A Randomized Controlled Trial of Functional Neuromuscular Stimulation in Chronic Stroke Subjects

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Abstract
Background and Purpose— Conventional therapies fail to restore normal gait to many patients after stroke. The study purpose was to test response to coordination exercise, overground gait training, and weight-supported treadmill training, both with and without functional neuromuscular stimulation (FNS) using intramuscular (IM) electrodes (FNS-IM). Methods— In a randomized controlled trial, 32 subjects (>1 year after stroke) were assigned to 1 of 2 groups: FNS-IM or No-FNS. Inclusion criteria included ability to walk independently but inability to execute a normal swing or stance phase. All subjects were treated 4 times per week for 12 weeks. The primary outcome measure, obtained by a blinded evaluator, was gait component execution, according to the Tinetti gait scale. Secondary measures were coordination, balance, and 6-minute walking distance. Results— Before treatment, there were no significant differences between the 2 groups for age, time since stroke, stroke severity, and each study measure. FNS-IM produced a statistically significant greater gain versus No-FNS for gait component execution ( P =0.003; parameter estimate 2.9; 95% CI, 1.2 to 4.6) and knee flexion coordination ( P =0.049). Conclusion— FNS-IM can have a significant advantage versus No-FNS in improving gait components and knee flexion coordination after stroke.

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