Gait rehabilitation in patients with severe hemiplegia requires substantial effort. Preliminary studies indicate potential beneficial effects of using multichannel functional electrical stimulation ...(MFES) for gait rehabilitation in these patients. In this study, a new method of gait rehabilitation for nonambulatory patients with hemiplegia by means of MFES added to conventional therapy was introduced. The results of the method's application were evaluated by comparing it with conventional therapeutic methods.
The proposed rehabilitation method was tested on a group of 20 patients with severe hemiplegia secondary to cerebrovascular accident. Subjects were randomly assigned to one of two groups. One group received 3 weeks of MFES followed by 3 weeks of conventional therapy. The other group received 3 weeks of conventional therapy followed by 3 weeks of MFES.
The effects of each therapeutic method were evaluated by measurements of temporal-distance variables and ground reaction forces and by assessment of each subject's physical status according to the Fugl-Meyer evaluation scale.
There was improved performance of the subjects during MFES combined with conventional therapy as compared with conventional therapy alone.
The superiority of the MFES method as compared with conventional therapy was mainly attributed to the enhanced motor learning accomplished by application of MFES. These results, however, are preliminary, and further research is needed.
Multichannel electrical stimulation was applied in 20 patients with hemiplegia secondary to stroke or head injury using a six-channel microprocessor stimulator-stride analyzer to restore independent ...gait and to reestablish a normal gait pattern in a two- to three-week therapy period. The therapy was followed up at every session by a stride analyzer incorporated into the stimulator. At the beginning and at the end of the therapy period, each subject's gait was measured with a ground reaction measuring system. Statistical results and observations are presented for the group of 20 subjects, and a detailed description of the results is given for one subject who is representative of the whole group. According to the measured gait characteristics, gait improved significantly in all subjects during the therapy period, resulting in a partly or completely independent gait. The subjects' posture and endurance also improved, and they spontaneously learned how to use a crutch. The measurements and visual assessment of the subjects' progress indicate that the described treatment protocol offers good prospects for faster and more efficient gait rehabilitation in severely impaired patients. To determine the efficacy of gait therapy with multichannel electrical stimulation, a comparative study of conventional therapeutic methods and the method described in this article should be conducted.
The effects of multichannel electrical stimulation of standing, weight-shift and gait were studied in hemiparetic patients. The ground reaction forces under both feet were assessed by two force ...plates during standing and weight-shift of 11 patients with and without three-channel stimulation of the pelvic and knee muscles. Stance symmetry and rate of the weight-shift significantly improved (p = 0.05) for 11.4% and 50.8% respectively during the stimulation. The gait of three hemiparetic patients was treated by adaptable, individually fitted four-channel stimulation. Besides peroneal nerve, knee extensor and flexor, hip extensor and abductor muscles, a shoulder-arm stimulation was introduced to elevate a depressed shoulder, initiate arm swing and erect the trunk. Gait parameters including symmetry improved consistently after the 25 stimulation sessions: velocity 33%, cadence 5%, stride length 26%, stance symmetry ratio from 0.62 to 0.97. Moreover the gait pattern was restored in all patients. The study investigated a possibility of neurophysiologically based treatment by the stimulation of standing, weight-shift and gait.
The effect of a treadmill training with partial body-weight support was investigated in nine nonambulatory hemiparetic patients with a mean poststroke interval of 129 days. They had received regular ...physiotherapy within a comprehensive stroke rehabilitation program at least 3 weeks before the treadmill training without marked improvement of their gait ability. After 25 additional treadmill training sessions scoring of functional performance and conventional gait analysis showed a definite improvement: gait ability, assessed by the Functional Ambulation Category (0 to 5) improved with a mean of 2.2 points, other motor functions, assessed by the Rivermead Motor Assessment Score with a mean of +3.9 points for gross function (range 0 to 13) and of +3.2 points for leg and trunk section (range 0 to 10) and gait cycle parameters (p < .01). Muscle tone and strength of the paretic lower limb remained stable. We suggest that treadmill training with partial body-weight support could augment restoration of ambulation and other motor functions in hemiparetic patients by active and repetitive training.
A dual-channel electrical stimulation system with a stimulator and a programmer/stride analyzer was designed for clinical rehabilitation of gait and for subsequent daily use as an orthotic aid. The ...stimulator, with controls to adjust amplitude only (50 mA), adapts chosen stimulation sequences to the walking rate of a patient. Pulse duration (50-500 microseconds), frequency (5-120 Hz), shape (symmetrical biphasic, monophasic), stimulation sequences (16 stride segments) and their cycle (2-12 sec), and right/left foot-switch choices are selected for each patient and programmed into a separate unit. The programming unit also statistically processes the foot-switch data collected by the stimulator. The device was evaluated with regard to the programmable parameters, effectiveness during gait, and feasibility in clinical use. It was applied to 11 stroke patients and 10 brain injury patients during gait, stimulating 22 combinations of peroneal nerve and hamstring, quadriceps, triceps brachii, and gluteus maximus muscles. Forces on both feet, equinovarus, knee extension and hyperextension, elbow flexion, and hip extension were corrected. Selection of the stimulation sequences, their adaptation, range of pulse duration, and valid statistics were verified. Improved forces and joint angles were recorded together with significant changes in the stride time, length, and velocity by the stimulation.
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DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A dual-channel orthotic electrical stimulator was designed for daily use at home by plegic and paretic patients who had completed a hospital rehabilitation program. With two independent channels, two ...muscle groups can be stimulated in chosen sequences. A microcomputer accommodates the stimulation sequences to the gait cadence of the patient for the stance and swing phase separately.
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