Functional Electrical Stimulation of Ankle Plantarflexor and Dorsiflexor Muscles Effects on Poststroke Gait

• Published in: Stroke (1970) Vol. 40; no. 12; pp. 3821 - 3827
• Main Authors: Kesar, Trisha M., Perumal, Ramu, Reisman, Darcy S., Jancosko, Angela, Rudolph, Katherine S., Higginson, Jill S., Binder-Macleod, Stuart A.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.12.2009
• Subjects: Aged; Ankle Joint - physiology; Biological and medical sciences; Electric Stimulation Therapy - methods; Female; Gait - physiology; Gait Disorders, Neurologic - therapy; Humans; Knee - physiology; Male; Medical sciences; Middle Aged; Muscle, Skeletal - physiology; Neurology; Neuropharmacology; Paresis - physiopathology; Paresis - therapy; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Range of Motion, Articular - physiology; Recovery of Function - physiology; Stroke - therapy; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Walking - physiology; Vascular disease; functional electrical stimulation; Stroke; Nervous system diseases; variable-frequency trains; ankle plantarflexors; Central nervous system disease; Cardiovascular disease; Cerebrovascular disease; Cerebral disorder
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.109.560375

Background and Purpose— Functional electrical stimulation (FES) is a popular poststroke gait rehabilitation intervention. Although stroke causes multijoint gait deficits, FES is commonly used only for the correction of swing-phase foot drop. Ankle plantarflexor muscles play an important role during gait. The aim of the current study was to test the immediate effects of delivering FES to both ankle plantarflexors and dorsiflexors on poststroke gait. Methods— Gait analysis was performed as subjects (N=13) with chronic poststroke hemiparesis walked at their self-selected walking speeds during walking with and without FES. Results— Compared with delivering FES to only the ankle dorsiflexor muscles during the swing phase, delivering FES to both the paretic ankle plantarflexors during terminal stance and dorsiflexors during the swing phase provided the advantage of greater swing-phase knee flexion, greater ankle plantarflexion angle at toe-off, and greater forward propulsion. Although FES of both the dorsiflexor and plantarflexor muscles improved swing-phase ankle dorsiflexion compared with noFES, the improvement was less than that observed by stimulating the dorsiflexors alone, suggesting the need to further optimize stimulation parameters and timing for the dorsiflexor muscles during gait. Conclusions— In contrast to the typical FES approach of stimulating ankle dorsiflexor muscles only during the swing phase, delivering FES to both the plantarflexor and dorsiflexor muscles can help to correct poststroke gait deficits at multiple joints (ankle and knee) during both the swing and stance phases of gait. Our study shows the feasibility and advantages of stimulating the ankle plantarflexors during FES for poststroke gait.