Department of Biomedical Engineering, University of Delaware, 540 S. College Ave, Suite 201, Newark, DE 19713.
University of Delaware.
J Biomech Eng. 2024 Dec 1;146(12). doi: 10.1115/1.4066419.
Functional electrical stimulation (FES) is often used in poststroke gait rehabilitation to address decreased walking speed, foot drop, and decreased forward propulsion. However, not all individuals experience clinically meaningful improvements in gait function with stimulation. Previous research has developed adaptive functional electrical stimulation (AFES) systems that adjust stimulation timing and amplitude at every stride to deliver optimal stimulation. The purpose of this work was to determine the effects of a novel AFES system on functional gait outcomes and compare them to the effects of the existing FES system. Twenty-four individuals with chronic poststroke hemiparesis completed 64-min walking trials on an adaptive and fixed-speed treadmill with no stimulation, stimulation from the existing FES system, and stimulation from the AFES system. There was no significant effect of stimulation condition on walking speed, peak dorsiflexion angle, or peak propulsive force. Walking speed was significantly faster and peak propulsive force was significantly larger on the adaptive treadmill (ATM) than the fixed-speed treadmill (both p < 0.0001). Dorsiflexor stimulation timing was similar between stimulation conditions, but plantarflexor stimulation timing was significantly improved with the AFES system compared to the FES system (p = 0.0059). Variability between and within subjects was substantial, and some subjects experienced clinically meaningful improvements in walking speed, peak dorsiflexion angle, and peak propulsive force. However, not all subjects experienced benefits, suggesting that further research to characterize which subjects exhibit the best instantaneous response to FES is needed to optimize poststroke gait rehabilitation using FES.
功能性电刺激（FES）常用于脑卒中后步态康复，以解决步行速度降低、足下垂和向前推进力降低的问题。然而，并非所有个体在接受刺激后都能在步态功能上获得明显的临床改善。先前的研究已经开发出适应性功能性电刺激（AFES）系统，该系统可在每一步调整刺激的时间和幅度，以提供最佳刺激。本研究旨在确定新型 AFES 系统对功能性步态结果的影响，并将其与现有的 FES 系统的效果进行比较。24 名慢性脑卒中偏瘫患者在自适应和定速跑步机上进行了 64 分钟的步行试验，无刺激、现有 FES 系统刺激和 AFES 系统刺激。刺激条件对步行速度、最大背屈角度和最大推进力没有显著影响。与定速跑步机相比，自适应跑步机上的步行速度显著更快，最大推进力显著更大（均 p < 0.0001）。在刺激条件之间，背屈肌刺激时间相似，但与 FES 系统相比，AFES 系统的跖屈肌刺激时间明显改善（p = 0.0059）。个体之间和个体内部的变异性很大，一些个体的步行速度、最大背屈角度和最大推进力有明显改善。然而，并非所有个体都受益，这表明需要进一步研究，以确定哪些个体对 FES 具有最佳的即时反应，从而优化脑卒中后步态康复中的 FES 应用。
