Feasibility of gait training for acute stroke patients using FNS with implanted electrodes

Following stroke, many patients do not regain a normal, safe gait pattern e ven after receiving conventional physical therapy. One promising technique is functional neuromuscular stimulation (FNS) with intramuscular (IM) elect rodes (FNS-LM). Five subjects were admitted into the study at 3 weeks to 3 months following the stroke. For each subject, electrodes were placed intra muscularly at the motor point of up to seven lower extremity paretic muscle s. Subjects were treated for 6 months, twice weekly with FNS-IM for exercis e and gait training. The stimulator and software provided individualized st imulation patterns, with flexible stimulus parameters and activation timing s of multiple muscles. Outcome measures were active joint movement, coordin ation (Fugl-Meyer scale), balance (Tinetti scale), gait (Tinetti scale), ac tivities of daily living (functional independence measure), and therapist a nd subject satisfaction (survey instrument). Subjects tolerated well the pl acement of IM electrodes with no adverse effects, and subjects lost no conv entional rehabilitation time. Therapists and subjects were satisfied with t he FNS-IM system as a rehabilitation tool. Post treatment, subjects demonst rated improvements in impairment and disability in active joint movement, c oordination, balance, gait and activities of daily living. Considered toget her with prior research for chronic stroke subjects, this research suggests that FNS-IM can be successfully and efficaciously utilized for gait traini ng for those with acute stroke. (C) 2000 Published by Elsevier Science B.V.