Ankle range of motion, strength, and coordination are critical in standing balance and gait. Patients with a wide range of diagnoses (CVA, PD, MS, COPD, TKA, THA, generalized weakness, etc.) have impaired ankle balance strategies and diminished walking ability. The use of functional electrical stimulation combines targeted e-stim with functional activity to improve strength and coordination. The studies below illustrate some of the benefits.
• Single session of gait training with FES resulted in an increase in plantarflexor corticomotor symmetry that was related to the observed increase in ankle moment symmetry inducing positive corticomotor plasticity in people in the chronic stage of stroke recovery.¹
• FES on ankle dorsiflexor muscles has a positive effect on muscle tone and stiffness of stroke patients.²
• The use of FES can significantly improve gait speed, decrease impact of MS on walking ability, and improve QOL in people with MS-related footdrop.³
Anterior Tibialis FES protocol
• During standing:
- Goal: To increase anterior tibialis strength/power for improved balance, coordination, and reaction to small perturbation forces.
o While standing in parallel bars or balance trainer, as the patient starts to weight shift backwards the therapist presses and holds the hand control button to facilitate rapid ankle dorsiflexion and ankle righting reaction.
• During gait:
- Goal: To increase anterior tibialis strength and ankle range of motion during the gait cycle for improved toe clearance and to decrease need for compensatory hip circumduction, facilitating improved gait pattern, decreased energy expenditure, increased gait speed, and decreased risk of falls.
o At toe off during gait cycle, FES is activated to facilitate dorsiflexion until heel strike occurs.
References:
1. Palmer JA, Hsiao HY, Wright T, Binder-Macleod SA: Single Session of Functional Electrical Stimulation-Assisted Walking Produces Corticomotor Symmetry Changes Related to Changes in Poststroke Walking Mechanics. Physical Therapy Journal 97 (5):550-560, 2017.
2. Moon SH, Choi JH, Park SE: The eff ects of functional electrical stimulation on muscle tone and stiffness of stroke patients. J Phys. Ther. Sci 29: 238-241, 2017.
3. Downing A, Van Ryn D, Fecko A, Aiken C, McGowan S, Sawers S, McInerny T, Moore K, Passariello L, Rogers H: Effect of 2-week trial of functional electrical stimulation on gait function and quality of life in people with multiple sclerosis. Int J MS Care. 16(3):146-52, 2014.
