Cycling Exercise With Functional Electrical Stimulation Improves Postural Control in Stroke Patients
Condition: Postural Control
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      The aim of this study is to determine whether a short-term of FES assisted cycling in stroke
      patients can reduce the muscle tone of the affected leg immediately and the influence the
      postural control of the subjects.
    

Detailed description: 
      Patients with stroke frequently results in secondary complications of the neuromuscular
      system. For post-stroke patients, varying deficits in sensation, muscle strength, muscle tone
      and associated reaction in the paretic limbs often affect the activities of daily living.
      Cycling exercise is commonly suggested to improve cardiovascular fitness and functional
      mobility in patients with stroke. (Janssen, 2008; Holt, 2001; Potempa 1995) Cycling exercise
      requires less balance capacity and exercise intensity can be controlled. The kinematic
      patterns of cycling are very similar to that of walking that is one of the most important
      motor functions to recover in a stroke patient (Ferrante, 2008). Others studies have reported
      that repetitive passive movement of spastic muscle can increase range motion and reduce
      stiffness of hypertonic joints in stroke patients (Bressel, 2002; Yeh, 2007). Above studies
      (Bressel, 2002; Yeh, 2007) suggest leg cyclic movement may be a possible therapeutic modality
      to reduce hypertonia that is one of the factors disturbed the functional activities for
      stroke patients.

      The application of functional electrical stimulation (FES) is usually used in physical
      therapy to assist the paretic limb to perform functional tasks (5-7). The previous studies
      reported the functional tasks of hemiplegic hands are improved after electrical stimulation
      treatment (Wu, 2006; Santos, 2006). FES has also been used to improve the walking ability of
      subjects with stroke (Bogataj, 1989; Yan, 2005; Salm, 2006). Clinical studies on central
      motor neuroplasticity also support the role of goal-oriented, repetitive, active movement in
      the therapy of paretic limbs to enhance motor recovery and relearning in stroke patients.
      (Ferrante, 2008) In the first half of the 1980s, FES was applied during cycling exercise on
      the paretic legs of people with spinal cord injury (SCI). The beneficial effects of cycling
      exercise via FES have evidenced increases in muscle strength and endurance, increases in bone
      density, suppression of spasticity, improvement of cardiopulmonary function, and many other
      physiological and psychological effects of benefit for SCI patients (Donaldson et al., 2000;
      Gfohler and Lugner, 2000; Gfohler et al., 2001). Recently, similar FES assisted cycling
      devices have also been used for stroke patients (Janssen, 2008; Ferrante, 2008). They
      reported that FES assisted training provided increased aerobic capacity and functional
      performance for them. However, in one study (Janssen, 2008) the functional performance was
      evaluated by clinical scales which do not reflect the changes on the affected limb influenced
      by the training exercise. It is worthwhile to realize the effects on the affected leg and the
      changes on postural control after the FES-cycling training.

      A new FES-cycling device (Figure.1), modified from our previous prototype (Chen, 2004), was
      used in this study. This device combines FES with a cycling system equipped with ankle-foot
      orthoses. The FES stimulates the quadriceps and hamstring when the affected leg sweeps past a
      specific angle. The aims of this study were to determine whether a short-term of FES-cycling
      program in stroke patients can reduce the muscle tone of the affected leg immediately and
      influence the postural control of the subjects.
    

Intervention name(s): Cycling Exercise with Functional Electrical Stimulation; cycling exercise
Intervention type(s): Device; Device
Intervention description(s): The subjects were randomly assigned to the cycling group (CG) performing cycling training without electrical stimulation or the FES-cycling group (FES-CG) performing the same training with the assistance of electrical stimulation. The duration of the training program was 20 minutes. The target cycling cadence was set at 45 rpm.; The subjects were randomly assigned to the cycling group (CG) performing cycling training without electrical stimulation or the FES-cycling group (FES-CG) performing the same training with the assistance of electrical stimulation. The duration of the training program was 20 minutes. The target cycling cadence was set at 45 rpm.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Cycling Exercise; Functional Electrical Stimulation; Stroke