Functional electrical stimulation for foot drop syndrome in patients with cerebral stroke

Abstract

BACKGROUND: The deterioration of walking function as a result of acute cerebrovascular accident manifested by the foot drop syndrome, leading to difficulties in maintaining balance in the standing position and increased substitution strategies, is the most important limiting factor that affects autonomy and independence. The results of short time training with functional electrical stimulation in patients with cerebral stroke in the early and late recovery periods remain unknown.
 AIM: to study the functional and clinical results of a short course of functional electrical stimulation in patients with cerebral stroke and foot drop syndrome.
 MATERIALS AND METHODS: The study involved 20 patients with early and late hemispheric acute cerebrovascular accident who received a course of single-channel 30-minute functional electrical stimulation training of the m. tibialis anterior in conjunction with the main program of motor rehabilitation (60 minutes), consisting of 12 sessions. The biomechanics of walking at a random pace before and after training was investigated. Spatial and temporal parameters of walking, movements in hip, knee and ankle joints and maximum amplitudes of electromyography of the main muscle groups responsible for walking were recorded. Classical clinical scales were also used.
 RESULTS: No negative reaction to training with functional electrical stimulation was obtained. After treatment, there was a significant improvement in the following scales was observed: "Dynamic Gait Index", "Hauser Ambulation Index", "Timed Up and Go Test" test, muscle strength assessment, "Activity and Participation" domains. Spatial and temporal parameters demonstrate a complex syndrome characteristic of post-stroke walking. Walking speed and step cycle length increased significantly after training. The kinematics of movements in the hip and knee joints do not reveal significant dynamics. The difference from the control group of contralateral side indices in knee and hip joints, indicating bilateral functional involvement in the pathologic process, draws attention. Goniograms of the ankle joints of the paretic limb revealed the following parameters characteristic of the sagging foot: increase in the circumduction parameter on the paresis side, total amplitude of hip joint movements, knee joint flexion in the transfer period (Ka3), and ankle joint flexion amplitude in the transfer period (A3). Following functional electrical stimulation training, no changes were observed in these parameters.
 CONCLUSION: All clinical parameters have improved. Objective diagnostic results of the functional electrical stimulation training showed no significant effect on ankle joint function. Taking into account the limitations of this study, a follow-up study is planned.