The aims of this study were to investigate whether introducing an interphase interval (IPI) to biphasic pulses during stimulation of the dorsiflexor muscles would affect force production and to determine whether the IPI effect is dependent on electrode position. Twelve healthy volunteers participated in the study. Each subject participated in one session during which electrically induced contraction (EIC) forces of the ankle dorsiflexors were measured with five different IPI settings ranging from 0 to 400 μs. Forces of EICs were assessed with the electrodes placed either with the proximal electrode positioned over the common peroneal nerve and the second electrode over the dorsiflexor muscles or with both electrodes located over the dorsiflexor muscles. The order of electrode placements and of the different IPI settings was randomized across subjects. The results indicated that the introduction of a 100-μs-long IPI may enhance force production when one electrode is located over the common peroneal nerve. However, increasing the duration of the IPI beyond 100 μs did not result in further increase in force production. In contrast, the introduction of an IPI did not increase force production when both electrodes were located over the dorsiflexor muscles. These findings may help to optimize stimulation settings during functional electrical stimulation to prevent foot-drop.

BackgroundFunctional electrical stimulation (FES) is becoming an accepted treatment method for enhancing gait performance in patients who present with gait difficulties resulting from hemiparesis. The purpose of this study was to test whether individuals with hemiparesis who have varied gait speeds, which place them in different functional categories, benefit to the same extent from the application of FES.MethodsThirty-six subjects with chronic hemiparesis demonstrating foot-drop and deficits in knee and/or hip control were fitted with a dual-channel FES system activating the dorsiflexors and hamstring muscles. Gait was assessed during a 2-minute walk test with and without stimulation. A second assessment was conducted after 6 weeks of daily use. Analysis was performed with the subjects stratified into three functional ambulation classes according to their initial gait categories.ResultsThe dual-channel FES improved the gait velocity of all three subgroups. No minimal gait velocity was required in order to gain benefits from FES. For example, subjects with limited household ambulation capabilities improved their gait speed by 63.3% (from 0.30 ± 0.09 m/sec to 0.49 ± 0.20 m/sec; P < 0.01), while subjects with functional community ambulation capabilities improved their gait speed by 25.5% (from 0.90 ± 0.11 m/sec to 1.13 ± 0.22 m/sec; P < 0.01).ConclusionDual-channel FES positively affects gait velocity in patients with chronic hemiparesis, regardless of their initial gait velocity. Furthermore, gait velocity gains may be large enough to change an individual’s ambulation status to a higher functional category.

The study objective was to investigate the effects of an interphase interval (IPI) interposed between the two phases of a biphasic symmetric pulse, on electrically induced contraction (EIC) forces and fatigue during stimulation of the ankle dorsiflexors in individuals with an upper motor neuron lesion (UMNL). The dorsiflexor muscles of 20 subjects with UMNL routinely using functional electrical stimulation to correct a foot drop during ambulation, were electrically stimulated with biphasic pulses (250 µs phase duration and 35 Hz pulse frequency) using nine IPI durations (ranging from 0 to 400 µs). The induced muscle force and fatigue were measured. A significant positive correlation was found between IPI duration and induced muscle force. Introducing a 250 µs IPI significantly decreased rate of muscle fatigue compared to stimulation with no IPI (P < 0.05). Thus, the introduction of an IPI may reduce the current intensity required to achieve a specific force during functional electrical stimulation in individuals with UMNL. Reduction in muscle fatigue may shorten the conditioning period necessary for first time users of functional electrical stimulation.