Functional electrical stimulation and weight loss treadmill synchronous training after botulinum toxin injection can relieve foot-drop and strephenopodia among stroke survivors

Abstract

Objective To explore the effect of functional electrical stimulation combined with treadmill training and botulinum toxin type A injection on foot-drop and strephenopodia among stroke survivors. Methods Sixty-seven stroke survivors with foot-drop and strephenopodia were randomly divided into an electrical stimulation group (n=23), a conventional treatment group (n=22) and a combined treatment group (n=22). All 3 groups received a 400 U injection of BTX-A and electrical stimulation. After 24 hours, the patients in the conventional treatment group received conventional treatment including a brain protection agent, limb function exercises, gait training, balance training and training in the activities of daily living. The patients in the combined treatment group received that conventional treatment, plus functional electrical stimulation and weight loss training on a treadmill. The patients in the electrical stimulation group received functional electrical stimulation treatment supplementing the conventional treatment. Therapeutic effects were evaluated before and after six weeks of treatment using integral electromyography (iEMS) of the anterior tibial muscle and the lateral head of the gastrocnemius muscle, the co-contraction ratio (CR) during ankle dorsiflexion, the modified Ashworth Scale (MAS), the Berg balance scale (BBS), a functional walking score (FAC), and the active range of motion (AROM) of the ankle in dorsiflexion and eversion. Results After the treatment, significant improvement was observed in all three groups in the average iEMS value of the anterior tibial muscle and the lateral head of the gastrocnemius muscle, the CR in ankle dorsiflexion, and in their MAS, BBS, FAC and AROM results. There was no significant difference among the three groups after treatment in their average iEMS values at the lateral head of the gastrocnemius. The average values of the other indicators were, however, significantly better in the combined treatment group than in the other 2 groups. Conclusion Functional electrical stimulation combined with treadmill training and botulinum toxin type A injection can significantly improve foot-drop, strephenopodia and the walking function of stroke survivors. This combined treatment deserves popularization and application in clinical practice. Key words: Stroke; Botulinum toxin type A; Surface electromyography; Functional electrical stimulation; Exercise; Treadmill training