Cycling Induced by Electrical Stimulation Improves Muscle Activation and Symmetry During Pedaling in Hemiparetic Patients

A randomized controlled trial, involving 35 post-acute hemiparetic patients, demonstrated that a four-week treatment of cycling induced by functional electrical stimulation (FES-cycling) promotes motor recovery. Analyzing additional data acquired during that study, the present work investigated whether these improvements were associated to changes in muscle strength and motor coordination. Participants were randomized to receive FES-cycling or placebo FES-cycling. Clinical outcome measures were: the Motricity Index (MI), the gait speed, the electromyography activation of the rectus femoris and biceps femoris, and the mechanical work produced by each leg during voluntary pedaling. To provide a comparison with normal values, healthy adults also carried out the pedaling test. Patients were evaluated before, after training, and at follow-up visits. A significant treatment effect in favor of FES-treated patients was found in terms of MI scores and unbalance in mechanical works, while differences in gait speed were not significant (ANCOVA). Significant improvements in the activation of the paretic muscles were highlighted in the FES group, while no significant change was found in the placebo group (Friedman test). Our findings suggested that improvements in motor functions induced by FES-cycling training were associated with a more symmetrical involvement of the two legs and an improved motor coordination.

[1]  R. Dickstein.  Rehabilitation of gait speed after stroke: a critical review of intervention approaches. , 2008, Neurorehabilitation and neural repair.

[2]  Susan T. Francis,et al.  fMRI analysis of active, passive and electrically stimulated ankle dorsiflexion , 2009, NeuroImage.

[3]  J. Hidler,et al.  Understanding Motor Impairment in the Paretic Lower Limb After a Stroke: A Review of the Literature , 2009, Topics in stroke rehabilitation.

[4]  J. Carey,et al.  Electrical stimulation driving functional improvements and cortical changes in subjects with stroke , 2004, Experimental Brain Research.

[5]  Richard R Neptune,et al.  Coordination of Hemiparetic Locomotion after Stroke Rehabilitation , 2005, Neurorehabilitation and neural repair.

[6]  Gad Alon,et al.  Intensive training of subjects with chronic hemiparesis on a motorized cycle combined with functional electrical stimulation (FES): a feasibility and safety study. , 2011, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[7]  D. Thelen,et al.  Differences in lower-extremity muscular activation during walking between healthy older and young adults. , 2009, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[8]  S A Kautz,et al.  Relationships between timing of muscle excitation and impaired motor performance during cyclical lower extremity movement in post-stroke hemiplegia. , 1998, Brain : a journal of neurology.

[9]  G. Ferrigno,et al.  A biofeedback cycling training to improve locomotion: a case series study based on gait pattern classification of 153 chronic stroke patients , 2011, Journal of NeuroEngineering and Rehabilitation.

[10]  C. Patten,et al.  Weakness and strength training in persons with poststroke hemiplegia: rationale, method, and efficacy. , 2004, Journal of rehabilitation research and development.

[11]  G Ferrigno,et al.  Cycling induced by functional electrical stimulation improves the muscular strength and the motor control of individuals with post-acute stroke. Europa Medicophysica-SIMFER 2007 Award Winner. , 2008, European journal of physical and rehabilitation medicine.

[12]  Steven R. Roys,et al.  Functional MRI determination of a dose-response relationship to lower extremity neuromuscular electrical stimulation in healthy subjects , 2003, Experimental Brain Research.

[13]  D. A. Brown,et al.  Phase reversal of biomechanical functions and muscle activity in backward pedaling. , 1999, Journal of neurophysiology.

[14]  J. Krakauer.  Motor learning: its relevance to stroke recovery and neurorehabilitation. , 2006, Current opinion in neurology.

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

[16]  Maarten J. IJzerman,et al.  Recovery of Gait After Stroke: What Changes? , 2008, Neurorehabilitation and neural repair.

[17]  François Hug,et al.  Electromyographic analysis of pedaling: a review. , 2009, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[18]  Giancarlo Ferrigno,et al.  Functional electrical stimulation controlled by artificial neural networks: pilot experiments with simple movements are promising for rehabilitation applications. , 2004, Functional neurology.

[19]  Allan Clark,et al.  Efficacy of Functional Strength Training on Restoration of Lower-Limb Motor Function Early After Stroke: Phase I Randomized Controlled Trial , 2010, Neurorehabilitation and neural repair.

[20]  B. Freriks,et al.  Development of recommendations for SEMG sensors and sensor placement procedures. , 2000, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[21]  A. de Haan,et al.  Intrinsic muscle strength and voluntary activation of both lower limbs and functional performance after stroke , 2008, Clinical physiology and functional imaging.

[22]  L. Sheffler,et al.  Neuromuscular electrical stimulation in neurorehabilitation , 2007, Muscle & nerve.

[23]  F. Zajac,et al.  Locomotor strategy for pedaling: muscle groups and biomechanical functions. , 1999, Journal of neurophysiology.

[24]  Simona Ferrante,et al.  Cycling, a tool for locomotor recovery after motor lesions? , 2008, NeuroRehabilitation.

[25]  Giancarlo Ferrigno,et al.  Design of a symmetry controller for cycling induced by electrical stimulation: preliminary results on post-acute stroke patients. , 2010, Artificial organs.

[26]  J Szecsi,et al.  Functional electrical stimulation assisted cycling of patients with subacute stroke: kinetic and kinematic analysis. , 2008, Clinical biomechanics.

[27]  D. Bourbonnais,et al.  Weakness in patients with hemiparesis. , 1989, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[28]  Steven Y Cen,et al.  Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference , 2010, Physical Therapy.

[29]  M. Popovic,et al.  Electrical stimulation as a means for achieving recovery of function in stroke patients. , 2009, NeuroRehabilitation.

[30]  Giancarlo Ferrigno,et al.  Metrological characterization of a cycle-ergometer to optimize the cycling induced by functional electrical stimulation on patients with stroke. , 2010, Medical engineering & physics.

[31]  Mary Ann O'Brien,et al.  Progressive resistance strengthening exercises after stroke: a single-blind randomized controlled trial. , 2003, Archives of physical medicine and rehabilitation.

[32]  S. Jang,et al.  Functional Magnetic Resonance Image Finding of Cortical Activation by Neuromuscular Electrical Stimulation on Wrist Extensor Muscles , 2003, American journal of physical medicine & rehabilitation.

[33]  D N Rushton,et al.  Functional electrical stimulation and rehabilitation--an hypothesis. , 2003, Medical engineering & physics.

[34]  G. Ferrigno,et al.  Cycling Induced by Electrical Stimulation Improves Motor Recovery in Postacute Hemiparetic Patients: A Randomized Controlled Trial , 2011, Stroke.