功能性电刺激结合快速步行训练对脑卒中偏瘫患者功能的影响

目的:观察功能性电刺激结合快速步行训练对脑卒中偏瘫后遗症期患者社区性步行能力及生理耗能的影响。方法:将30例脑卒中偏瘫足下垂患者随机分为观察组和对照组各15例,均接受神经内科常规药物及康复功能训练;观察组采用功能性电刺激(FES)结合快速步行训练,FES刺激患侧腓总神经和胫前肌;对照组采用常规的减重跑台快速步行训练。分别在治疗前、治疗后评定6分钟步行距离(6MWD)及生理耗能指数(PCI)。结果:治疗4周后,2组PCI较治疗前有显著降低(P0.05),6MWD均较治疗前显著增加(P0.05);静息心率治疗前后比较差值无统计学意义。2组治疗后,观察组的PCI明显低于对照组(P0.05),而6MWD、静息心率组间差异无统计学意义。结论:功能性电刺激结合快速步行训练和传统的减重跑台快速步行训练都能够显著改善脑卒中偏瘫后遗症期患者的社区性步行能力及生理耗能;功能性电刺激结合快速步行训练降低生理耗能更明显。     

Experiences of functional electrical stimulation (FES) and ankle foot orthoses (AFOs) for foot-drop in people with multiple sclerosis

Purpose: A constructivist phenomenological study explored impacts of ankle foot orthoses (AFOs) or functional electrical stimulation (FES) on people with foot-drop from multiple sclerosis (MS). Method: Focus groups following topic guides were analysed using interpretative phenomenological analysis, with researcher reflexivity, participant verification and peer checking of analysis. Participants with sustained use of the devices (under 2 y) were invited from two quantitative studies that (a) investigated immediate FES effects (n?=?12) and (b) compared habitual use of AFO (n?=?7) or FES (n?=?6). Two focus groups addressed AFO (n?=?4) and FES (n?=?6) experiences. Results: Similar numbers of positive and negative aspects were described for AFO and FES. Both reduced fatigue, improved gait, reduced trips and falls, increased participation, and increased confidence; greater balance/stability was reported for AFOs, and increased walking distance, fitness and physical activity for FES. Barriers to both included avoiding reliance on devices and implications for shoes and clothing; a non-normal gait pattern was reported for AFO, and difficulties of application and limitations in the design of FES. However, participants felt the positives outweighed the negatives. Conclusions: Participants felt benefits outweighed the drawbacks for AFO and FES; greater understanding of user preferences and satisfaction may increase likelihood of usage and efficacy.

• Implications for Rehabilitation

• Interventions to reduce the impacts of foot-drop in people with multiple sclerosis (MS) are important to optimise physical activity participation and participation in life; they include ankle foot orthoses (AFOs) and functional electrical stimulation (FES).

• Research is lacking regarding user satisfaction and perceived outcomes, therefore, two separate focus groups were conducted from a constructivist phenomenological perspective to explore the impacts of AFOs (n?=?4) and FES (n?=?6) on people with foot-drop from MS.

• Some similar positive aspects of AFO and FES use were described, including reduced fatigue, improved gait and fewer trips and falls, while common barriers included finding the device cumbersome, uncomfortable, and inconvenient, with some psychological barriers to their use.

• On balance, the impacts of the devices on improving activities and participation were more important for participants than practical barriers, highlighting the importance of combining understanding of individual experiences and preferences with clinical decision-making when prescribing a device to manage foot-drop.

     

步态触发功能性电刺激对偏瘫足下垂患者步行能力的影响

目的:比较步态诱发式功能性电刺激(FES)与神经肌肉电刺激(NMES)对脑卒中后足下垂患者下肢运动功能以及步行速度的影响。方法:将30例脑卒中偏瘫足下垂患者随机分为两组,试验组和对照组,均接受神经内科常规药物及康复功能训练,试验组采用步态诱发式FES,刺激患侧腓总神经和胫前肌,2次/天,每次20min,每周7天,共4周。对照组采用NMES。分别在治疗前、治疗后评定偏瘫侧主动踝背伸的角度、FMA下肢运动功能以及步行速度。结果:治疗4周后,两组患者偏瘫侧主动踝背伸的角度、FMA值以及10m最大步行速度较治疗前都有显著改善(P0.05)。主动踝背伸角度试验组增加了58.3%,对照组增加了29.6%;FMA值试验组增加了38%,对照组增加了19%;10米最大步行速度试验组增加了34%,对照组增加了11%;治疗后与治疗前的差值,两组比较有显著性差异(P0.05)。结论:常规康复训练结合NMES能够改善偏瘫侧下肢运动功能及步行速度,常规康复训练结合FES后效果更明显,因此步态诱发式FES可以作为一种常规的训练方法在临床上广泛使用。     

Early and intensive rehabilitation predicts good functional outcomes in patients admitted to the stroke intensive care unit

Purpose.?Earlier and more intense rehabilitation benefit stroke patients. Yet, studies have caution intensive therapy during acute brain injury. This study examined the rehabilitation commencement time and intensity as predictors of functional outcomes in acute stroke patients admitted to the stroke intensive care unit (ICU).

Method.?Sociodemographic, medical, rehabilitative and functional data were collected on 154 acute stroke patients. Regression analyses were used to identify predictors for the basic activities of daily living (Barthel Index, BI) and the walking ability at discharge.

Result.?Rehabilitation commencement time and intensity significantly predicted the BI score at discharge after adjusting for initial severity (National Institute of Health Stroke Scale, NIHSS) and age (p?<?0.05). For the walking function at discharge, only the rehabilitation intensity was a significant predictor after adjusting for initial severity and age (p?<?0.05). Furthermore, with increasing rehabilitation intensity, patients with severe stroke benefited more than those with moderate stroke.

Conclusion.?Rehabilitation commencement time and intensity, after adjusting for admission functional status and severity of stroke, remained to be important predictors of stroke functional outcomes. This study supported the recommendation to commence rehabilitation early and intensively and provided evidence that this claim can be extended to acute stroke patients admitted to an ICU.     

功能电刺激治疗脑卒中足下垂合并内翻的疗效观察

目的:观察动作反馈的功能性电刺激(FES)对脑卒中足下垂合并足内翻患者下肢运动功能和步行能力的影响。方法:脑卒中足下垂合并足内翻患者34例,随机分为观察组和对照组各17例,2组均进行基础康复治疗,观察组另行功能电刺激下20min步行训练,对照组行相同时间的常规步行训练。在康复治疗前和治疗4周后采用Fug1-Meyer量表下肢部分(FMA-LE)、起立-行走计时测试(TUGT)、徒手肌力测试(MMT)和改良Ashworth量表(MAS)对两组患者进行功能评估;观察组另记录步态不对称指数(GAI)和非偏瘫侧摆动时间变异(STV)。结果:治疗4周后,观察组患者FMA-LE、TUGT、MMT、MAS、GAI和STV评分均较治疗前显著提高(P0.05),对照组TUGT及MMT评分较治疗前明显提高(P0.05),其余各评分治疗前后比较均差异无统计学意义;治疗后组间比较,观察组FMA-LE、TUGT和MAS评分均显著高于对照组(P0.05),但MMT评分组间比较差异无统计学意义。结论:动作反馈功能性电刺激能显著改善脑卒中足下垂合并足内翻患者的运动功能和步行能力,并能提高踝背屈肌力、缓解踝关节相关肌群痉挛。     

Recovery of walking ability using a robotic device in subacute stroke patients: a randomized controlled study

Purpose: This study investigates the effectiveness of Lokomat + conventional therapy in recovering walking ability in non-ambulatory subacute stroke subjects involved in inpatient rehabilitation. Method: Thirty first-ever stroke patients completed 8 weeks of intervention. One group (n?=?16) received Lokomat therapy twice a week, combined with three times 30?min a week of conventional overground therapy. The second group (n?=?14) received conventional assisted overground therapy only, during a similar amount of time (3.5?h a week). The intervention was part of the normal rehabilitation program. Primary outcome measure was walking speed. Secondary outcome measures assessed other walking- and mobility-related tests, lower-limb strength and quality of life measures. All outcome measures were assessed before and after the intervention and at wk 24 and wk 36 after start of the intervention. Results: Patients showed significant (p?Conclusion: These results indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as conventional therapy alone.

• Implications for Rehabilitation

• Recovery of walking after stroke is important.

• Robot-assisted therapy is currently receiving much attention in research and rehabilitation practice as devices such as the Lokomat seem to be promising assistive devices.

• Technical developments, sub-optimal study designs in literature and new therapy insights warrant new effectiveness studies.

• Results of a financially and practically feasible study indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as compared to conventional overground therapy alone.

     

Effects of low frequency functional electrical stimulation with 15 and 50 Hz on muscle strength in heart failure patients

Purpose.?To compare the acute effects of functional electrical stimulation (FES) with 15 and 50 Hertz (Hz) frequencies on muscle strength in patients with heart failure with healthy individuals.

Methods.?Twenty-two 61.6?±?1.0 y-old male volunteers were studied: 10 patients with heart failure (functional class II-III) and 12 healthy controls. The isometric muscle peak torque (IMPT) of the quadriceps femoral muscle was measured through a Biodex dynamometer in maximum voluntary contraction (MVC), and under FES of 50?Hz and 15?Hz, which was applied with a 0.4?ms pulse width, 10-s contraction time, 50- s resting time and maximum tolerable intensity.

Results.?The IMPT differed in MVC, 50?Hz and 15?Hz FES both in patients (201.9?±?14, 55.6?±?13 and 42.1?±?12 Newton-metre, respectively; p?<?0.001) and in controls (179.3?±?9, 62.4?±?8 and 52.3?±?7 Newton-metre, respectively; p?<?0.001). There were no differences between the groups. In patients and controls, respectively, the 50?Hz FES corresponded to 27% versus 35% and the 15?Hz to 21% versus 29% of the IMPT generated at the MVC (p?<?0.001).

Discussion.?This result can be attributed to the fact that muscle strength is proportional to the stimulation frequency and to the number of recruited motor units. Thus, the higher the frequency, the greater the motor recruiting, producing increased muscle strength.

Conclusion.?The IMPT generated by acute 50?Hz application of FES is higher than the one generated by 15?Hz, but it is lower than MVC in controls and patients with heart failure.     

The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: A randomized controlled trial

Purpose.?To investigate the effect of functional electrical stimulation (FES) for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients.

Method.?A total of 50 hemiplegic patients with shoulder subluxation and shoulder pain were included in the study. The patients were randomly divided into the study and control groups. All patients were put on a rehabilitation program using conventional methods while the study group patients were additionally applied FES to supraspinatus and posterior deltoid muscles. The shoulder pain of all patients during resting, passive range of motion (PROM) and active range of motion (AROM) was measured with the visual analog scale (VAS) while the shoulder subluxation levels were evaluated with the classification developed by Van Langenberghe and by using the millimetric measurements on anteroposterior shoulder X-ray before and after the physical treatment and rehabilitation program and compared.

Results.?Comparison of the resting AROM vs. PROM VAS value changes showed no significant difference between the groups. There was a significant difference between the two groups for the amount of change in shoulder subluxation in favor of the study group.

Conclusions.?The results of our study have shown that applying FES treatment to the supraspinatus and posterior deltoid muscles in addition to conventional treatment when treating the subluxation in hemiplegic patients is more beneficial than conventional treatment by itself.     

The effects of neuromuscular electrical stimulation on clinical improvement in hemiplegic lower extremity rehabilitation in chronic stroke: A single-blind,randomised, controlled trial

Objective.?In this study, the effectiveness of neuromuscular electrical stimulation (NMES) was evaluated in lower extremity rehabilitation in patients with chronic stroke.

Method.?The study enrolled 40 patients with chronic stroke. Twenty patients each were assigned to the treatment group and the control group. All patients received a conventional rehabilitation program for a 4-week period. In addition to this rehabilitation program, patients in the treatment group received NMES treatment for hemiplegic foot dorsiflexor muscles for 4 weeks, 5 days a week. The sessions were performed as one session per day and added to a total of 20 sessions. Clinical parameters were evaluated before and after the treatment.

Results.?Pre-treatment and post-treatment evaluations showed a significant increase in ankle dorsiflexion and a significant decrease in the level of spasticity in the treatment group (p?<?0.05); however, there were no significant differences in the control group between the pre-treatment and post-treatment measures. Although Brunnstrom Stage, Rivermead leg and trunk score and Functional Independence Measurement motor subscore showed a significant improvement in pre- and post-treatment comparisons for both groups, the treatment group's scores were significantly higher than the control group (p?<?0.05). Functional Ambulation Categories showed a significant improvement in both groups following the treatment; however, there was no significant difference between the two groups (p?>?0.05).

Conclusions.?Use of NMES in hemiplegic foot dorsiflexion can contribute to the clinical improvement of patients when used in combination with rehabilitation programs.     

Glide-symmetric locomotion reinforcement in patients with multiple sclerosis by visual feedback

Purpose.?To compare the effects of gait training with distinct glide-symmetric visual feedback cues, adapted to the geometry of human locomotion, to the effects of training with visual cues of no distinct symmetry, on the walking abilities of subjects with gait disorders due to multiple sclerosis (MS).

Methods.?Ten patients trained with transverse lines while 11 patients trained with checkerboard tiles, both provided by a wearable virtual reality device. Baseline performance (walking speed and stride length along a 10?m straight track) was measured before device use. Following 20?min training with the device and 10?min rest, performance without the device was measured again and compared to the baseline performance.

Results.?The average improvement in the group using the visual cue of transverse lines was 7.79%?±?4.24% in walking speed and 7.20%?±?3.92% in stride length. The average improvement in the group using the visual cue of checkerboard tiles was 21.09%?±?18.39% in walking speed and 12.99%?±?1.72% in stride length.

Conclusions.?Patients with gait disorders due to MS, training with a glide-symmetric visual feedback cue, showed a significantly higher improvement in their gait parameters than patients training with a visual feedback cue of no without distinct symmetry.     

Effect of robotic locomotor training in an individual with Parkinson's disease: a case report

Purpose.?The purpose was to test the effect of robot-assisted gait therapy with the Lokomat system in one representative individual with Parkinson's disease (PD).

Methods.?The patient was a 67-year-old female with more than an 8-year history of PD. The manifestations of the disease included depressive mood with lack of motivation, moderate bradykinesia, rigidity and resting tremor, both involving more the right side of the body, slow and shuffling gait with episodes of freezing and risk of falling. The patient underwent six sessions of robot-assisted gait training. The practice included treadmill walking at variable speed for 25–40?min with a partial body weight support and assistance from the Lokomat orthosis.

Results.?After the therapy, the patient increased the gait speed, stride length and foot clearance during over ground walking. She reduced the time required to complete a 180° turn and the latency of gait initiation. Improvements were observed in some items of the Unified Parkinson's Disease Rating Scale including motivation, bradykinesia, rigidity, freezing, leg agility, gait and posture.

Conclusions.?Although the results supported the feasibility of using robot-assisted gait therapy in the rehabilitation an individual with PD, further studies are needed to assess a potential advantage of the Lokomat system over conventional locomotor training for this population.     

Enhanced life-role participation in response to comprehensive gait training in chronic stroke survivors*

Purpose: Intensive gait training can produce improvements in gait and function (> 6 months after stroke); findings are mixed for enhanced life role participation. Therefore, it is unclear if improved gait and function translate into life role participation gain. Our objective was to evaluate whether intensive gait therapy can produce significant improvements in life role participation for chronic stroke survivors. Methods: In conjunction with a clinical gait training trial, we conducted a secondary analysis for a 44-member cohort with stroke (>6 months). Gait training interventions included exercise, body weight supported treadmill training (BWSTT), over-ground gait training, and functional electrical stimulation (FES) for 1.5 h/day, 4 days/wk for 12 weeks. Study measures included Tinetti Gait (TG) (gait impairment), Functional Independence Measure (FIM, function), Stroke Impact Scale Subscale of Life Role Participation (SISpart), and Craig Handicap Assessment & Reporting Technique (CHART, life-role participation). Analyses included Wilcoxon Signed Rank Test and PLUM Regression Model. Results: Gait interventions produced significant improvement in CHART (p = 0.020), SISpart (p = 0.011), FIM (p < 0.0001), and Tinetti Gait (p < 0.0001). Age, gender and time since stroke did not predict response to treatment. Conclusions: Intensive, multi-modal, long-duration gait therapy resulted in significant gain in life-role participation, according to a relatively comprehensive, homogeneous measure.

Implications for Rehabilitation

• It is important to measure life role participation in rehabilitation intervention studies, and using a homogenous measure of life role participation provides clear results.

• Intensive gait training produced a significant improvement in life role participation in the chronic phase after stroke.

• Functional electrical stimulation (FES) had no significant additive effect on life role participation during the treatment phase, but FES did have an additive effect during the follow-up period, in enhancing life role participation beyond that obtained using an identical comprehensive gait training intervention without FES.

     

The impact of walking speed on the effects of functional electrical stimulation for foot drop in people with multiple sclerosis

Purpose: Functional electrical stimulation (FES) is effective in assisting people with multiple sclerosis (pwMS) with gait. Previous studies have investigated the effects of FES in pwMS with slow self-selected walking speeds (SSWS). This study reports on the effect of the Odstock Dropped Foot Stimulator (ODFS) on the speed and oxygen (O₂) cost of gait in pwMS walking at a range of SSWS. Methods: Twenty pwMS (mean age 50.4?±?7.3 years) currently using FES walked at their SSWS for 5?min with and without FES. O₂ cost of gait was measured using a gas analysis system, and gait speed was calculated. Data were analysed for all participants, and comparisons were made between those with a SSWS < and >0.8?m/s (walking speed required for community ambulation). Results: Significant improvements in the speed and O₂ cost of gait were seen using FES in the group with SSWS <0.8?m/s (n?=?11, p?=?0.005). When participants’ SSWS >0.8?m/s, no difference in gait speed was noted, and a significant increase in O₂ cost of gait using FES (n?=?9, p?=?0.004) was noted. Conclusion: FES has a different effect on the speed and O₂ cost of gait dependent on the SSWS of pwMS. This requires further investigation.

• Implications for Rehabilitation

• Functional electrical stimulation (FES) used for foot drop is effective in improving the speed and oxygen cost of walking in pwMS walking at SSWS <0.8?m/s.

• FES does not seem to have a beneficial effect on the speed and oxygen cost of walking in pwMS walking at SSWS >0.8?m/s.

• Further research is needed to understand the possible mechanisms involved so that FES for foot drop can be efficiently prescribed.

     

功能性电刺激同步踝足矫形器步态训练对脑卒中患者步行功能的影响

目的 观察功能性电刺激同步踝足矫形器步态训练对脑卒中后偏瘫患者下肢运动功能、步态时-空参数和关节角度参数的影响。 方法 将符合入选标准的脑卒中患者32例随机分为对照组（n=10）、支具组（n=10）和联合组（n=12）。3组患者均接受常规药物治疗和常规康复训练,对照组在此基础上增加步态训练,支具组则增加佩戴AFO行步态训练,联合组在常规药物和常规康复训练的基础上增加FES治疗,且在FES治疗的同时佩戴AFO行步态训练。3组患者均接受为期4周的治疗,并于治疗前和治疗4周后（治疗后）采用下肢Fugl-Meyer评定量表（FMA-LE）、下肢Brunnstrom运动恢复分期量表（BRL）、步行功能评定表（FAC）对其下肢运动功能和步行能力进行评估,同时使用三维步态分析仪获取3组患者步态参数,比较其治疗前、后偏瘫步态的变化。 结果 治疗4周后,3组患者的FMA-LE、FAC、BRL评分、时-空参数和各关节最大屈曲角度较组内治疗前均显著改善,差异均有统计学意义(P＜0.05）。治疗后,联合组患者的FMA-LE评分［（28.42±1.38）分］、FAC评分［（4.33±0.49）分］、BRL评分［（5.41±0.67）分］、步频［（79.58±19.08）步/min］、步速［（56.97±19.08）cm/s］、步幅［（77.33±15.20）cm］、步行周期［（1.42±0.29）s］、双支撑相［（34.00±5.39）%］以及髋、膝、踝关节最大屈曲角度均显著优于对照组和支具组治疗后,差异均有统计学意义（P＜0.05）。 结论 功能性电刺激的同时行踝足矫形器步态训练可显著改善脑卒中后偏瘫患者的下肢运动和步行功能,增加其关节活动度。     

A home-based rehabilitation program for the hemiplegic upper extremity by power-assisted functional electrical stimulation

Purpose. To assess the effects of daily power-assisted functional electrical stimulation (FES) home program therapy in chronic stroke.

Methods. A total of 20 consecutively enrolled stroke patients with spastic upper-extremity impairments >1 year after stroke were recruited for this non-blinded randomized controlled trial. Subjects were assigned to control and FES groups and followed for 5 months. The FES group used a power-assisted FES device to induce greater muscle contraction by electrical stimulation in proportion to the integrated electromyography (EMG) signal picked up on surface electrodes. Target muscles were the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB), extensor digitorum communis (EDC), extensor indicis proprius (EIP), and deltoid (Del). Patients underwent 30 ～ 60 min FES sessions at home about 6 days/week. Root mean square (RMS) of ECRL, EDC and Del maximum voluntary EMGs, active range of motion (ROM) of wrist and finger extension and shoulder flexion, modified Ashworth scale (MAS), and clinical tests were investigated before and after FES training.

Results. The FES group displayed significantly greater improvements in RMS, active ROM, MAS and functional hand tests, and was able to smoothly perform activities of daily life using the hemiplegic upper extremities.

Conclusions. Daily power-assisted FES home program therapy can effectively improve wrist and finger extension and shoulder flexion. Proprioceptional sensory feedback might play an important role in power-assisted FES therapy.     

Patient-specific functional electrical stimulation strategy based on muscle synergy and walking posture analysis for gait rehabilitation of stroke patients

ObjectiveTo evaluate a novel multi-channel functional electrical stimulation (FES) rehabilitation method based on the evaluation of patient-specific walking dysfunction.MethodsThis study investigated a novel multi-channel FES-based rehabilitation method that analysed the patient’s muscle synergy and walking posture. A patient-specific FES profile was produced in the pre-evaluation stage by comparing the muscle synergy and walking posture of the patient with those of healthy control subjects. During the rehabilitation phase, this profile was used to determine an appropriate FES pulse width and amplitude for stimulating the patient’s muscles as they walked across a flat surface.ResultsTwo stroke patients with hemiplegic symptoms participated in a clinical evaluation of the proposed method involving a 4-week course of rehabilitation. An evaluation of the rehabilitation results based on a comparison of the pre- and post-rehabilitation muscle synergy and walking posture revealed that the rehabilitation enhanced the muscle synergy similarity between the patients and healthy control subjects and their quantitative walking performance, as measured by a 10-m walk test and walking speed, by up to 23.38% and 30.00%, respectively.ConclusionThese results indicated that the proposed rehabilitation method improved walking ability by improving muscle coordination and adequately supporting weakened muscles in stroke patients.     

Enhanced life-role participation in response to comprehensive gait training in chronic-stroke survivors

Purpose: Intensive gait training can produce improvements in gait and function (>6 months after stroke); however, findings are mixed for enhanced life-role participation. Therefore, it is unclear if improved gait and function translate into life-role participation gain. Our objective was to evaluate whether intensive gait therapy can produce improvements in life-role participation for chronic-stroke survivors, according to a comprehensive measure dedicated to life-role participation. Methods: In conjunction with a clinical gait-training trial, we conducted a secondary analysis for a 44-member cohort with stroke (>6 months). Gait-training interventions included functional neuromuscular stimulation, body-weight supported treadmill training, over-ground gait training and exercise for 1.5 hours/day, 4 days/week for 12 weeks. Study measures included Tinetti Gait (gait impairment), Functional Independence Measure (FIM, function), Stroke Impact Scale subscale of life-role participation (SIS part) and Craig Handicap Assessment and Reporting Technique (CHART, life-role participation). Analysis included Wilcoxon signed rank test and polytomous universal regression model. Results: Gait interventions produced significant improvement in CHART (p = 0.020), SIS part (p = 0.011), FIM (p < 0.0001), and Tinetti Gait (p < 0.0001). Age, gender and time since stroke did not predict response to treatment. Conclusions: Intensive gait therapy resulted in significant gain in life-role participation, according to a comprehensive measure, so dedicated.

Implications for Rehabilitation

• It is important to measure life-role participation in rehabilitation intervention studies, and using a homogeneous measure of life-role participation provides clear results.

• Intensive gait training produced a significant improvement in life-role participation in the chronic phase after stroke.

• Functional electrical stimulation (FES) had no significant additive effect on life-role participation during the treatment phase, but FES did have an additive effect during the follow-up period in enhancing life-role participation beyond that obtained using an identical comprehensive gait-training intervention without FES.

     

肉毒毒素注射后功能性电刺激与运动平板同步治疗脑卒中后足下垂及足内翻的疗效观察

目的观察A型肉毒毒素(BTX-A)注射后功能性电刺激同步减重平板治疗对脑卒中患者足下垂及足内翻的影响。 方法采用随机数字表法将67例脑卒中后出现足下垂及内翻的患者分为联合治疗组（22例）、电刺激组（23例）及常规治疗组（22例）。3组患者均在B超及电刺激引导下进行BTX-A注射治疗,24h后常规治疗组患者给予常规干预（包括使用脑保护剂及进行肢体功能锻炼、步态训练、平衡训练、日常生活活动能力训练等）,联合治疗组在常规治疗基础上辅以功能性电刺激与减重平板同步治疗,电刺激组则在常规治疗基础上辅以功能性电刺激。于治疗前、治疗6周后对各组患者进行疗效评定,具体疗效评定指标包括胫骨前肌与腓肠肌外侧头积分肌电值（iEMG）、踝背伸协同收缩率(CR)、改良Ashworth量表(MAS)评分、Berg平衡量表(BBS)评分、功能性步行分级(FAC)、踝背伸与外翻活动度(ROM)等。 结果治疗后3组患者胫骨前肌iEMG、腓肠肌外侧头iEMG、踝背伸CR、MAS评分、BBS评分、FAC评分、踝背伸与外翻ROM均较治疗前明显改善（P<0.05）;通过组间比较发现,治疗后3组患者腓肠肌外侧头iEMG组间差异无统计学意义(P>0.05);联合治疗组胫骨前肌iEMG［(1.54±0.23)mV］、踝背伸CR［(13.32±8.47)%］、MAS评分［(0.29±0.35)分］、BBS评分［(42.37±4.28)分］、FAC评分［(4.26±1.14)分］、踝背伸ROM［(15.58±1.32)°］与外翻ROM［(14.33±1.41)°］均显著优于电刺激组及常规治疗组水平(P<0.05)。 结论于BTX-A注射后同步进行功能性电刺激及减重平板训练,能进一步改善脑卒中患者足下垂及足内翻畸形,促其步行功能改善,该联合疗法值得临床推广、应用。     

Ambulation study of a woman with paraplegia using a reciprocating gait orthosis with functional electrical stimulation in Taiwan: A case report

Purpose. Many patients who suffer from spinal cord injuries with paraplegia cannot recover to walk independently. They need to use a special walking orthoses to support their body to walk properly. Traditionally, long leg braces (LLB) were fitted to patients for walking. Unfortunately, the results were not satisfactory as this device supplies adequate support with less than optimum mobility. This study used the latest reciprocating gait orthosis (RGO) combined with functional electrical stimulation (FES). This combination provides a greater support range while applying assistant mechanical walking structures. The FES co-ordination helps restore natural walking abilities that the paralysed patient has lost.

Method. This study developed a walking orthosis with FES, using FES to stimulate specific muscles (quadriceps, hamstring) in the paralysed patients' lower limbs. The proposed method can achieve the benefits of physical therapeutics while paralysed patients can achieve the purpose of walking. The FES is designed with control buttons on the walking orthosis. A patient can control the left or right leg in walking and speed control via the control buttons.

Results. Several practical tests were conducted on the new walking orthosis. A 25-year-old female paralysed patient (L1 complete spinal cord injury) used traditional LLB, RGO and RGO with FES to proceed with walking rehabilitation and clinical assessment. Heart rate difference (HRdifference), mean blood pressure (MBPdifference), walking speed, length of steps, number of steps and oxygen consumption comparisons were made before and after walking. The results show that RGO and RGO with FES were both better than LLB. However, the differences between RGO and RGO with FES in HRdifference, MBPdifference, and walking speed were not significant. This is because the patient's right leg reaction to the electrical stimulation was relatively low.

Discussion and conclusions. In general, RGO can help the patient achieve quicker and more independent walking. The combination of RGO and FES can increase the effectiveness of RGO for more mobile aid. These two walking orthoses are better than traditional LLB. Both methods provide patients who suffer from paraplegia with better choices.     

步行模式的功能性电刺激不同治疗时间对脑卒中患者下肢功能影响的随机对照研究CSCD

目的:探讨基于正常行走模式的智能化、多通道步行模式功能性电刺激(FES)改善脑卒中患者下肢运动功能的疗效及其与治疗时间的相关性,为步行模式FES的临床应用提供依据。方法:采用Minimize软件将18例脑卒中患者随机分为60 min步行模式FES组(60 min组)和30 min步行模式FES组(30 min组),每组各9例。2组的常规治疗相同,在此基础上,60 min组采用步行模式FES辅助行走30 min+卧位电刺激30 min;30 min组采用步行模式FES辅助行走30 min+卧位安慰刺激30 min。电刺激1次/d,5 d/周,共15次。在治疗前、治疗7次后、治疗15次后、治疗结束1个月后分别进行改良Ashworth量表(MAS)、徒手肌力检查(MMT)、Fugl-Meyer下肢功能评定(FMA-LE)、Berg平衡评定(BBS)、10 m步行测试(10MWT)步速和改良Barthel指数(MBI)评估,以判断患者患侧下肢运动功能和日常生活活动能力的变化。结果:组内比较发现,与治疗前相比,2组治疗7次后、治疗15次后和随访时的MAS、MMT、FMA-LE、BBS差异均有统计学意义(P<0.05);60 min组在治疗后的3次评估中MBI的变化均有统计学意义(P<0.05),而30 min组仅在治疗7次后和治疗15次后的MBI变化有统计学意义(P<0.05);60 min组在治疗7次后和治疗15次后10 MWT步速的差异有统计学意义(P<0.05),而30 min组仅在治疗15次后的10 MWT步速变化有统计学意义(P<0.05)。组间比较发现,治疗7次后,60 min组MAS、10MWT步速改善更明显(P<0.05);治疗15次后,MAS、FMA-LE、MBI组间差异均有统计学意义(P<0.05);随访时,MAS、MBI组间比较差异有统计学意义(P<0.05)。结论:智能化、多通道步行模式功能性电刺激能有效改善脑卒中患者下肢运动功能、平衡、行走和日常生活活动能力;而延长治疗时间(从治疗30 min到60 min)可以达到降低肌张力、改善患侧下肢运动功能、提高步速和生活自理能力的效果,且能够延长生活自理能力的疗效持续时间。