Contralaterally Controlled Neuromuscular Electrical Stimulation for Recovery of Ankle Dorsiflexion

Abstract

Objective Compare the effects of contralaterally controlled neuromuscular electrical stimulation (CCNMES) versus cyclic neuromuscular electrical stimulation (NMES) on lower extremity impairment, functional ambulation, and gait characteristics. Design Twenty-six stroke survivors with chronic (≥6mo) footdrop during ambulation were randomly assigned to six weeks 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, posttreatment, and at 1 and 3 months posttreatment. Results There were no significant differences between 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 chronic patients.

Neuromuscular Electrical Stimulation for Motor Restoration in Hemiplegia

“…21,49,50 Contralaterally controlled NMES, where the patient controlled the intensity of stimulation to the paretic ankle dorsiflexors by dorsiflexing their non-paretic ankle while seated, was first tested in a case series 51 and later in an RCT. 52 Contralaterally controlled NMES was shown to increase lower extremity Fugl-Meyer score, maximum dorsiflexion angle and moment while seated, and performance on the modified Emory Functional Ambulation Profile in chronic patients, but not more than cyclic NMES.…”

Effects of neuromuscular electrical stimulation on masticatory muscles in elderly stroke patients

“…The oxygen levels of tissues increase and the intrinsic characteristics of paralyzed muscles are altered as a result of NMES application 10 ) . Recently, NMES application for stroke patients was reported to effectively reduce lower-extremity impairment and improve the functional locomotion ability 11 ) ; moreover, it improved isometric finger-extension strength and increased cortical intensity in the somatosensory cortex 12 ) . Therefore, NMES is currently successfully applied in clinical practice for muscle re-education, prevention of muscle atrophy, and recovery of functions in stroke patients.…”

Smart Protocols for Physical Therapy of Foot Drop Based on Functional Electrical Stimulation: A Case Study

“…The authors presumed that the third patient’s lack of progress could be due to fewer of the prescribed exercises, cognitive deficits, or a depressive state. A larger study failed to demonstrate the advantages of CCFES compared to cyclic FES where patients had a task to synchronously dorsiflex the ankle with the FES [ 26 ]. Data from both groups showed significant improvements in the maximum DF angle (median change 6.5°).…”

“…Inspired by promising results of CCFES for the upper limbs, Knutson et al developed a new CCFES system for the lower limbs [ 26 ]. The DF of the paretic ankle was controlled by volitional dorsiflexion of the unaffected ankle.…”