Treadmill training augmented with real-time visualisation feedback and function electrical stimulation for gait rehabilitation after stroke: a feasibility study

Chanwit Phongamwong, Philip Rowe, Karen Chase, Andrew Kerr, Lindsay Millar, Chanwit Phongamwong, Philip Rowe, Karen Chase, Andrew Kerr, Lindsay Millar

Abstract

Background: Stroke rehabilitation often uses the motor relearning concept that require patients to perform active practice of skill-specific training and to receive feedback. Treadmill training augmented with real-time visualisation feedback and functional electrical stimulation may have a beneficial synergistic effect on motor recovery. This study aims to determine the feasibility of this kind of enhanced treadmill training for gait rehabilitation among patients after stroke. A system for dynamic visualisation of lower-limb movement based on 3-dimentional motion capture and a computer timed functional electrical stimulation system was developed. Participants received up to 20-min enhanced treadmill training instead of their over-ground gait training once or twice a week for 6 weeks at Coathill hospital, Lanarkshire, United Kingdom. Number of training sessions attended, and training duration were used to assess feasibility. Ankle kinematics in the sagittal plane of walking with and without functional electrical stimulation support of the pre-tibial muscles were also compared and used to confirm the functional electrical stimulation was triggered at the targeted time.

Results: Six patients after stroke participated in the study. The majority of participants were male (5/6) with a age range from 30 to 84 years and 4/6 had left hemiplegia. All participants suffered from brain infarction and were at least 3 months after stroke. Number of training sessions attended ranged from 5 to 12. The duration of training sessions ranged from 11 to 20 min. No serious adverse events were reported. The computerised functional electrical stimulation to the pre-tibial muscles was able to reduce plantarflexion angle during the swing phase with statistical significance (p = 0.015 at 80%; p = 0.008 at 90 and 100% of the gait cycle).

Conclusions: It is safe and feasible to use treadmill gait training augmented with real-time visual feedback and computer-controlled functional electrical stimulation with patients after stroke in routine clinical practice.

Trial registration: NCT03348215. Registered 20 November 2017.

Keywords: 3-dimentional motion capture; Functional electrical stimulation; Stroke; Treadmill training; Visualisation feedback.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2019.

Figures

Fig. 1
Fig. 1
The ankle kinematics when walking with and without FES to the pre-tibial muscles
Fig. 2
Fig. 2
Treadmill and body-weight support system
Fig. 3
Fig. 3
The phase of the gait cycle determined by toe marker trajectory
Fig. 4
Fig. 4
Stimulation pattern of FES
Fig. 5
Fig. 5
Real-time visualisation feedback

References

    1. Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology. 2015;45(3):161–176. doi: 10.1159/000441085.
    1. Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med. 2013;369(5):448–457. doi: 10.1056/NEJMra1201534.
    1. Lawrence ES, Coshall C, Dundas R, Stewart J, Rudd AG, Howard R, et al. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke. 2001;32(6):1279–1284. doi: 10.1161/01.STR.32.6.1279.
    1. Mehrholz J, Wagner K, Rutte K, Meissner D, Pohl M. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil. 2007;88(10):1314–1319. doi: 10.1016/j.apmr.2007.06.764.
    1. Chan DY, Chan CC, Au DK. Motor relearning programme for stroke patients: a randomized controlled trial. Clin Rehabil. 2006;20(3):191–200. doi: 10.1191/0269215506cr930oa.
    1. Chae J, Sheffler L, Knutson J. Neuromuscular electrical stimulation for motor restoration in hemiplegia. Top Stroke Rehabil. 2008;15(5):412–426. doi: 10.1310/tsr1505-412.
    1. Knutson JS, Fu MJ, Sheffler LR, Chae J. Neuromuscular electrical stimulation for motor restoration in hemiplegia. Phys Med Rehabil Clin N Am. 2015;26(4):729–745. doi: 10.1016/j.pmr.2015.06.002.
    1. Daly JJ, Roenigk K, Holcomb J, Rogers JM, Butler K, Gansen J, et al. A randomized controlled trial of functional neuromuscular stimulation in chronic stroke subjects. Stroke. 2006;37(1):172–178. doi: 10.1161/01.STR.0000195129.95220.77.
    1. Daly JJ, Zimbelman J, Roenigk KL, McCabe JP, Rogers JM, Butler K, et al. Recovery of coordinated gait: randomized controlled stroke trial of functional electrical stimulation (FES) versus no FES, with weight-supported treadmill and over-ground training. Neurorehabil Neural Repair. 2011;25(7):588–596. doi: 10.1177/1545968311400092.
    1. Daly JJ, Ruff RL. Feasibility of combining multi-channel functional neuromuscular stimulation with weight-supported treadmill training. J Neurol Sci. 2004;225(1–2):105–115. doi: 10.1016/j.jns.2004.07.006.
    1. Daly JJ, Ruff RL, Haycook K, Strasshofer B, Marsolais EB, Dobos L. Feasibility of gait training for acute stroke patients using FNS with implanted electrodes. J Neurol Sci. 2000;179(S 1–2):103–107. doi: 10.1016/S0022-510X(00)00391-9.
    1. Macdonald AS, Loudon D, Rowe PJ. Visualisation of biomechanical data to assist therapeutic rehabilitation. Gerontechnology. 2010;9(2):98–99.
    1. Thikey H, Grealy M, van Wijck F, Barber M, Rowe P. Augmented visual feedback of movement performance to enhance walking recovery after stroke: study protocol for a pilot randomised controlled trial. Trials. 2012;13(1):163. doi: 10.1186/1745-6215-13-163.
    1. Sloot LH, van der Krogt MM, Harlaar J. Self-paced versus fixed speed treadmill walking. Gait Posture. 2014;39(1):478–484. doi: 10.1016/j.gaitpost.2013.08.022.
    1. Belda-Lois JM, Mena-del Horno S, Bermejo-Bosch I, Moreno JC, Pons JL, Farina D, et al. Rehabilitation of gait after stroke: a review towards a top-down approach. J Neuroeng Rehabil. 2011;8:66. doi: 10.1186/1743-0003-8-66.
    1. Rossano C, Terrier P. Visually-guided gait training in paretic patients during the first rehabilitation phase: study protocol for a randomized controlled trial. Trials. 2016;17(1):523. doi: 10.1186/s13063-016-1630-8.
    1. Bogataj U, Gros N, Malezic M, Kelih B, Kljajic M, Acimovic R. Restoration of gait during two to three weeks of therapy with multichannel electrical stimulation. Phys Ther. 1989;69(5):319–327. doi: 10.1093/ptj/69.5.319.
    1. van Bloemendaal M, Bus SA, de Boer CE, Nollet F, Geurts ACH, Beelen A. Gait training assisted by multi-channel functional electrical stimulation early after stroke: study protocol for a randomized controlled trial. Trials. 2016;17(1):477. doi: 10.1186/s13063-016-1604-x.
    1. Aminian K, Najafi B, Büla C, Leyvraz PF, Robert P. Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes. J Biomech. 2002;35(5):689–699. doi: 10.1016/S0021-9290(02)00008-8.
    1. Millar Lindsay Jane, Meng Lin, Rowe Philip John. Routine clinical motion analysis: comparison of a bespoke real-time protocol to current clinical methods. Computer Methods in Biomechanics and Biomedical Engineering. 2018;22(2):149–158. doi: 10.1080/10255842.2018.1541089.
    1. Green J, Forster A, Young J. A test-retest reliability study of the Barthel index, the Rivermead mobility index, the Nottingham extended activities of daily living scale and the Frenchay activities index in stroke patients. Disabil Rehabil. 2001;23(15):670–676. doi: 10.1080/09638280110045382.
    1. Hsieh CL, Hsueh IP, Mao HF. Validity and responsiveness of the rivermead mobility index in stroke patients. Scand J Rehabil Med. 2000;32(3):140–142. doi: 10.1080/003655000750045497.
    1. Roorda LD, Green JR, Houwink A, Bagley PJ, Smith J, Molenaar IW, et al. The Rivermead mobility index allows valid comparisons between subgroups of patients undergoing rehabilitation after stroke who differ with respect to age, sex, or side of lesion. Arch Phys Med Rehabil. 2012;93(6):1086–1090. doi: 10.1016/j.apmr.2011.12.015.

Source: PubMed

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