Template stimulation patterns were used for a multichannel functional neuromuscular stimulation (FNS) system to synthesize movements for walking in paraplegia. Rules were developed and tested for tailoring template walking stimulation patterns to individuals. The criteria for effective rule application were based on the degree to which the paraplegic gait approached normal appearance, independence of forward progression, the least amount of upper body support, and the minimum amount of energy used as perceived by the user. The ability of preset microprocessor-controlled stimuli to generate walking in paraplegia were limited by muscle strength, fatigue, and timing of stimulation. Joint moment testing showed that paraplegic subjects had 2040% of normal strength. In individuals at the lower end of the range, the strength was insufficient to allow independent forward progression. The muscle fatigue effected the strength and timing of joint movements during walking. Timing of hip extensor activation at heel strike was found to be critical for progression. Excessive forces were taken up through arm support, especially with hip and trunk extensor fatigue, and forward lean was essential for progression. Hip and trunk stability was achieved through stiffening by co-contraction and upper body support. This resulted in metabolic energy expenditure as high as four times normal.
Background and Purpose-Conventional therapies fail to restore normal gait to many patients after stroke. The study purpose was to test response to coordination exercise, overground gait training, and weight-supported treadmill training, both with and without functional neuromuscular stimulation (FNS) using intramuscular (IM) electrodes (FNS-IM). Methods-In a randomized controlled trial, 32 subjects (Ͼ1 year after stroke) were assigned to 1 of 2 groups: FNS-IM or No-FNS. Inclusion criteria included ability to walk independently but inability to execute a normal swing or stance phase. All subjects were treated 4 times per week for 12 weeks. The primary outcome measure, obtained by a blinded evaluator, was gait component execution, according to the Tinetti gait scale. Secondary measures were coordination, balance, and 6-minute walking distance. Results-Before treatment, there were no significant differences between the 2 groups for age, time since stroke, stroke severity, and each study measure. FNS-IM produced a statistically significant greater gain versus No-FNS for gait component execution (Pϭ0.003; parameter estimate 2.9; 95% CI, 1.2 to 4.6) and knee flexion coordination (Pϭ0.049).
Conclusion-FNS-IM
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