Abstract
Functional electrical stimulation (FES) facilitates ambulatory function after paralysis by activating the muscles of the lower extremities. The FES-assisted stepping can either be triggered by a heel-swich, or by an electromyogram-(EMG-) based gait event detector. A group of six chronic (>6 months poststroke) hemiplegic stroke survivors underwent transcutaneous FES-assisted training for 1 hour on stepping task with EMG biofeedback from paretic tibialis anterior (TA) and medial gastrocnemius (GM) muscles, where the stimulation of the paretic TA or GM was triggered with surface EMG from the same muscle. During the baseline, postintervention, and 2-day-postintervention assessments, a total of 5 minutes of surface EMG was recorded from paretic GM and TA muscles during volitional treadmill walking. Two-way ANOVA showed significant effects in terms of P values for the 6 stroke subjects, 0.002, the 3 assessments, 0, and the interaction between subjects and assessments, 6.21E-19. The study showed a significant improvement from baseline in paretic GM and TA muscles coordination during volitional treadmill walking. Moreover, it was found that the EMG-triggered FES-assisted therapy for stand-to-walk transition helped in convergence of the deviation in centroidal angular momentum from the normative value to a quasi-steady state during the double-support phase of the nonparetic. Also, the observational gait analysis showed improvement in ankle plantarflexion during late stance, knee flexion, and ground clearance of the foot during swing phase of the gait.
Highlights
Stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow thereby preventing delivery of oxygen and nutrients
Miller and Verstraete showed that steady state in terms of total mechanical energy of the body was reached by the end of three full steps [36]
Dutta et al investigated the periodicity of kinematic joint trajectories and showed that the quasiperiodic behavior found during able-bodied steady state walking was not attained during first five steps of functional electrical stimulation- (FES)-assisted walking following partial paralysis [12]
Summary
Stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow thereby preventing delivery of oxygen and nutrients. Global Burden of Disease Study estimated a populationbased annual stroke incidence in India to be 89/100,000 in 2005, which is projected to increase to 91/100,000 in 2015 and to 98/100,000 in 2030 [1]. Foot drop is a common symptom in stroke survivors that inhibits the sufferer from being able to raise their foot during the swing phase of gait. The ability to walk is important for independent performance of activities of daily living and determines the quality of life [2]. Reduced walking for activities of daily living further affects their cardiovascular health which can make them susceptible to another stroke. FES has been shown in studies to enhance walking abilities in stroke survivors, increase gait speed while lowering effort, increase confidence during walking due to reduced fear of tripping, reduce spasticity in the paretic leg while increasing the range
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