M. van Bloemendaal1,2, S.A. Bus2, F. Nollet2, A.C.H. Geurts3, A. Beelen1,2,4
1Merem Medical Rehabilitation, Hilversum, Netherlands, 2Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands, 3Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, Netherlands, 4Centre of Excellence for Rehabilitation Medicine, Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands
Background: Many people after stroke present with asymmetrical gait patterns due to leg muscle paresis. Asymmetry forms a risk of overloading the trunk and non-paretic side and is associated with limited gait adaptability, increased fall risk and energy cost, and reduced physical activity. Interventions targeting asymmetry early after stroke may enhance recovery of walking. Multi-channel functional electrical stimulation (MFES) may be a valuable new technique to improve gait symmetry by supporting the activation of specific paretic leg muscles.
Purpose: The purpose of this pilot randomised controlled trial was to determine the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by MFES (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of spatiotemporal gait symmetry and walking capacity in patients starting in the sub-acute phase after stroke.
Methods: We randomised 40 participants (≤31 days after stroke) from a Dutch rehabilitation centre to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday during the inpatient rehabilitation period. Adherence (≥75% sessions) and satisfaction with gait training (score ≥7 out of 10) were used to determine feasibility. Step length symmetry was used as the primary outcome for efficacy. Secondary outcomes included other spatiotemporal gait parameters (step time symmetry, single-leg stance time symmetry, stride length, and stride time for the barefoot and shod conditions) and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect post-intervention and at 3-month follow-up.
Results: Thirty-seven participants completed the study protocol whereof 19 participants in the experimental group. Feasibility was confirmed by good adherence (90% of the participants attended ≥75% sessions) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome.
Conclusion(s): MFES gait training is feasible in early stroke rehabilitation, but this pilot demonstrated no beneficial effects over conventional gait training as regards to improving step length symmetry, other spatiotemporal gait parameters, or walking capacity.
Implications: As MFES gait training is feasible in clinical practice and appears as effective as other interventions, it can be part of the gait training interventions arsenal. However, it must be realised that MFES application is time consuming and expensive. Additional benefits such as increasing exercise intensity when an individual is able to train (semi)independently should be explored.
Funding, acknowledgements: This work was financially supported by the foundation ‘Stichting Vrienden van Merem’, Amsterdam, The Netherlands.
Keywords: stroke, electric stimulation, gait
Topic: Neurology: stroke
Did this work require ethics approval? Yes
Institution: Amsterdam University Medical Centres
Committee: Medical Ethics Committee of the Academic Medical Center
Ethics number: NL50002.018.14
All authors, affiliations and abstracts have been published as submitted.
