Effect of cycling and functional electrical stimulation with linear and interval patterns of timing on gait parameters in patients after stroke: a randomized clinical trial

Abstract

Objective

Patients in the chronic phase after a stroke are an underrepresented group in the literature. Therefore, the aim of this study was to compare the effects of cycling and functional electrical stimulation with linear versus interval patterns of timing on gait parameters in patients after stroke.

Design

A double blinded, parallel, randomized clinical trial.

Setting

Neuroscience Institute.

Participants

Patients with lower limb disability due to stroke (N = 30) with a stroke onset >6 months and <18 months.

Interventions

Twenty-eight minutes of leg cycling with functional electrical stimulation with linear or interval patterns of timing applied to the peroneal and biceps femoris muscles, 3 times/week for 4 weeks.

Main measures

Timed 10-Meter Walk Test and Functional Ambulation Classification were the primary outcome measures. The Modified Modified Ashworth scale, active range of motion, Timed Up and Go Test, and Single Leg Stance Test were the secondary outcome measures. Evaluation was performed at baseline, after 4, and after 8 weeks.

Results

Thirty participants completed the 4-week intervention (interval group, n = 16; linear group, n = 14). The Functional Ambulation Classification, Timed 10-Meter Walk Test, and the Timed Up and Go Test improved significantly in both groups. The Modified Modified Ashworth scale scores for quadriceps and plantar flexion statistically decreased after 4-weeks in the interval group. Significant group-by-time interaction was shown for Timed Up and Go Test (p = 0.003, np²=0.228), knee flexion active range of motion (p < 0.001, np²=0.256) and dorsiflexion active range of motion (p < 0.001, np²=0.359). Modified Modified Ashworth scale and active range of motion in both the ankle and knee improved significantly in the interval group.

Conclusions

The functional electrical stimulation with cycling protocols improved the Functional Ambulation Classification, Timed 10-Meter Walk Test, active range of motion, Timed Up and Go Test, and Modified Modified Ashworth scale. An interval protocol of timing was more effective than the linear protocol in terms of spasticity and active range of motion.

Implications for rehabilitation

• Cycling + functional electrical stimulation training with an interval pattern of timing seems superior to cycling + functional electrical stimulation training with a linear pattern.

• Interval protocol has positive effects on spasticity and range of motion after 12 sessions in patients post stroke.

• Cycling + functional electrical stimulation improves functional mobility and speed in stroke survivors and the effects of this intervention lasted in follow-up assessment after one month.

Keywords:

• Stroke
• neurorehabilitation
• cycling
• functional electrical stimulation
• gait

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported and approved by Tehran University of Medical Sciences (Trial ID: 29001, Reference number: IR.TUMS.VCR.REC.1396.4226).