How to prepare a person with complete spinal cord injury to use surface electrodes for FES trike cycling.

Functional Electrical Stimulation (FES) cycling could benefit people with Spinal Cord Injury (SCI). The FES cycling involves large muscle groups during the training, and thus improves the cardiovascular function, increases the muscle bulk and reduces the secondary complications. This study developed an outdoor FES exercise cycling system for complete SCI persons to exercise their lower limbs without putting extra load on upper extremities. The mechanical structure of the cycling system was specially redesigned to secure the SCI persons in the cycling system. A six-phase-angle-driven control algorithm was designed to stimulate the quadriceps and hamstrings muscles. Two training modes, i.e., continuous mode and on-off mode, were designed and tested to increase the duration of the electrical stimulation to reduce muscle fatigue. A complete SCI volunteer participated in this training for six months. Beneficial effects could be observed such as paralyzed lower limb muscles had regained the muscle mass and reduced edema from the improved blood circulation. Moreover, the SCI volunteer attended the Cybathlon FES-bike competition in Zurich in October 2016 with Team Phoenix from the CUHK.

A pilot study of randomized clinical controlled trial of gait training in subacute stroke patients with partial body-weight support electromechanical gait trainer and functional electrical stimulation: six-month follow-up.

BACKGROUND AND PURPOSE: This study aimed to assess the effectiveness of gait training using an electromechanical gait trainer with or without functional electrical stimulation for people with subacute stroke. METHODS: This was a nonblinded randomized controlled trial with a 6-month follow-up. Fifty-four subjects were recruited within 6 weeks after stroke onset and were randomly assigned to 1 of 3 gait intervention groups: conventional overground gait training treatment (CT, n=21), electromechanical gait trainer (GT, n=17) and, electromechanical gait trainer with functional electrical stimulation (GT-FES, n=16). All subjects were to undergo an assigned intervention program comprising a 20-minute session every weekday for 4 weeks. The outcome measures were Functional Independence Measure, Barthel Index, Motricity Index leg subscale, Elderly Mobility Scale (EMS), Berg Balance Scale, Functional Ambulatory Category (FAC), and 5-meter walking speed test. Assessments were made at baseline, at the end of the 4-week intervention program, and 6 months after the program ended. RESULTS: By intention-to-treat and multivariate analysis, statistically significant differences showed up in EMS (Wilks' lambda=0.743, P=0.005), FAC (Wilks' lambda=0.744, P=0.005) and gait speed (Wilks' lambda=0.658, P<0.0001). Post hoc analysis (univariate 2-way ANCOVA) revealed that the GT and GT-FES groups showed significantly better improvement in comparison with the CT group at the end of the 4 weeks of training and in the 6-month follow-up. CONCLUSIONS: For the early stage after stroke, this study indicated a higher effectiveness in poststroke gait training that used an electromechanical gait trainer compared with conventional overground gait training. The training effect was sustained through to the 6-month follow-up after the intervention.

Gait training of patients after stroke using an electromechanical gait trainer combined with simultaneous functional electrical stimulation.

BACKGROUND AND PURPOSE: This case report describes the implementation of gait training intervention that used an electromechanical gait trainer with simultaneous functional electrical stimulation (FES) for 2 patients with acute ischemic stroke. CASE DESCRIPTION: Two individuals with post-stroke hemiplegia of less than 6 weeks' duration participated in a 4-week gait training program as an adjunct to physical therapy received at a hospital. After the 4-week intervention, both patients were discharged from the hospital, and they returned after 6 months for a follow-up evaluation. OUTCOMES: By the end of the 4-week intervention, both patients had shown improvements in scores on the Barthel Index, Berg Balance Scale, Functional Ambulation Categories Scale, 5-m timed walking test, and Motricity Index. In the 6-month follow-up evaluation, both patients continued to have improvements in all outcome measures. DISCUSSION: This case report shows that, following the use of an electromechanical gait trainer simultaneously with FES, patients after acute stroke had improvements in gait performance, functional activities, balance, and motor control in the long term.