Gait Rehabilitation Using Functional Electrical Stimulation Induces Changes in Ankle Muscle Coordination in Stroke Survivors: A Preliminary Study
Gait Rehabilitation Using Functional Electrical Stimulation Induces Changes in Ankle Muscle Coordination in Stroke Survivors: A Preliminary Study
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DOI：
10.3389/fneur.2018.01127
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发表时间：
2018-12-20
影响因子：
3.4
通讯作者：
Kesar, Trisha M.
中科院分区：
文献类型：
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作者：
Allen, Jessica L.;Ting, Lena H.;Kesar, Trisha M.
背景：之前的研究表明，中风后步态康复结合在跑步机上快速步行（FastFES）期间对踝关节肌肉施加功能性电刺激（FES）可以改善步态生物力学和临床步行功能。然而，个体对 FastFES 的反应存在相当大的差异。尽管 FastFES 旨在塑造踝关节肌肉协调性，但踝关节肌肉活动的变化是否是观察到的步态改善的基础尚不清楚。本研究的目的是调查三个案例，说明 FastFES 如何在步行过程中调节踝关节肌肉募集。 方法：我们对参加 18 次 FastFES 课程（每周 3 次；ClinicalTrials.gov：NCT01668602）的三人（53-70 岁；2 M；中风后 35-60 个月；19-22 下肢 Fugl-Meyer）进行了初步病例系列研究。在 FastFES 前后无刺激行走时，评估临床步行功能（速度、6 分钟步行测试和定时起立行走测试）、步态生物力学（初始接触时的麻痹推进力和踝关节角度）和跖屈肌（比目鱼肌）/背屈肌（胫骨前肌）肌肉募集。结果：根据临床步行功能的改善情况，两名参与者（R1、R2）被归类为响应者。与步态康复后通常观察到的临床和生物力学变化的异质性一致，FastFES 改变肌肉活动的方式在反应者之间存在差异。 R1 在站立期间表现出改善的跖屈肌募集，同时伴随着麻痹推进力的增加。 R2 在摆动期间表现出改善的背屈肌募集，同时在初始接触时改善了麻痹性踝关节角度。相比之下，第三名参与者（NR1）被归类为无反应者，在步态周期的不适当阶段表现出踝关节肌肉活动增加。在所有参与者中，FastFES 后步行速度的增加与 SOL/TA 肌肉共激活的减少之间存在正相关关系。 结论：我们的初步病例系列研究首次证明，中风后个体接受 FastFES 后，踝关节跖屈肌和背屈肌募集（FastFES 的目标肌肉）的改善伴随着步态生物力学和步行功能的改善。我们的结果还表明，诱导更适当的（即减少的）踝跖/背屈肌共激活可能是 FastFES 训练后步态功能改善的重要神经肌肉机制，这表明治疗前的踝关节肌肉状态可用于纳入 FastFES。该案例系列研究的结果虽然是初步的，但为使用类似方法的大样本研究提供了基本原理和基础。
Background: Previous studies have demonstrated that post-stroke gait rehabilitation combining functional electrical stimulation (FES) applied to the ankle muscles during fast treadmill walking (FastFES) improves gait biomechanics and clinical walking function. However, there is considerable inter-individual variability in response to FastFES. Although FastFES aims to sculpt ankle muscle coordination, whether changes in ankle muscle activity underlie observed gait improvements is unknown. The aim of this study was to investigate three cases illustrating how FastFES modulates ankle muscle recruitment during walking.Methods: We conducted a preliminary case series study on three individuals (53-70 y; 2 M; 35-60 months post-stroke; 19-22 lower extremity Fugl-Meyer) who participated in 18 sessions of FastFES (3 sessions/week; ClinicalTrials.gov: NCT01668602). Clinical walking function (speed, 6-min walk test, and Timed-Up-and-Go test), gait biomechanics (paretic propulsion and ankle angle at initial-contact), and plantarflexor (soleus)/dorsiflexor (tibialis anterior) muscle recruitment were assessed pre- and post-FastFES while walking without stimulation.Results: Two participants (R1, R2) were categorized as responders based on improvements in clinical walking function. Consistent with heterogeneity of clinical and biomechanical changes commonly observed following gait rehabilitation, how muscle activity was altered with FastFES differed between responders. R1 exhibited improved plantarflexor recruitment during stance accompanied by increased paretic propulsion. R2 exhibited improved dorsiflexor recruitment during swing accompanied by improved paretic ankle angle at initial-contact. In contrast, the third participant (NR1), classified as a non-responder, demonstrated increased ankle muscle activity during inappropriate phases of the gait cycle. Across all participants, there was a positive relationship between increased walking speeds after FastFES and reduced SOL/TA muscle coactivation.Conclusion: Our preliminary case series study is the first to demonstrate that improvements in ankle plantarfiexor and dorsiflexor muscle recruitment (muscles targeted by FastFES) accompanied improvements in gait biomechanics and walking function following FastFES in individuals post-stroke. Our results also suggest that inducing more appropriate (i.e., reduced) ankle plantar/dorsi-flexor muscle coactivation may be an important neuromuscular mechanism underlying improvements in gait function after FastFES training, suggesting that pre-treatment ankle muscle status could be used for inclusion into FastFES. The findings of this case-seriesstudy, albeit preliminary, provide the rationale and foundations for larger-sample studies using similar methodology.