title: Recovery of coordinated gait: randomized controlled stroke trial of functional electrical stimulation (FES) versus no FES, with weight-supported treadmill and over-ground training.
abstract: BACKGROUND
  No single intervention restores the coordinated components of gait after stroke.
  
  
  OBJECTIVE
  The authors tested the multimodal Gait Training Protocol, with or without functional electrical stimulation (FES), to improve volitional walking (without FES) in patients with persistent (>6 months) dyscoordinated gait.
  
  
  METHODS
  A total of 53 subjects were stratified and randomly allocated to either FES with intramuscular (IM) electrodes (FES-IM) or No-FES. Both groups received 1.5-hour training sessions 4 times a week for 12 weeks of coordination exercises, body weight-supported treadmill training (BWSTT), and over-ground walking, provided with FES-IM or No-FES. The primary outcome was the Gait Assessment and Intervention Tool (G.A.I.T.) of coordinated movement components, with secondary measures, including manual muscle testing, isolated leg movements (Fugl-Meyer scale), 6-Minute Walk Test, and Locomotion/Mobility subscale of the Functional Independence Measure (FIM).
  
  
  RESULTS
  No baseline differences in subject characteristics and measures were found. The G.A.I.T. showed an additive advantage with FES-IM versus No-FES (parameter statistic 1.10; P = .045, 95% CI = 0.023-2.179) at the end of training. For both FES-IM and No-FES, a within-group, pre/posttreatment gain was present for all measures (P < .05), and a continued benefit from mid- to posttreatment (P < .05) was present. For FES-IM, recovered coordinated gait persisted at 6-month follow-up but not for No-FES.
  
  
  CONCLUSIONS
  Improved gait coordination and function were produced by the multimodal Gait Training Protocol. FES-IM added significant gains that were maintained for 6 months after the completion of training.
authors.affiliation: Cognitive and Motor Learning Research Program, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106, USA. jjd17@case.edu
authors.forename: Janis J
authors.initials: JJ
authors.lastname: Daly
authors.forename: Janice
authors.initials: J
authors.lastname: Zimbelman
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Roenigk
authors.forename: Jessica P
authors.initials: JP
authors.lastname: McCabe
authors.forename: Jean M
authors.initials: JM
authors.lastname: Rogers
authors.forename: Kristi
authors.initials: K
authors.lastname: Butler
authors.forename: Richard
authors.initials: R
authors.lastname: Burdsall
authors.forename: John P
authors.initials: JP
authors.lastname: Holcomb
authors.forename: E Byron
authors.initials: EB
authors.lastname: Marsolais
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ruff
mesh_terms: D000368:Aged; D003627:Data Interpretation, Statistical; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D057187:Independent Living; D008124:Locomotion / Q000502:physiology; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D055070:Resistance Training; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology