Effect of visual feedback treadmill walking exercise using FES system
for stroke outpatients with hemiplegia. - 2 cases pilot study
K Ota, MD1)2); H Matsuura, MD1)2); K Onogi, MD1)
E Yoshihashi, PT2); S Kageyama, PT2); D Kikuchi, PT2); K Chinzei PT2)
1) Fujita Health University 2) Dep. Rehabilitation,Toyota Reginal Medical Center, Japan

Background and Aims
Treadmill walking exercise is practiced using ankle-foot orthosis for stroke hemiplegic patients with drop foot.
This training is reported to be more effective than level walking exercise in the improvement of stable gait pattern
and the increase of walking endurance1). Nowadays, walking exercise using functional electrical stimulation systemwith common peroneal nerve stimulation during swing phase for drop foot is considered more useful in the point ofactivation to neuromuscular system than the ankle foot orthosis treatment. However, both trainer and the patient
could not find the right electrical stimulation timing during usual treadmill walking exercise.
This study examined the effectiveness of visual feedback system on treadmill walking exercise using Welwalk
WW-1000TM and a FES system for chronic stroke patients with drop foot.
Subjects and Methods<Study design>
Prospective observational pilot case study.
＜Subjects＞
Two chronic hemiplegiic stroke outpatients with drop foot.
Age 76 and 78. Subjects can walk with t-cane and ankle
foot orthosis under caregivers supervised condition.
<Methods>
Visual feedback treadmill walking exercise with FES weredone twice a week for three months. Welwalk WW-1000TM
was used as a visual feedback treadmill with a digitalmonitor displaying a lateral walking image(Fig-1), andWalkAidTM was used as a FES system for drop foot(Fig-2).
Treadmill walking exercise was done for 20 minutes ineach 40 minutes physical therapy session.
Results#1: Visual feedback was useful to get stabilization ofwalking pattern during FES stimulation (Fig-3).
#2: 10m gait time of two subjects changed from 122.5 to56.7sec., 33.5 to 28.4 sec. respectively (Fig-4).
#3: 6 minutes walking distance(6MD) increased from 10to 59 m and 107 to 165m (Fig-4).
This intervention course gained excellent improvement inwalking ability with patients satisfaction indicated in Visual
Analog Scale; VAS 7 and 8.

Both patient and PT can watch
the lateral view of patient’s
walking on the front monitor

Fig-1. Welwalk WW-1000

CCD-Camera shows lateralview on the front Monitor

For severe hemiplegic patients, knee-ankle-foot orthoses (KAFO) are frequently used to prevent
giving way in the stance phase. However, it is very difficult to swing paralytic leg with KAFO. As
a result, walking exercise with KAFO requires a high level of assistance and raise low exercise
intensity. To solve these problems, Welwalk WW-1000, which has a motor on the knee joint with
KAFO-like framework, was developed. Welwalk can extend and flex the knee in appropriate
timing. Subacute stroke patients with hemiplegia who had walking exercise using Welwalk WW1000 showed early improvement in walking independence compared to patients using KAFO 3).

®
WalkAide
The WalkAide® System is an advanced Functional Electrical (FES)
Stimulation System for the treatment of Foot Drop caused byupper motor neuron injury.
Utilizing a tilt sensor and accelerometer technology, the WalkAide
stimulates the common peroneal nerve to lift the foot at the righttime during the gait cycle, prompting a more natural, efficient,and safe walking pattern. WalkAide users have the freedom towalk with or without footwear, up and down the stairs, and all
directions.

Heel Off

Heel StrikeDiscussion
Stimulation Period
This study demonstrated that the visual feedback
Stimulation Off Fig2. Treadmill walking exercise using WalkAde
Stimulation On
Manual stimulation mode during walking
treadmill walking exercise is useful for improving gait
pattern of chronic hemiplegic patients. Welwalk WW-1000TM
Fig-3. Change of walking pattern between first and final stage in this walking ex. program Fig-4. Change of 10m gait time and 6MD
has a big display front monitor on which both a patient anda physical therapist can watch the lateral view of thepatient’s walking. The timing of functional electricalstimulation is reported to be an essential key point tofacilitate neuro-motor systems2), thus our trial of visualfeedback treadmill walking exercise using Welwalk WW1000TM and Walk AideTM stimulation is considered to bequite useful on the standpoint of Neurorehabilitation.
TMConclusions
The visual feedback system that uses a lateral view of thepatient’s walking, is thought to be useful in treadmill
walking exercise with the FES system, particularly forchronic hemiplegic stroke patients with drop foot.

Reference1)A.Srivastava et al. Bodyweight-supported treadmill training for retraining gait
among chronic stroke survivors :Anal Phys Rehab Med 59(2016)235-241
2)K.Takeda et al. Review of devices used in neuromuscular electrical stimulation
for stroke rehabilitation. Medical Devices 10(2017) 207-213

3)S.Hirano et al.Welwalk facilitate early improvement in walking
independence of with hemiplegia:Annals of Physical and Rehabilitation Medicine
61:e93DOI: 10.1016/j.rehab.2018