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.
Knutson
Jayme S
JS
Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.
Chae
John
J
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