title: Rehabilitation of the hemiparetic gait by nociceptive withdrawal reflex-based functional electrical therapy: a randomized, single-blinded study.
abstract: BACKGROUND
  Gait deficits are very common after stroke and improved therapeutic interventions are needed. The objective of this study was therefore to investigate the therapeutic use of the nociceptive withdrawal reflex to support gait training in the subacute post-stroke phase.
  
  
  METHODS
  Individuals were randomly allocated to a treatment group that received physiotherapy-based gait training supported by withdrawal reflex stimulation and a control group that received physiotherapy-based gait training alone. Electrical stimuli delivered to the arch of the foot elicited the withdrawal reflex at heel-off with the purpose of facilitating the initiation and execution of the swing phase. Gait was assessed before and immediately after finishing treatment, and one month and six months after finishing treatment. Assessments included the Functional Ambulation Category (FAC) test, the preferred and maximum gait velocities, the duration of the stance phase in the hemiparetic side, the duration of the gait cycle, and the stance time symmetry ratio.
  
  
  RESULTS
  The treatment group showed an improved post treatment preferred walking velocity (p < 0.001) and fast walking velocity (p < 0.001) compared to the control group. Furthermore, subjects in the treatment group with severe walking impairment at inclusion time showed the best improvement as assessed by a longer duration of the stance phase in the hemiparetic side (p < 0.002) and a shorter duration of the gait cycle (p < 0.002). The stance time symmetry ratio was significantly better for the treatment than the control group after finishing training (p < 0.02). No differences between groups were detected with the FAC test after finishing training (p = 0.09).
  
  
  CONCLUSIONS
  Withdrawal reflex-based functional electrical therapy was useful in the rehabilitation of the hemiparetic gait of severely impaired patients.
authors.affiliation: Center for Sensory-Motor Interaction (SMI), Aalborg University, Fredrik Bajers Vej 7-D3, DK-9220 Aalborg, Denmark. espaich@hst.aau.dk.
authors.forename: Erika Geraldina
authors.initials: EG
authors.lastname: Spaich
authors.forename: Niels
authors.initials: N
authors.lastname: Svaneborg
authors.forename: Helle Rovsing Møller
authors.initials: HR
authors.lastname: Jørgensen
authors.forename: Ole Kæseler
authors.initials: OK
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D020127:Recovery of Function; D012018:Reflex / Q000502:physiology; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation