Response of sagittal plane gait kinematics to weight-supported treadmill training and functional neuromuscular stimulation following stroke

Abstract

After stroke, persistent gait deficits cause debilitating falls and poor functional mobility. Gait restoration can preclude these outcomes. Sixteen subjects (>12 months poststroke) were randomized to two gait training groups. Group 1 received 12 weeks of treatment, 4 times a week, 90 min per session, including 30 min strengthening and coordination, 30 min overground gait training, and 30 min weight-supported treadmill training. Group 2 received the same treatment, but also used functional neuromuscular stimulation (FNS) with intramuscular (IM) electrodes (FNS-IM) for each aspect of treatment. Outcome measures were kinematics of gait swing phase. Both groups showed no significant pre-/posttreatment gains in peak swing hip flexion. Group 1 (no FNS) had no significant gains in other gait components at posttreatment or at follow-up. Group 2 (FNS-IM) had significant gains in peak swing knee flexion and mid-swing ankle dorsiflexion (p < 0.05) that were maintained for 6 months.

Evaluation of lower limb cross planar kinetic connectivity signatures post-stroke

“…For example putative mechanisms to compensate for paretic ankle plantarflexion weakness (Dietz et al 1981; Higginson et al 2006), impaired knee flexion weakness and velocity (Goldberg & Anderson 2004), and over activity of hip flexors (Sung et al 2000, Piazza & Delp 1996) have been extensively investigated. Similar studies have focused their investigation to exclusively sagittal plane mechanics for specific gait rehabilitation outcome measures (Jonkers 2009; Daly 2004). However the unique 3D observations of post-stroke gait abnormalities include impaired dynamic coupling between multiple lower limb joints across sagittal and frontal planes such as circumduction (Kerrigan et al 2001).…”

Locomotor training: Experiencing the changing body

“…The principles of training applied in the BWS and treadmill environment also extend to training over ground. Alternative methods for promoting relearning of walking include robotic-assisted LT, which uses a gait-driven orthosis to facilitate stepping [21][22], and functional electrical stimulation (FES)-or functional neuromuscular stimulation (FNS)-assisted LT, which use FES/FNS technology as facilitators [23][24][25][26][27][28]. Unless otherwise specified, we use the term "LT" to denote manually assisted LT and the transfer of skills to walking over ground.…”

Effects of the addition of functional electrical stimulation to ground level gait training with body weight support after chronic stroke

“…BWS also provides better balance control, and reduces the risk of falls 8 . Recently, the BWS on a treadmill has also been used combined with functional electrical stimulation (FES), showing gait improvements [9][10][11][12][13] . The first FES system was implemented by Liberson et al 14 to promote the drop foot correction.…”