The Effects of Dynamic Functional Electrical Stimulation With Treadmill Gait Training on Functional Ability, Balance Confidence and Gait in Chronic Stroke Patients원문보기
Cho, Young-Ki
(Dept. of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine)
,
Ahn, Jun-Su
(Dept. of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine)
,
Park, Yong-Wan
(Dept. of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine)
,
Do, Jung-Wha
(Dept. of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine)
,
Lee, Nam-Hyun
(Dept. of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine)
,
Kwon, Oh-Yun
(Kinetic Ergocise Based on Movement Analysis Laboratory)
The aim of this study was to evaluate the effects of walking on a treadmill while using dynamic functional electrical stimulation (Dynamic FES) on functional ability and gait in chronic stroke patients. This was a prospective, randomized controlled study. Twelve patients with chronic stroke (>24 mon...
The aim of this study was to evaluate the effects of walking on a treadmill while using dynamic functional electrical stimulation (Dynamic FES) on functional ability and gait in chronic stroke patients. This was a prospective, randomized controlled study. Twelve patients with chronic stroke (>24 months) who were under grade 3 in dorsiflexor strength with manual muscle test were included and randomized into intervention (Dynamic FES) ($n_1$=7) and control (FES) ($n_2$=5). Both the Dynamic FES group and FES group were given a neuromuscular development treatment. The Dynamic FES group has implemented a total of 60 minutes of exercise treatment and gait training with Dynamic FES application. The FES group, with the addition of applying FES while sitting, has also implemented a total of 90 minutes of gait training on treadmill after the exercise treatment. Both two groups accomplished the program, twice a week, for a total of 24 times in a 12-week period. Exercise treatment, gait training on treadmill, and both Dynamic FES and FES were implemented for 30 minutes each. Korean version activities-specific balance confidence scale (K-ABC) was measured to determine self-efficacy in balance function. Timed up and go (TUG) test was performed to evaluate the physical performance. K-ABC, TUG, Berg balance scale (BBS), modified physical performance test (mPPT) and G-walk were evaluated at baseline and at 12 weeks. After 12 weeks, statistically significant differences (p<.05) were apparent in the Dynamic FES group in the changes in K-ABC and BBS. mPPT, TUG, gait speed, stride length and stance phase duration (%) were compared with the FES group. K-ABC had higher correlation to BBS, along with mPPT to TUG. Our results suggest that walking with Dynamic FES in chronic stroke patients may be beneficial for improving their balance confidence, functional ability and gait.
The aim of this study was to evaluate the effects of walking on a treadmill while using dynamic functional electrical stimulation (Dynamic FES) on functional ability and gait in chronic stroke patients. This was a prospective, randomized controlled study. Twelve patients with chronic stroke (>24 months) who were under grade 3 in dorsiflexor strength with manual muscle test were included and randomized into intervention (Dynamic FES) ($n_1$=7) and control (FES) ($n_2$=5). Both the Dynamic FES group and FES group were given a neuromuscular development treatment. The Dynamic FES group has implemented a total of 60 minutes of exercise treatment and gait training with Dynamic FES application. The FES group, with the addition of applying FES while sitting, has also implemented a total of 90 minutes of gait training on treadmill after the exercise treatment. Both two groups accomplished the program, twice a week, for a total of 24 times in a 12-week period. Exercise treatment, gait training on treadmill, and both Dynamic FES and FES were implemented for 30 minutes each. Korean version activities-specific balance confidence scale (K-ABC) was measured to determine self-efficacy in balance function. Timed up and go (TUG) test was performed to evaluate the physical performance. K-ABC, TUG, Berg balance scale (BBS), modified physical performance test (mPPT) and G-walk were evaluated at baseline and at 12 weeks. After 12 weeks, statistically significant differences (p<.05) were apparent in the Dynamic FES group in the changes in K-ABC and BBS. mPPT, TUG, gait speed, stride length and stance phase duration (%) were compared with the FES group. K-ABC had higher correlation to BBS, along with mPPT to TUG. Our results suggest that walking with Dynamic FES in chronic stroke patients may be beneficial for improving their balance confidence, functional ability and gait.
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문제 정의
This study focused on the effects of Dynamic FES on balance control, balance confidence, functional ability and gait to chronic stroke patients passing 24 months after onset of illness. The results showed that the Dynamic FES group showed a significant increase over the FES group in functional ability, dynamic balance control, and balance confidence.
South Korea is not clinically implementing FES to hemiplegic stroke patients after 2 years of onset. This study has showed an improvement of balance control, balance confidence, functional performance and gait in the Dynamic FES group than in the FES group. Therefore, it is necessary to develop and enforce various gait training programs in the clinical field where it applies Dynamic FES during gait training on patients who have experienced chronic stroke since the last two years.
제안 방법
A total of 90 minutes, 30 minutes each, was implemented on a day. Both two groups accomplished the program, twice a week, for a total of 24 times in a 12-week period. The gait speed on treadmill was set to the speed where the participant felt most comfortable.
Also, there were some difficulties in explaining ankle stability and trunk control capability due to lack of measurements in ankle movements. Moreover, this study was not able to have a follow-up after 3 months on FES effects which limits our knowing whether Dynamic FES aided motor learning transfer. Thus, further studies are needed, with a larger sample size, a longer duration, and more diverse gait training program on patients with chronic stroke, which can be determine the optimal treatment protocol.
Paired t-test was implemented to find out comparisons between pre- and post-test to find out the significance on each of the groups’ exercise.
The gait speed on treadmill was set to the speed where the participant felt most comfortable. Physical therapists with professional knowledge supervised all the programs including treatment and gait training in order for participants to participate in the experiment with the right posture and movement.
Thorough explanations of the evaluation were given to the participants prior to the measurement. The evaluation was carried out in a separate space excluded from all noises and external disturbances with a fatigue-reduced state after an adequate amount of rest. The assessment was stopped immediately if the patient appealed dizziness or fatigue during the evaluation.
FES (Microstim, MEDEL Medizinische Elektronik Handelsgesellschaft mbH, Hamburg, Germany) has provided a stimulus with the intensity that allows ankle dorsiflexion by attaching two electrode pads on the tibialis anterior muscle of the patient sitting down before gait training. The patients were told to purposely contract tibialis anterior to make ankle dorsiflexion when they received FES electric current. We have instructed the patient to observe the movement of the foot in order for them to get visual feedback
However, there are few studies related to the effect of FES on patients with stroke after 24 months of onset. The purpose of this study were as follows: First, to determine the effects of Dynamic FES application on the functional ability of achievement, balance confidence and gait of patients with stroke after 24 months of onset. Second, to compare the effect of Dynamic FES and FES application.
Timed up and go test is a test method of basic motility and locomotion which measures the time of one starting from a sitting position to stand up and walking 3 meters forward and passing the halfway point to come back and sit to the starting position (Podsiadlo and Richardson, 1991). This study instructed patients to pass the halfway point with their uninvolved side. The evaluator used a stopwatch to measure three times and record its average.
This study only used gait speed, affected limb’s stride length and stance phase duration (%) values out of various measurable parameters (Figure 1) (Figure 2).
대상 데이터
In addition, patients unable to get treatment for 3 consecutive sessions or unable to receive 80% of the treatment were excluded in the study. 20 patients were enrolled. 8 participants discontinued due to exclusion or them being declined caused by distance to the hospital.
, which evaluates various domains of body functions by observing diverse activities of daily living. This test is comprised of a total of nine items consisting of a five-point scale ranging from zero to four which adds up to a total of 36. The higher score shows better physical function.
Twelve university-affiliated hospital out-patient department patients with chronic stroke (>24 months) were studied.
데이터처리
All data analysis was performed using SPSS ver. 18.0 (SPSS Inc., Chicago, IL, USA) to examine the general features of the Dynamic FES and FES group by analyzing the mean and standard deviation. Spearman coefficient applied correlation analysis was used to know correlations between clinical scales.
이론/모형
86) (Powell and Myers, 1995). This study used K-ABC translated by the research of Hwang et al (2007). They had high reliability (ICC=.
성능/효과
Our results demonstrate that K-ABC and mPPT have higher correlation to BBS and TUG, respectively. Our results suggest that Dynamic FES in chronic stroke patients may be beneficial for improving balance, balance confidence, functional ability and gait. More long term follow-up studies and various type of walking studies are needed to determine the optimal treatment protocol.
The comparison result of each clinical scale showed a highly significant correlation in the correlation analysis between the K-ABC, BBS, mPPT and TUG (R=.772, R=.782, R=-7.798, p<.005).
This study focused on the effects of Dynamic FES on balance control, balance confidence, functional ability and gait to chronic stroke patients passing 24 months after onset of illness. The results showed that the Dynamic FES group showed a significant increase over the FES group in functional ability, dynamic balance control, and balance confidence. These results may be seen as increase in trunk control capability through increase in ankle stability.
020) in the comparison of pre- and post-intervention. The variation of the change in the difference of average in K-ABC, BBS, mPPT, TUG, gait speed, stride length, and stance duration showed a statistically significant difference (p=.000, p=.015, p=.032, p=.019, p=.007, p=.025, p=.031) except in cadence (p=.118) between the two groups after intervention (Table 2).
This study showed a significant increase in gait speed, affected limb’s stride length and stance phase duration (%) more on the Dynamic FES group compared to the FES group.
후속연구
Moreover, this study was not able to have a follow-up after 3 months on FES effects which limits our knowing whether Dynamic FES aided motor learning transfer. Thus, further studies are needed, with a larger sample size, a longer duration, and more diverse gait training program on patients with chronic stroke, which can be determine the optimal treatment protocol.
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