Predictive simulation of post-stroke gait with functional electrical stimulation

Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical stimulation (FES) improves drop foot gait although the mechanistic basis for this effect is not well understood. To answer this question, we evaluated the...

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Published inScientific reports Vol. 11; no. 1; pp. 21351 - 12
Main Authors Santos, Gilmar F., Jakubowitz, Eike, Pronost, Nicolas, Bonis, Thomas, Hurschler, Christof
Format Journal Article
LanguageEnglish
Published London Nature Publishing Group UK 01.11.2021
Nature Publishing Group
Nature Portfolio
Subjects
631/1647/767/2200
631/57/2266
639/166/985
639/766/747
692/617/375/534
Adult
Ankle
Bioengineering
Biomechanical Phenomena
Biomechanics
Cause-effect relationships
Electric Stimulation Therapy
Electrical stimuli
Engineering Sciences
Feet
Female
Gait
Gait Disorders, Neurologic - etiology
Gait Disorders, Neurologic - physiopathology
Gait Disorders, Neurologic - therapy
Human health and pathology
Humanities and Social Sciences
Humans
Knee
Life Sciences
Mechanics
multidisciplinary
Muscle strength
Patients
Rehabilitation
Science
Science (multidisciplinary)
Stroke
Stroke - complications
Stroke - physiopathology
Stroke Rehabilitation
Walking
Online AccessGet full text
ISSN2045-2322
2045-2322
DOI10.1038/s41598-021-00658-z

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Abstract Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical stimulation (FES) improves drop foot gait although the mechanistic basis for this effect is not well understood. To answer this question, we evaluated the gait of a post-stroke patient walking with and without FES by inverse dynamics analysis and compared the results to an optimal control framework. The effect of FES and cause-effect relationship of changes in knee and ankle muscle strength were investigated; personalized muscle–tendon parameters allowed the prediction of pathologic gait. We also predicted healthy gait patterns at different speeds to simulate the subject walking without impairment. The passive moment of the knee played an important role in the estimation of muscle force with knee hyperextension, which was decreased during FES and knee extensor strengthening. Weakening the knee extensors and strengthening the flexors improved SKG. During FES, weak ankle plantarflexors and strong ankle dorsiflexors resulted in increased ankle dorsiflexion, which reduced drop foot. FES also improved gait speed and reduced circumduction. These findings provide insight into compensatory strategies adopted by post-stroke patients that can guide the design of individualized rehabilitation and treatment programs.
AbstractList Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical stimulation (FES) improves drop foot gait although the mechanistic basis for this effect is not well understood. To answer this question, we evaluated the gait of a post-stroke patient walking with and without FES by inverse dynamics analysis and compared the results to an optimal control framework. The effect of FES and cause-effect relationship of changes in knee and ankle muscle strength were investigated; personalized muscle–tendon parameters allowed the prediction of pathologic gait. We also predicted healthy gait patterns at different speeds to simulate the subject walking without impairment. The passive moment of the knee played an important role in the estimation of muscle force with knee hyperextension, which was decreased during FES and knee extensor strengthening. Weakening the knee extensors and strengthening the flexors improved SKG. During FES, weak ankle plantarflexors and strong ankle dorsiflexors resulted in increased ankle dorsiflexion, which reduced drop foot. FES also improved gait speed and reduced circumduction. These findings provide insight into compensatory strategies adopted by post-stroke patients that can guide the design of individualized rehabilitation and treatment programs.
Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical stimulation (FES) improves drop foot gait although the mechanistic basis for this effect is not well understood. To answer this question, we evaluated the gait of a post-stroke patient walking with and without FES by inverse dynamics analysis and compared the results to an optimal control framework. The effect of FES and cause-effect relationship of changes in knee and ankle muscle strength were investigated; personalized muscle-tendon parameters allowed the prediction of pathologic gait. We also predicted healthy gait patterns at different speeds to simulate the subject walking without impairment. The passive moment of the knee played an important role in the estimation of muscle force with knee hyperextension, which was decreased during FES and knee extensor strengthening. Weakening the knee extensors and strengthening the flexors improved SKG. During FES, weak ankle plantarflexors and strong ankle dorsiflexors resulted in increased ankle dorsiflexion, which reduced drop foot. FES also improved gait speed and reduced circumduction. These findings provide insight into compensatory strategies adopted by post-stroke patients that can guide the design of individualized rehabilitation and treatment programs.Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical stimulation (FES) improves drop foot gait although the mechanistic basis for this effect is not well understood. To answer this question, we evaluated the gait of a post-stroke patient walking with and without FES by inverse dynamics analysis and compared the results to an optimal control framework. The effect of FES and cause-effect relationship of changes in knee and ankle muscle strength were investigated; personalized muscle-tendon parameters allowed the prediction of pathologic gait. We also predicted healthy gait patterns at different speeds to simulate the subject walking without impairment. The passive moment of the knee played an important role in the estimation of muscle force with knee hyperextension, which was decreased during FES and knee extensor strengthening. Weakening the knee extensors and strengthening the flexors improved SKG. During FES, weak ankle plantarflexors and strong ankle dorsiflexors resulted in increased ankle dorsiflexion, which reduced drop foot. FES also improved gait speed and reduced circumduction. These findings provide insight into compensatory strategies adopted by post-stroke patients that can guide the design of individualized rehabilitation and treatment programs.
Abstract Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical stimulation (FES) improves drop foot gait although the mechanistic basis for this effect is not well understood. To answer this question, we evaluated the gait of a post-stroke patient walking with and without FES by inverse dynamics analysis and compared the results to an optimal control framework. The effect of FES and cause-effect relationship of changes in knee and ankle muscle strength were investigated; personalized muscle–tendon parameters allowed the prediction of pathologic gait. We also predicted healthy gait patterns at different speeds to simulate the subject walking without impairment. The passive moment of the knee played an important role in the estimation of muscle force with knee hyperextension, which was decreased during FES and knee extensor strengthening. Weakening the knee extensors and strengthening the flexors improved SKG. During FES, weak ankle plantarflexors and strong ankle dorsiflexors resulted in increased ankle dorsiflexion, which reduced drop foot. FES also improved gait speed and reduced circumduction. These findings provide insight into compensatory strategies adopted by post-stroke patients that can guide the design of individualized rehabilitation and treatment programs.
ArticleNumber 21351
Author Hurschler, Christof
Pronost, Nicolas
Santos, Gilmar F.
Bonis, Thomas
Jakubowitz, Eike
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Snippet Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical stimulation...
Abstract Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical...
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Biomechanical Phenomena
Biomechanics
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Electric Stimulation Therapy
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Feet
Female
Gait
Gait Disorders, Neurologic - etiology
Gait Disorders, Neurologic - physiopathology
Gait Disorders, Neurologic - therapy
Human health and pathology
Humanities and Social Sciences
Humans
Knee
Life Sciences
Mechanics
multidisciplinary
Muscle strength
Patients
Rehabilitation
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Science (multidisciplinary)
Stroke
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Title Predictive simulation of post-stroke gait with functional electrical stimulation
URI https://link.springer.com/article/10.1038/s41598-021-00658-z
https://www.ncbi.nlm.nih.gov/pubmed/34725376
https://www.proquest.com/docview/2590782755
https://www.proquest.com/docview/2592308588
https://hal.science/hal-03542660
https://pubmed.ncbi.nlm.nih.gov/PMC8560756
https://doaj.org/article/00ac3cc2e7fd44bf997aece27423c8a3
Volume 11
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