Phongamwong Chanwit, Rowe Philip, Chase Karen, Kerr Andrew, Millar Lindsay
Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
BMC Biomed Eng. 2019 Aug 22;1:20. doi: 10.1186/s42490-019-0020-1. eCollection 2019.
Stroke rehabilitation often uses the motor relearning concept that require patients to perform active practice of skill-specific training and to receive feedback. Treadmill training augmented with real-time visualisation feedback and functional electrical stimulation may have a beneficial synergistic effect on motor recovery. This study aims to determine the feasibility of this kind of enhanced treadmill training for gait rehabilitation among patients after stroke. A system for dynamic visualisation of lower-limb movement based on 3-dimentional motion capture and a computer timed functional electrical stimulation system was developed. Participants received up to 20-min enhanced treadmill training instead of their over-ground gait training once or twice a week for 6 weeks at Coathill hospital, Lanarkshire, United Kingdom. Number of training sessions attended, and training duration were used to assess feasibility. Ankle kinematics in the sagittal plane of walking with and without functional electrical stimulation support of the pre-tibial muscles were also compared and used to confirm the functional electrical stimulation was triggered at the targeted time.
Six patients after stroke participated in the study. The majority of participants were male (5/6) with a age range from 30 to 84 years and 4/6 had left hemiplegia. All participants suffered from brain infarction and were at least 3 months after stroke. Number of training sessions attended ranged from 5 to 12. The duration of training sessions ranged from 11 to 20 min. No serious adverse events were reported. The computerised functional electrical stimulation to the pre-tibial muscles was able to reduce plantarflexion angle during the swing phase with statistical significance ( = 0.015 at 80%; = 0.008 at 90 and 100% of the gait cycle).
It is safe and feasible to use treadmill gait training augmented with real-time visual feedback and computer-controlled functional electrical stimulation with patients after stroke in routine clinical practice.
NCT03348215. Registered 20 November 2017.
中风康复通常采用运动再学习概念，要求患者进行特定技能训练的主动练习并接受反馈。结合实时可视化反馈和功能性电刺激的跑步机训练可能对运动恢复产生有益的协同作用。本研究旨在确定这种强化跑步机训练对中风后患者步态康复的可行性。开发了一种基于三维运动捕捉的下肢运动动态可视化系统和一个计算机定时功能性电刺激系统。在英国拉纳克郡的科希尔医院，参与者每周接受一次或两次长达20分钟的强化跑步机训练，替代其地面步态训练，为期6周。通过参加训练的次数和训练时长来评估可行性。还比较了在有和没有胫前肌功能性电刺激支持的情况下行走时矢状面的踝关节运动学，以确认功能性电刺激在目标时间触发。
6名中风后患者参与了该研究。大多数参与者为男性（5/6），年龄在30至84岁之间，4/6有左侧偏瘫。所有参与者均患有脑梗死，且中风后至少3个月。参加训练的次数在5至12次之间。训练时长在11至20分钟之间。未报告严重不良事件。对胫前肌的计算机化功能性电刺激能够在摆动期减少跖屈角度，具有统计学意义（在步态周期的80%时，P = 0.015；在90%和100%时，P = 0.008）。
在常规临床实践中，对中风后患者使用结合实时视觉反馈和计算机控制功能性电刺激的跑步机步态训练是安全可行的。
NCT03348215。于2017年11月20日注册。
