Response of gait deficits to neuromuscular electrical stimulation for stroke survivors

Abstract

Persistent gait deficits after stroke can cause falls, elevated energy cost and poor endurance. Coordination impairment is an underlying cause of gait deficits. Few efficacious interventions have been described that have targeted and measured restoration of coordinated gait components. Neuromuscular electrical stimulation can provide the critical gait practice characteristic of close-to-normal movements, by electrically inducing muscle contractions and coordinated movements that are not possible under volitional effort. Two-channel, surface neuromuscular electrical stimulation can be synchronized with phases of gait and can provide faster, more symmetrical neuromuscular electrical stimulation-assisted gait than gait with no neuromuscular electrical stimulation. Difficulties encountered during the use of surface neuromuscular electrical stimulation for gait training led to the development of neuromuscular electrical stimulation with implanted technologies. Implanted electrodes and/or stimulators proved to be feasible for gait training in stroke survivors. Gait training with a multichannel neuromuscular electrical stimulation system with implanted electrodes proved more advantageous than gait training without neuromuscular electrical stimulation, according to measures of volitional coordinated gait components (neuromuscular electrical stimulation deactivated).

Keywords::

• coordination
• electrical stimulation
• functional electrical stimulation
• FES
• functional neuromuscular stimulation
• FNS
• gait
• gait deficits
• gait training
• rehabilitation
• stroke

Acknowledgements

Department of Veterans Affairs, Rehabilitation Research and Development, Grant A3102R. Many scientists have contributed to the body of literature on NMES and gait; owing to space constraints, representative publications were described in this article.