Article

No single intervention restores the coordinated components of gait
after stroke.The authors tested the multimodal Gait Training
Protocol, with or without functional electrical stimulation (FES), to improve
volitional walking (without FES) in patients with persistent (>6 months)
dyscoordinated gait. METHODS: A total of 53 subjects were stratified and randomly
allocated to either FES with intramuscular (IM) electrodes (FES-IM) or No-FES.
Both groups received 1.5-hour training sessions 4 times a week for 12 weeks of
coordination exercises, body weight-supported treadmill training (BWSTT), and
over-ground walking, provided with FES-IM or No-FES. The primary outcome was the
Gait Assessment and Intervention Tool (G.A.I.T.) of coordinated movement
components, with secondary measures, including manual muscle testing, isolated
leg movements (Fugl-Meyer scale), 6-Minute Walk Test, and Locomotion/Mobility
subscale of the Functional Independence Measure (FIM). RESULTS: No baseline
differences in subject characteristics and measures were found. The G.A.I.T.
showed an additive advantage with FES-IM versus No-FES (parameter statistic 1.10;
P = .045, 95% CI = 0.023-2.179) at the end of training. For both FES-IM and
No-FES, a within-group, pre/posttreatment gain was present for all measures (P <
.05), and a continued benefit from mid- to posttreatment (P < .05) was present.
For FES-IM, recovered coordinated gait persisted at 6-month follow-up but not for
No-FES. CONCLUSION: Improved gait coordination and function were produced by the
multimodal Gait Training Protocol. FES-IM added significant gains that were
maintained for 6 months after the completion of training.

Langue : ANGLAIS