Gait and hand function enhancement following training with a multi-segment hybrid-orthosis stimulation system in stroke patients

Abstract

The majority of stroke survivors continue to suffer residual functional deficits due to weakness and inadequate motor control of their paretic muscles. Non-invasive functional electrical stimulation has been limited to stimulation of only 1-2 muscle groups. The purpose of this study was to test if the use of a multi-segment hybrid orthosis-stimulation system combined with electrically augmented functional training would promote improvement in gait and hand functions of patients with chronic hemiparesis. A control group (n = 9) received individual instructions for specific functional training and self-exercised up to 60 minutes twice daily. The stimulated group (n = 10) received self-administered electrical stimulation training using the NESS system. Training time increased to 60 minutes twice daily and comprised of specific functional exercise. Each group trained for 3 months. Upper limb outcome measures included the Box & Block (B & B) and 3 sub-tests of the Jebsen-Taylor (J & T) battery. Gait outcomes included 10-meter walk time, speed, cadence, and number of steps. Post-test-pretest data were analyzed by unpaired t-tests (P = 0.05). The stimulated group improved significantly compared to the control group in B & B (7.9 +/- 4.5 vs 0.2 +/- 2.2 more blocks); J & T simulated feeding (12.6 +/- 14.8 vs 1.2 +/- 2.09 sec); J & T light object lift (8.2 +/- 9.7 vs. -0.3 +/- 2.8 sec); J & T heavy object lift (7.6 +/- 11.0 vs -0.8 +/- 1.6 sec); walk time (3.3 +/- 1.1 sec vs -0.3 +/- 1.8 sec); walking speed (0.33 +/- 0.12 vs. -0.01 +/- 0.1 m/sec); cadence (0.30 +/- 0.18 vs. -0.02 +/- 0.14 steps/sec). The number of steps over 10 m decreased 2.7 +/- 1.4 vs -0.2 +/- 1.98 steps. We concluded that electrically-dependent functional training with multi-segment hybrid orthosis-stimulation system can improve the studied functional outcomes of chronic stroke survivors.