None listed
Conditions
Brief summary
Walking dysfunction is a major problem leading to physical disability even after rehabilitation in stoke. Decreased gait speed and asymmetric gait pattern are common gait deficits resulted from spasticity, muscle weakness and poor motor control, especially in ankle joint. There are many strategies focused on the improvement of ankle control in the stroke rehabilitation. Neuromuscular electrical stimulation (NMES) is one possible treatment strategy, which is commonly used in clinic. Previous studies suggested that NMES not only improved muscle strength but also decreased static spasticity through reciprocal inhibition. However, controversial results are noted in these studies. Besides, the static measurement of ankle plantarflexors spasticity may not explain the spasticity in the dynamic status during gait. Furthermore, the effects of NMES on gait symmetry were not established. The purpose of this study was to investigate the effects of NMES applied to ankle dorsiflexors or plantarflexors on ankle control and gait performance in individuals with chronic stroke. Twenty-five stroke subjects with inadequate ankle control were recruited and randomized to the NMES-tibialis anterior (NMES-TA, N=8), NMES-medial gastrocnemius (NMES-MG, N=9) and control group (N=8). Participants in NMES groups received 20 minutes NMES on either tibialis anterior or gastrocnemius followed by 15 minutes of ambulation training 3 times per week for 7 weeks. Participants in control group received 20 minutes of range of motions (ROM) and stretching exercises followed by 15 minutes of ambulation training 3 times per week for 7 weeks. The outcomes included ankle control, muscles strength of dorsiflexors and plantarflexors, spasticity of plantarflexors, EMG activities during walking and gait performance. All assessments were administered at baseline (pre) and after training (post).
Interventions
Stroke individuals with inadequate ankle control were recruited and randomized to three groups: neuromuscular electrical stimulation on tibialis anterior muscle (NMES-TA), neuromuscular electrical stimulation on medial gastrocnemius muscle (NMES-MG), and control group.
Participants in both NMES groups received 20 minutes NMES on either tibialis anterior (NMES-TA) or gastrocnemius (NMES-MG) followed by 15 minutes of ambulation training 3 times per week for 7 weeks. The NMES was triggered by elec
Stroke individuals with inadequate ankle control were recruited and randomized to three groups: neuromuscular electrical stimulation on tibialis anterior muscle (NMES-TA), neuromuscular electrical stimulation on medial gastrocnemius muscle (NMES-MG), and control group. Participants in both NMES groups received 20 minutes NMES on either tibialis anterior (NMES-TA) or gastrocnemius (NMES-MG) followed by 15 minutes of ambulation training 3 times per week for 7 weeks. The NMES was triggered by electromyographic biofeedback devices. The participants were asked to actively dorsiflex (NMES-TA) or plantarflex (NMES-GA group) to reach the training goal to activate the electrical stimulation. After participants completed 5 cycles of active ankle dorsiflexion or plantarflexion successfully, the training goal was increased by 2 uV progressively and lasted for 20 minutes. Participants in control group received general exercises for 20 minutes, including stretching for 5 minutes and range of motion exercises for 15 minutes, followed by 15 minutes of ambulation training 3 times per week for 7 weeks. The ambulation training was focused on ankle movement and ankle control. While the participant was walking, a physiotherapist provided verbal cues and immediate corrections when necessary to improve participant’s gait performance. All trainings were instructed by a physiotherapist with individual one-on-one sessions at the training center in National Yang Ming University.
Sponsors
National Yang-Ming University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
20 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
The inclusion criteria were (1) first stroke at least 6 months ago, (2) with passive range of motion of ankle dorsiflexion at least to neural position (neutral position is defined as 0 degree), (3) with inadequate ankle control during gait (dorsiflexion less than -5 degree at heel strike and plantarflexion less than 10 degree at push off), (4) ability to walk at least 10 m with or without assistive devices, and (5) a detectable surface Electromyographic signal (>5 microvolt) from the TA and medial gastrocnemius (MG) of the affected leg
Exclusion criteria
The exclusion criteria were (1) sensory loss, (2) insufficient cognition (Mini-Mental State Examination < 24) and communication function, (3) contraindications to Neuromuscular electrical stimulation such as a pacemaker and tumor, (4) other orthopedic and neurologic disorders affecting walking functions.
Outcome results
None listed