Their Physical Component Summary of SF-36 (primary outcome) was not different at 6 months (50 (IQR 21–69) vs 49 (IQR 26–77); p=0.26). At ICU discharge, there were no differences in the ICU length of stay, functional performance, rectus femoris cross-sectional diameter or muscle power despite the daily nitrogen balance was being 0.6 (95% CI 0.2 to 1.0; p=0.004) gN/m2 less negative in the intervention group.ConclusionEarly delivery of FESCE-based protocolised rehabilitation to ICU patients does not improve physical functioning at 6 months in survivors.Trial registration numberNCT02864745.

Download Full-text

EFFECT OF ACCUPRESSURE PEN ON DISTANCE VARIABLE IN SCIATICA PATIENTS -A RANDOMIZED CONTROL TRIAL

10.36106/ijsr/8718134 ◽

2021 ◽

pp. 28-31

Author(s):

Urja S. Vaidya ◽

Roshani S. Patel

Keyword(s):

Randomized Control Trial ◽

Stride Length ◽

Step Length ◽

Control Group ◽

Exclusion Criteria ◽

Parametric Test ◽

Group A ◽

Randomized Control ◽

Experimental Group ◽

Distance Variable

Background: Sciatica is a radiating pain which is treated with manual accupressure and after a time electro accupressure came into introduction. Aim And Objective: Aim: To nd out the effectiveness of accupressure pen to improve the distance variable To nd out the effect of Objective: accupressure pen on pain and distance variable in sciatica patient To compare the experimental group to the control group On the basis of Method: inclusion and exclusion criteria 30 participants were selected. They were treated with electro accupressure pen for 3 alternative days / week for 3 weeks, after that re-assessment was taken with NPRS, Slump and Distance variables. The data was analyzed using SPSS Version Results: 21.Parametric test was used .In Group A improvement was seen Accupressure Conclusions: pen is effective to reduce pain and improve step length and stride length in Sciatica Patients

Download Full-text