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de Sousa D.G.1,2,3, Harvey L.A.2,3, Dorsch S.4, Leung J.5, Harris W.6
1Graythwaite Rehabilitation Centre, Ryde Hospital, Northern Sydney Local Health District, Eastwood, NSW, Australia, 2John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia, 3Sydney Medical School Northern, University of Sydney, Sydney, Australia, 4Australian Catholic University, School of Physiotherapy, Sydney, Australia, 5Royal Rehab, Ryde, NSW, Australia, 6Prince of Wales Hospital, South Eastern Sydney Local Health District, Randwick, NSW, Australia
Background: Walking and moving around are some of the most important goals for people with acquired brain injury caused by stroke or trauma. However, these goals are often not achieved. To improve the ability to walk and move around, people with acquired brain injury require intensive repetitive practice in combination with interventions that address impairments such as weakness. Functional electrical stimulation (FES) cycling can help patients exercise without physical assistance from physiotherapists. This may be a cost-effective way for patients to exercise independently. If used in addition to routine face-to-face physiotherapy, FES cycling may increase strength in the lower limbs which may have carryover effects on patients' ability to walk and move around.
Purpose: The aim of this study was to determine whether four weeks of active FES cycling in addition to usual care results in greater improvements in mobility and strength than usual care alone in people with a sub-acute acquired brain injury caused by stroke or trauma.
Methods: A multi-centre randomised controlled trial was conducted. Forty patients from three Sydney hospitals with recently acquired brain injury and a mean (SD) composite strength score in the affected lower limb of 7/20 (5) points were recruited. Experimental participants received an incremental, progressive, FES cycling program five times a week over a four-week period. All participants received usual care. Outcome measures were taken at baseline and at four weeks. Primary outcomes were mobility measured with three mobility items of the Functional Independence Measure and strength of the knee extensors of the affected lower limb measured with a dynamometer. Secondary outcomes were strength of the knee extensors of the unaffected lower limb, strength of key muscles of the affected lower limb, and spasticity of the affected plantar flexors.
Results: All but one participant completed the study. The mean between-group differences (95% CI) for mobility and strength of the knee extensors of the affected lower limb were -0.3/21 points (-3.2 to 2.7) and 7.5Nm (-5.1 to 20.2) where positive values favour the experimental group. The only secondary outcome that suggested a possible treatment effect was strength of key muscles of the affected lower limb with a mean between-group difference (95% CI) of 3.0/20 points (1.3 to 4.8).
Conclusion(s): Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and these results cannot be explained by an insufficient sample size. The effects of FES cycling on strength are less clear. However, our results need replicating in other independent studies. In particular, future studies could clarify the effects of FES cycling on strength although the clinical significance may be limited without accompanying effects on mobility.
Implications: The results of this one trial are not sufficient to rule out the possibility of the therapeutic effects of FES cycling on strength or other variables in people with acquired brain injury. However, they are sufficient to rule out a therapeutic effect on mobility.
Funding acknowledgements: Research grant from the National Stroke Foundation - Australia
Topic: Neurology: stroke
Ethics approval: Approved by Northern Sydney and South Eastern Sydney LHD Human Research Ethics Committees, Royal Rehab and The University of Sydney.
All authors, affiliations and abstracts have been published as submitted.
