1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

O-53
EFFECT OF SENSORY-THRESHOLD ELECTRICAL NERVE STIMULATION ON
MOTOR RECOVERY AND GAIT KINEMATICS AFTER STROKE
Yavuzer, Gunes, MD, Assoc Prof 1 , Oken, Oznur, MD, 2 Atay, Mesut, MD, Prof, 1
Stam, Henk, MD, Prof 3
1 Department of Physical Medicine & Rehabilitation, Ankara University Faculty of Medicine,
Ankara, Turkey
2 Physical Medicine & Rehabilitation Clinic of Ankara State Hospital, Ankara, Turkey
3 Erasmus University Medical Center, Department of Rehabilitation Medicine, Rotterdam, The
Netherlands
Summary/conclusions
Sensory-threshold electrical stimulation (SES) of the paretic leg in addition to a conventional
rehabilitation program was not superior to conventional rehabilitation program alone, in terms
of lower extremity motor recovery and gait kinematics of our group of patients with stroke.
Introduction
Sensory input can modulate reorganization of the motor cortex, which may be beneficial in
therapeutic interventions to improve motor function in stroke rehabilitation [1]. It has been
shown that sub-threshold sensory stimulation of the paretic limb using glove or sock electrodes
improved limb function late after stroke [2].
Statement of clinical significance
This prospective randomized controlled trial was designed to assess the effects of SES of the
paretic leg on motor recovery and gait kinematics of patients with stroke.
Methods
A total of 30 consecutive inpatients with stroke (mean age of 63.2 years), all within 6 months
post-stroke and without volitional ankle dorsiflexion were studied. Both the SES group (n=15)
and the placebo group (n=15) participated in a conventional stroke rehabilitation program, 5
days a week for 4 weeks. The conventional program is patient-specific and consists of
neurodevelopmental facilitation techniques, physiotherapy, occupational therapy, and speech
therapy (if needed). The SES group also received 30 minutes of SES to the paretic leg, 5 days a
week for 4 weeks. Stimulation pads were placed at the anatomical localization of the peroneal
nerve while the patients were in supine position. Asymmetric biphasic rectangular stimulation
at a frequency of 35Hz with a pulse width of 240μs was delivered. The stimulation amplitude
was adjusted at each session to the point where the patient perceived a mild tingling sensation
(roughly 10mA), but below an observable or palpable muscle contraction. The same set-up was
used for the placebo group without any stimulation. Main outcome measures were
Brunnstrom’s Motor Recovery Stage (BMRS), and time-distance and kinematic characteristics
of gait. BMRS I-III indicates more synergistic and mass movements, whereas stages IV-VI
indicate isolated and selective movements. Three-dimensional gait data were collected with the
Vicon 370 system and processed by the Vicon Clinical Manager (version 3.2) software. Initial
and final evaluations were made 1-3 days before and after the 4 weeks of the treatment period.
The group means and percentage changes were compared between the SES and the placebo
group using non-parametric paired and unpaired t tests. The Chi-square test was used to
compare the groups in terms of the number of patients with BMRS for lower extremity I-III or
IV-VI.
Results
Age, gender, height, weight, injury and clinical characteristics, time since stroke and walking
velocity were all similar between the SES and the placebo group. BMRS improved
significantly in both groups (p