A novel neuromuscular electrical stimulation treatment for recovery of ankle dorsiflexion in chronic hemiplegia: a case series pilot study.
OBJECTIVE
To evaluate the feasibility of improving active ankle dorsiflexion with contralaterally controlled neuromuscular electrical stimulation (CCNMES).


METHODS
CCNMES dorsiflexes the paretic ankle with a stimulation intensity that is directly proportional to the degree of voluntary dorsiflexion of the unimpaired contralateral ankle, which is detected by an instrumented sock. Three subjects with chronic (>6-mo poststroke) dorsiflexor paresis participated in a 6-wk CCNMES treatment, which consisted of self-administering CCNMES-assisted ankle dorsiflexion exercises at home daily and practicing an ankle motor control task in the research laboratory twice a week.


RESULTS
For subjects 1 and 2, respectively, maximum voluntary ankle dorsiflexion increased by 13 and 17 degrees, ankle movement tracking error decreased by approximately 57% and 57%, and lower limb Fugl-Meyer score (maximum score is 34) increased by 4 and 5 points. Subject 3 had no appreciable improvement in these measures. Both subjects 1 and 2 maintained their performance in ankle movement tracking through the 3-mo follow-up; subject 2 also maintained the gains in maximum ankle dorsiflexion and Fugl-Meyer score.


CONCLUSIONS
These results suggest that CCNMES may have a positive effect on ankle motor impairment in some stroke survivors. Further investigation of the effect of CCNMES on gait is warranted.
Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.
Jayme S
JS
Knutson
John
J
Chae
D000328:Adult; D000843:Ankle Joint / Q000294:innervation / Q000503:physiopathology*; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D006429:Hemiplegia / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation*; D010865:Pilot Projects; D016059:Range of Motion, Articular / Q000502:physiology*; D020521:Stroke / Q000503:physiopathology