Effects of Passive Bi-axial Ankle Movement Training with Electrical Stimulation on Ankle Sensorimotor Functions in Stroke Patients: A Randomized Controlled Pilot Study

Abstract

Background: This study was conducted to investigate the effect of passive biaxial ankle movement training synchronized with electrical stimulation therapy (AMT-EST) on ankle proprioception, ankle strength, balance, and gait in chronic stroke patients. We observed the changes in ankle sensorimotor function after stroke.Methods: Thirty-five stroke patients were randomized to an experimental or control group, and 30 patients completed the trials. The experimental group received AMT-EST on the affected ankle for 30 minutes a day, 5 times a week for 4 weeks, for a total of 20 sessions. The control group received electrical stimulation therapy on the affected ankle. The primary outcome measures were ankle proprioception, passive range of motion, and strength. The secondary outcome measures were balance and gait-related functional abilities.Results: Compared with those in the control group, the participants in the experimental group who received AMT-EST showed significant post-training improvement in ankle proprioception of eversion (P<0.05). The ankle passive range of motion (inversion and eversion), ankle strength (dorsiflexion, plantarflexion, inversion, and eversion), and functional abilities (Fugl–Meyer Assessment, Berg Balance Scale, Timed Up and Go test, Fall Efficacy Scale, and walking speed) significantly improved in the experimental group (P<0.05). Significant group×time interactions were observed in ankle passive range of motion (inversion and eversion), ankle strength (dorsiflexion), and Fugl–Meyer Assessment (P<0.05). All ankle proprioception moderately correlated with ankle passive range of motion (eversion), ankle strength (dorsiflexion and eversion), the Berg Balance Scale, and Fugl–Meyer Assessment (P<0.05).Conclusions: Biaxial AMT-EST effectively increased ankle proprioception, range of motion, strength, and functional abilities in chronic stroke patients. These findings suggest that AMT-EST can be proposed as a novel ankle rehabilitation program for chronic stroke patients with ankle sensorimotor impairment.Trial registration: This study was approved by the Institutional Review Board at a rehabilitation hospital (NRC-2017-04-035, National Rehabilitation Center, Seoul, South Korea) and retrospectively registered at a clinical trial registry on January 31, 2020 (CRIS, KCT0004688, https://cris.nih.go.kr/).