Article

Neurorehabilitation efforts have been limited in their ability to
restore walking function after stroke. Recent work has demonstrated
proof-of-concept for a functional electrical stimulation (FES)-based combination
therapy designed to improve poststroke walking by targeting deficits in paretic
propulsion. Objectives To determine the effects on the energy cost of walking
(EC) and long-distance walking ability of locomotor training that combines fast
walking with FES to the paretic ankle musculature (FastFES). Methods Fifty
participants >6 months poststroke were randomized to 12 weeks of gait training at
self-selected speeds (SS), fast speeds (Fast), or FastFES. Participants' 6-minute
walk test (6MWT) distance and EC at comfortable (EC-CWS) and fast (EC-Fast)
walking speeds were measured pretraining, posttraining, and at a 3-month
follow-up. A reduction in EC-CWS, independent of changes in speed, was the
primary outcome. Group differences in the number of 6MWT responders and
moderation by baseline speed were also evaluated. Results When compared with SS
and Fast, FastFES produced larger reductions in EC (Ps </=.03). FastFES produced
reductions of 24% and 19% in EC-CWS and EC-Fast (Ps <.001), respectively, whereas
neither Fast nor SS influenced EC. Between-group 6MWT differences were not
observed; however, 73% of FastFES and 68% of Fast participants were responders,
in contrast to 35% of SS participants. Conclusions Combining fast locomotor
training with FES is an effective approach to reducing the high EC of persons
poststroke. Surprisingly, differences in 6MWT gains were not observed between
groups. Closer inspection of the 6MWT and EC relationship and elucidation of how
reduced EC may influence walking-related disability is warranted.
CI - (c) The Author(s) 2015.

Langue : ANGLAIS