Effect of a bout of leg cycling with electrical stimulation on reduction of hypertonia in patients with stroke.

OBJECTIVES To evaluate whether a bout of leg cycling in patients with stroke reduces muscle tone and to determine whether neuromuscular functional electrical stimulation (FES) to the affected leg during cycling is more effective than cycling without FES. DESIGN Within-subject comparison. SETTING University hospital. PARTICIPANTS Patients with stroke (N=16; age range, 42-72y; <8wk poststroke) with hypertonia in the affected leg. INTERVENTIONS Subjects' affected leg (1) performed cycling exercise with the assistance of FES (assisted-cycling session) and (2) performed cycling exercise without the assistance of FES (nonassisted-cycling session). Subjects sat in a specially designed wheelchair positioned on a resistance-free roller for each 20-minute session. MAIN OUTCOME MEASURES Changes in muscle tone pre- and posttest session were compared by using the Modified Ashworth Scale and the pendulum test (relaxation index and peak velocity). RESULTS Modified Ashworth Scale scores were significantly lower (P<.05) and relaxation index and peak velocity values were significantly higher (P<.05) after both sessions. Changes in Modified Ashworth Scale scores, relaxation index, and peak velocity values showed a significant (P<.05) difference between the 2 sessions, and assisted cycling reduced hypertonia more than nonassisted cycling. CONCLUSIONS The hypertonia of patients with stroke showed a significant decrease immediately after a bout of leg-cycling exercise. FES-assisted leg cycling was better than nonassisted cycling for reducing hypertonia.

[1]  Chien-Hung Lai,et al.  Effects of surface electrical stimulation on the muscle–tendon junction of spastic gastrocnemius in stroke patients , 2005, Disability and rehabilitation.

[2]  S. Hesse,et al.  Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movements in hemiparetic subjects. , 2003, Archives of physical medicine and rehabilitation.

[3]  H Rodgers,et al.  Biomechanical examination of a commonly used measure of spasticity. , 2001, Clinical biomechanics.

[4]  P. Pohl,et al.  Therapeutic interventions to improve upper extremity recovery and function. , 1999, Clinics in geriatric medicine.

[5]  A. de Haan,et al.  Effects of electric stimulation-assisted cycling training in people with chronic stroke. , 2008, Archives of physical medicine and rehabilitation.

[6]  E. V. Jones,et al.  Functional electrical stimulation in tetraplegic patients to restore hand function. , 2002, Journal of long-term effects of medical implants.

[7]  R. Young,et al.  Spasticity, disordered motor control , 1980 .

[8]  C. Kirtley,et al.  Intrarater reliability of manual passive movement velocity in the clinical evaluation of knee extensor muscle tone. , 2000, Archives of physical medicine and rehabilitation.

[9]  T. Evetovich,et al.  Effect of Static Stretching of the Biceps Brachii on Torque, Electromyography, and Mechanomyography During Concentric Isokinetic Muscle Actions , 2003, Journal of strength and conditioning research.

[10]  Noritaka Kawashima,et al.  Effects of Passive Leg Movement on the Oxygenation Level of Lower Limb Muscle in Chronic Stroke Patients , 2008, Neurorehabilitation and neural repair.

[11]  R. G. Lee,et al.  Reciprocal Ia inhibition in patients with asymmetric spinal spasticity , 2002, Clinical Neurophysiology.

[12]  A. Straube,et al.  Changes in spastic muscle tone increase in patients with spinal cord injury using functional electrical stimulation and passive leg movements , 2008, Clinical rehabilitation.

[13]  J. Chen,et al.  Quantifying the effectiveness of the sustained muscle stretching treatments in stroke patients with ankle hypertonia. , 2007, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[14]  Mark Nash,et al.  Effects of functional electrical stimulation training for six months on body composition and spasticity in motor complete tetraplegic spinal cord-injured individuals. , 2002, Journal of rehabilitation medicine.

[15]  R. Chan,et al.  Effects of surface spinal cord stimulation on spasticity and quantitative assessment of muscle tone in hemiplegic patients. , 1998, American journal of physical medicine & rehabilitation.

[16]  H. Hermens,et al.  Influence of posture and muscle length on stretch reflex activity in poststroke patients with spasticity. , 2006, Archives of physical medicine and rehabilitation.

[17]  J. Rothwell.  Control of Human Voluntary Movement , 1994, Springer Netherlands.

[18]  T. Bajd,et al.  Pendulum testing of spasticity. , 1984, Journal of biomedical engineering.

[19]  T. Angeli,et al.  Test bed with force-measuring crank for static and dynamic investigations on cycling by means of functional electrical stimulation , 2001, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[20]  J. Delisa,et al.  Functional Electrical Stimulation Bicycle Ergometry: Patient Perceptions , 1989, American journal of physical medicine & rehabilitation.

[21]  J. Opara,et al.  Treatment of spinal spasticity by electrical stimulation. , 1988, Journal of biomedical engineering.

[22]  B. Bhakta,et al.  Management of spasticity in stroke. , 2000, British medical bulletin.

[23]  Chun-Yu Yeh,et al.  Effects of prolonged muscle stretching with constant torque or constant angle on hypertonic calf muscles. , 2005, Archives of physical medicine and rehabilitation.

[24]  T. Yan,et al.  Functional Electrical Stimulation Improves Motor Recovery of the Lower Extremity and Walking Ability of Subjects With First Acute Stroke: A Randomized Placebo-Controlled Trial , 2005, Stroke.

[25]  B. Brouwer,et al.  Ankle stiffness and tissue compliance in stroke survivors: a validation of Myotonometer measurements. , 2004, Archives of physical medicine and rehabilitation.

[26]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.

[27]  Eadric Bressel,et al.  The effect of prolonged static and cyclic stretching on ankle joint stiffness, torque relaxation, and gait in people with stroke. , 2002, Physical therapy.

[28]  T. Perkins,et al.  FES cycling may promote recovery of leg function after incomplete spinal cord injury , 2000, Spinal Cord.

[29]  R. Chan,et al.  Effects of thoraco-lumbar electric sensory stimulation on knee extensor spasticity of persons who survived cerebrovascular accident (CVA). , 2000, Journal of rehabilitation research and development.

[30]  D. Gelber,et al.  Therapeutics in the Management of Spasticity , 1999 .

[31]  DE Wood,et al.  Theoretical and methodological considerations in the measurement of spasticity , 2005, Disability and rehabilitation.

[32]  Shauna Dudley-Javoroski,et al.  Musculoskeletal Adaptations in Chronic Spinal Cord Injury: Effects of Long-term Soleus Electrical Stimulation Training , 2007, Neurorehabilitation and neural repair.

[33]  B. Andrews,et al.  The role of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injury - observed benefits during gait studies , 1993, Paraplegia.

[34]  A Ashburn,et al.  The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists' perspective , 2000, Disability and rehabilitation.

[35]  Functional electrical stimulation for the reduction of spasticity in the hemiplegic hand. , 1993, Biomedical sciences instrumentation.

[36]  L. Vodovnik,et al.  Effects of electrical stimulation on spinal spasticity. , 2020, Scandinavian journal of rehabilitation medicine.

[37]  R. Kearney,et al.  The effects of long-term FES-assisted walking on intrinsic and reflex dynamic stiffness in spastic spinal-cord-injured subjects , 2002, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[38]  Jane Burridge,et al.  The Effect of Common Peroneal Nerve Stimulation on Quadriceps Spasticity in Hemiplegia , 1997 .

[39]  AD Pandyan,et al.  Spasticity: Clinical perceptions, neurological realities and meaningful measurement , 2005, Disability and rehabilitation.

[40]  A. Kralj,et al.  Functional Electrical Stimulation: Standing and Walking after Spinal Cord Injury , 1989 .

[41]  Maarten J. IJzerman,et al.  Comparison of electric stimulation methods for reduction of triceps surae spasticity in spinal cord injury. , 2006, Archives of physical medicine and rehabilitation.

[42]  Mehdi M Mirbagheri,et al.  The effect of locomotor training combined with functional electrical stimulation in chronic spinal cord injured subjects: walking and reflex studies , 2002, Brain Research Reviews.

[43]  R. D'ambrosia,et al.  Reciprocating gait orthosis powered with electrical muscle stimulation (RGO II). Part I: Performance evaluation of 70 paraplegic patients. , 1997, Orthopedics.

[44]  A. Kralj,et al.  Use of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injuries. , 1989, Journal of biomedical engineering.

[45]  R. Gajdosik,et al.  Passive extensibility of skeletal muscle: review of the literature with clinical implications. , 2001, Clinical biomechanics.

[46]  T. Fukunaga,et al.  Effect of stretching training on the viscoelastic properties of human tendon structures in vivo. , 2002, Journal of applied physiology.