ǂAn ǂevaluation of gait parameters after the utilization of novel multi-pad functional electrical stimulation in stroke patients

[S. Dedijer Dujović]

str.112

medicina / biomedicinsko inženjerstvo i tehnologije

medicine / biomedical engineering

Nemogućnost podizanja stopala je najčešća manifestacija poremećaja hoda kod pacijenata nakon moždanog udara. I pored primenjene terapije 25-30% osoba nakon moždanog udara i dalje nije samostalno u izvođenju svakodnevnih životnih aktivnosti. Osnovni pristup korekcije pada stopala jeste primena konvencionalne terapije i potkolene plastične peronealne ortoze koja stabilizuje zglob. Od primene funkcionalne električne stimulacije očekuje se, posebno kada se primenjuje prema protokolu koji omogućava selektivnu stimulaciju da unapredi motorni oporavka. Međutim, pregled literature pokazuje nekonzistentan stepen efikasnosti u različitim modelima kliničkih istraživanja. Ciljevi: Ispitivanje efikasnosti funkcionalne električne stimulacije (primenom posebnog protokola koji obezbeđuje selektivnu stimulaciju) na motorni oporavak nakon moždanog udara u odnosu na konvencione metode, praćenjem kliničkih i kinematičkih parametara hoda. Metod: Funkcionalna procena pacijenata obuhvatila je: brzinu hoda na distanci od 10 metara, Fugl-Meyer skala, Bergova skala balansa, Barthel index. Procena hoda vršena je i površinskom elektromiografijom mišića pokretača stopala i kinematičkom analizom prostorno-vremenskih parametara hoda. Rezultati: Pokazano je da funkcionalna električna stimulacija primenjena posebnim protokolom koji obezbeđuje selektivnu stimulaciju, značajnije doprinosi poboljšanju funkcije hoda u odnosu na efikasnost samostalne konvencionalne terapije. Postignuto unapređenje brzine hoda i motornog oporavka korelira sa promenama mišićnih obrazaca kao i sa prostorno-vremenskim parametrima hoda. Zaključak: Klinička implementacija unapređenog sistema za funkcionalnu električnu stimulaciju i metoda za procenu hoda značajnije doprinose funkcionalnom oporavku pacijenata nakon moždanog udara.

The loss of the ability to lift a foot is the most common manifestation of gait disturbances which patients who survived a stroke may experience. Albeit therapy, 25-30% of people who survive a stroke remain unable to independently carry out various activities of daily living. The main approach to correct a foot drop is conventional therapy and ankle foot orthosis which stabilises a joint. The application of functional electrical stimulation is expected to improve motor recovery - especially when it is applied according to a protocol which enables selective stimulation. However, a review of available studies shows an inconsistent level of effectiveness in different clinical research models. Objectives: The examination of the effectiveness of functional electrical stimulation (applied as a specific protocol which enables selective stimulation) in motor recovery after a stroke compared to conventional therapy - by following clinical and kinematic parameters of walking. Method: The functional assessment of patients included the gait velocity at 10 meters distance, the Fugl-Meyer Assessment, the Berg Balance Scale and the Barthel Index. Gait assessment was also done by using surface electromyography of the muscles in charge of foot movement and by kinematic analysis of spatial-temporal parameters in walking. Results: It has been demonstrated that the functional electrical stimulation applied as a specific protocol which enables selective stimulation significantly contributes to the improvement of walking function when compared to the efficiency of conventional rehabilitation therapy only. The achieved improvement in the gait velocity and motor recovery correlates to the changes in muscle patterns as well as to the spatial-temporal parameters in walking. Conclusion: The clinical implementation of an improved system for functional electrical stimulation and the methods for the assessment of walking significantly contribute to the functional recovery of stroke patients.

moždani udar, padajuće stopalo, analiza hoda, rehabilitacija, funkcionalna električna stimulacija, višepoljne elektrode.

stroke, foot drop, gait analysis, rehabilitation, functional electrical stimulation, multi-pad electrode array

61:621.3.032.2(043.3)

Tekst