Lower Limb Table 13: Studies Using Functional Electrical Stimulation to Improve Locomotor Function

Author Year; Country
Score
Research Design

Sample Size

Methods

Outcomes

Bittar & Cliquet 2010;

Brazil

Case Control

N=51

Population: Mean ages between 29 and 35 for each group. Group A – 6 females, 24 males, 9 cervical SCI, 21 thoracic SCI, mean lesion time 8.2 years; Group B – 1 female, 9 males, 5 cervical SCI, 5 thoracic SCI, mean lesion time 3.8 years; Group C (healthy controls) – 5 males, 6 females.

Treatment: NMES for Group A only: 20-30 minutes per sessions, twice/week and minimum 1 year (mean of 3.4 years)

Outcome Measures: Ankle joint mobility using a goniometer was measured according to the American Orthopaedic Foot and Ankle Society criteria. Assessment of callosities, skin conditions, ulcers, mycosis, onycochryptosis and deformities.

  1. Mean subtalar joint mobility was significantly higher in group A (23.4°) and group C (28.9°) than in group B (13.5°).
  2. Mean midfoot joint mobility was significantly higher in group A (22.5°) and group C (24.1°) than in group B (15.3°).
  3. Mean ankle joint mobility was significantly higher in group C (63.6°) than in group A (41.4°) and group B (41.4°).
  4. Mean lateral talocalcaneal angle was significantly lower in group C (31.1°) than in group A (44.7°) and group B (36.8°).
  5. Mean talus-first metatarsal angle was significantly lower in group C (4.0°) than in group A (13.8°) and group B (19.3°).

 

Thrasher et al. 2006;

Canada

Pre-post

N=5

Population: 5 males and females; age 24-72 yrs; all subjects had an incomplete SCI; C5-T12 lesion level; 2-24 yrs post-injury.

Treatment: Gait training regimen with FES neuroprosthesis 2-5x/week for 12-18 weeks. First 4-8 sessions consisted of lower limb muscle strengthening performed in 4 sets of 5 min with 5 min rest. Subjects then performed walking exercises with the neuroprosthesis for 15-30 min/session (rest as needed) either on a treadmill or overground.

Outcome Measures: Walking speed, stride length, step frequency

  1. 4/5 subjects significantly increased walking speeds. These subjects also significantly increased step frequency and stride length.

Ladouceur & Barbeau 2000a;

Canada

Pre-post
N=14 (enrolled)

N=10 (analyzed)

Population: 14 subjects; age 25-49 yrs; all subjects had an incomplete SCI; C3-L1 lesion level; 1.8-19.1 yrs post-injury,

Treatment: Surface FES: bilateral or unilateral common peroneal nerve, home use as much as possible ~1 year (26 and 56 weeks), 2 subjects also had bilateral quadriceps.

Outcome measurestemporal gait measures.

  1. Mean increase of 0.10 m/s in walking speed and increase of 0.12 m in stride length (both with and without FES) over the first year of FES use.

Ladouceur & Barbeau 2000b;

Canada

Pre-post
N=14 (recruited)

N=10 (completed)

Population: 14 subjects; age 25-49 yrs; all subjects had an incomplete SCI; C3-L1 lesion level; 1.8-19.1 yrs post-injury

Treatment: Surface FES: bilateral or unilateral common peroneal nerve, 2 subjects also had bilateral quadriceps, home use as much as possible ~1 year.

Outcome measures: temporal gait measures.

  1. 7/14 subjects showed improvement based on type of ambulatory device.
  2. 13/14 subjects improved gait speed with FES.
  3. Training/carryover effect after long-term use: increase evident even when FES off in 12/14 subjects.

Wieler et al. 1999;

Canada

Pre-post
N=31

Population: 31 males and females; mean(SD) age 36(2) yrs; all subjects had an incomplete SCI; mean(SD) 6(1) yrs post-injury.

Treatment: Surface FES: common peroneal nerve; some subjects also received FES to hamstrings, quadriceps, gluteus medius, duration of FES ranged from 3 months to over 3 years.

Outcome measures: walking speed, stride length, cycle time.

  1. Overall improvement in gait speed that persisted even when subjects walked without FES.
  2. Greatest % improvements particularly for the initially slow walkers.

Klose et al. 1997;

USA

Pre-post
N=16

Population: Mean (SD) age 28.4 (6.6) years; all subjects had complete SCI; T4-T11 lesion level; 0.7-9.0 yrs post-injury

Treatment: Surface FES: Parastep: 6 channels (bilateral common peroneal nerve, quadriceps, glutei); 3X/week, 32 sessions (once subjects had sufficient strength to stand).

Outcome measures: walking distance and speed (with FES).

  1. Most subjects improved endurance and gait speed. Longest distance walked with FES was between 12 to 1707 m (mean: 334 m; SD 402 m).

Granat et al. 1993;

Scotland

Pre-post
N=6

Population: 6 males and females; age 20-40 yrs; all subjects had diagnosis of Frankel C and D; C3-L1 lesion level; 2 to 18 yrs post-injury

Treatment: Surface FES: quadriceps, hip abductors, hamstrings, erector spinae, common peroneal nerve,
home program >30 min, 5X/week, 3 months.

Outcome measures: walking speed, stride length, cadence.

  1. Significant mean increase in stride length, but not speed or cadence.
  2. 3 to 4 subjects had significant individual increases in gait speed, stride length and cadence.

Stein et al. 1993;

Canada

Pre-post
N=10

Population: 10 males and females; age 20-44 yrs; all subjects had an incomplete SCI ; C2-T10 lesion level; 2.5-10 years post-injury.

Treatment: Surface, percutaneous, or implanted FES of common peroneal nerve, and sometimes quadriceps, glutei, and psoas.

Outcome measures: speed, gait parameters.

  1. All subjects improved gait speed when FES was on (mean change was 4 m/min), particularly significant for more disabled subjects.

Granat et al. 1992;

Scotland

Pre-post

N=6

Population: 3 males and 3 females; age 18-40 yrs; all subjects had an incomplete SCI; C4-T12 lesion level; 2-10 yrs post-injury.

Treatment: 12-months of FES to quadriceps for strengthening and gait (specific program not specified). Additional stimulation to hip abductors and erector spinae as needed.

Outcome Measures: walking speed with FES compared to orthosis.

  1. No significant difference in gait speed with FES compared to ambulation with orthosis.
  2. Subjects were able to use FES for 10-45 minutes.
  3. All subjects were able to use FES at home for standing and walking; 2 also use FES for outdoor walking.
  4. 3 patients eventually discontinued use of FES citing impracticality for regular use
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