Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.
Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Guangdong, China.
J Neuroeng Rehabil. 2022 Jun 7;19(1):56. doi: 10.1186/s12984-022-01036-0.
Gait disability affects the daily lives of patients with stroke in both home and community settings. An abnormal foot-ankle position can cause instability on the supporting surface and negatively affect gait. Our research team explored the ability of a portable peroneal nerve-targeting electrical stimulator to improve gait ability by adjusting the foot-ankle position during walking in patients with chronic stroke undergoing home-based rehabilitation.
This was a double-blinded, parallel-group randomized controlled trial. Thirty-one patients with chronic stroke and ankle-foot motor impairment were randomized to receive 3 weeks of gait training, which involved using the transcutaneous peroneal nerve stimulator while walking (tPNS group; n = 16, mean age: 52.25 years), or conventional home and/or community gait training therapy (CT group; n = 15, mean age: 54.8 years). Functional assessments were performed before and after the 3-week intervention. The outcome measures included spatiotemporal gait parameters, three-dimensional kinematic and kinetic data on the ankle-foot joint, and a clinical motor and balance function assessment based on the Fugl-Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance scales (BBS). Additionally, 16 age-matched healthy adults served as a baseline control of three-dimensional gait data for both trial groups.
The FMA-LE and BBS scores improved in both the tPNS groups (p = 0.004 and 0.001, respectively) and CT groups (p = 0.034 and 0.028, respectively) from before to after training. Participants in the tPNS group exhibited significant differences in spatiotemporal gait parameters, including double feet support, stride length, and walking speed of affected side, and the unaffected foot off within a gait cycle after training (p = 0.043, 0.017, 0.001 and 0.010, respectively). Additionally, the tPNS group exhibited significant differences in kinematic parameters, such as the ankle angle at the transverse plane (p = 0.021) and foot progression angle at the frontal plane (p = 0.009) upon initial contact, and the peak ankle joint angle at the transverse plane (p = 0.023) and foot progression angle (FPA) at the frontal and transverse planes (p = 0.032 and 0.046, respectively) during gait cycles after 3 weeks of training.
Use of a portable tPNS device during walking tasks appeared to improve spatiotemporal gait parameters and ankle and foot angles more effectively than conventional home rehabilitation in patients with chronic stroke. Although guidelines for home-based rehabilitation training services and an increasing variety of market devices are available, no evidence for improvement of motor function and balance was superior to conventional rehabilitation. Trial registration Chictr, ChiCTR2000040137. Registered 22 November 2020, https://www.chictr.org.cn/showproj.aspx?proj=64424.
步态障碍会影响中风患者在家庭和社区环境中的日常生活。异常的足踝位置会导致支撑面不稳定，并对步态产生负面影响。我们的研究团队探索了一种便携式腓总神经靶向电刺激器的能力，通过在慢性中风患者进行家庭康复期间行走时调整足踝位置来改善步态能力。
这是一项双盲、平行组随机对照试验。31 名患有慢性中风和踝关节运动障碍的患者被随机分为接受 3 周的步行训练组，其中包括使用经皮腓总神经刺激器（tPNS 组；n=16，平均年龄：52.25 岁），或传统家庭和/或社区步态训练治疗（CT 组；n=15，平均年龄：54.8 岁）。在干预 3 周前后进行功能评估。结局测量包括时空步态参数、踝关节和足部的三维运动学和动力学数据，以及基于 Fugl-Meyer 下肢评估（FMA-LE）和 Berg 平衡量表（BBS）的临床运动和平衡功能评估。此外，16 名年龄匹配的健康成年人作为两个试验组的三维步态数据的基线对照组。
tPNS 组（p=0.004 和 0.001）和 CT 组（p=0.034 和 0.028）在训练前后 FMA-LE 和 BBS 评分均有改善。tPNS 组的时空步态参数，包括双侧支撑、步长和患侧行走速度，以及步态周期内患侧足离地时间，均有显著差异（p=0.043、0.017、0.001 和 0.010）。此外，tPNS 组在初始接触时的踝关节在横平面上的角度（p=0.021）和足在额状面上的推进角度（p=0.009），以及踝关节在横平面上的峰值角度（p=0.023）和足在额状面和横平面上的推进角度（p=0.032 和 0.046）等运动学参数方面也有显著差异。
与传统家庭康复相比，使用便携式 tPNS 设备在步行任务中似乎更能有效改善慢性中风患者的时空步态参数以及踝关节和足部角度。尽管有家庭康复训练服务的指南和越来越多的市场设备，但在改善运动功能和平衡方面没有证据优于传统康复。
Chictr，ChiCTR2000040137。注册于 2020 年 11 月 22 日，https://www.chictr.org.cn/showproj.aspx？proj=64424。
