Feasibility of combining multi-channel functional neuromuscular stimulation with weight-supported treadmill training Janis J. Daly * , Robert L. Ruff Department of Neurology, Case Western Reserve University School of Medicine, United States Louis Stokes Cleveland VA Medical Center, Research Service 151-W 10701 E. Blvd., Cleveland, OH 44106, United States Received 13 April 2004; received in revised form 30 June 2004; accepted 2 July 2004 Available online 27 August 2004 Abstract More than 3 million stroke survivors live with residual disabilities and mobility deficits even after rehabilitation. Therefore, it is important to develop new, more effective, gait training methods. The purpose of this study was twofold: (1) testing the feasibility of combining multi- channel functional neuromuscular stimulation (FNS) using intramuscular (IM) electrodes and body weight supported treadmill training (BWSTT) for gait training; and (2) documenting the potential gait practice advantages afforded by combining FNS-IM and BWSTT. Eight subjects with gait deficits in the chronic phase (N12 months) were enrolled. Intramuscular electrodes were placed in the paretic hip abductors, knee flexors and extensors, and ankle dorsiflexors, plantarflexors, and evertors. Subjects were treated with exercise and gait training using the combined technologies 1 1/2 h/week, four times/week, for 12 weeks. Feasibility was tested according to performance of the technologies, clinician skill factors, and subject satisfaction. Impairment, function, and quality of life were measured. Provision of practice for eight gait characteristics was catalogued. We found the following results for the combined technologies: (1) the combined technologies were safe and feasible; (2) clinicians required five training sessions to reach proficiency; (3) subjects were satisfied; (4) there were significant gains in impairment and functional measures; (5) a greater number of gait practice characteristics were provided with the combined technologies than with either alone. D 2004 Elsevier B.V. All rights reserved. Keywords: Stroke; Gait; FES; FNS; Rehabilitation; Weight-supported treadmill training 1. Introduction It is important to develop new, more effective, gait training methods for patients following stroke, because more than 3 million Americans live with residual disabilities and mobility deficits even after they are brehabilitatedQ [1]. For successful motor learning, the desired motor task must be practiced in a pattern as closely approximating normal as possible [2–5] and intensive practice must be provided [6– 8]. Current widely used, conventional gait training methods do not provide practice of a gait pattern that is close to normal, nor are many repetitions of the desired movement practiced. There is a dearth of studies showing gait kinematic improvements to normal, in response to treatment following stroke. In past work, we showed that multi-channel, functional neuromuscular stimulation (FNS) with intraumsucular (IM), percutaneous electrodes (FNS-IM) could produce gains in gait kinematics [9,10], for those with persistent gait deficits (1–4 years after stroke). The advantages of FNS-IM exercises and gait training included provision of practice movements that were close to normal for swing phase hip, knee, and ankle. Additionally, FNS-IM provided practice of knee control during loading and mid-stance that was closer to normal than over ground gait training [11]. However, FNS-IM could not produce practice of normal knee control during terminal stance, normal medial/lateral ankle stability nor normal pelvic control throughout stance phase. More- over, the duration of the treatment protocol (6–18 months) 0022-510X/$ - see front matter D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.jns.2004.07.006 * Corresponding author. Tel.: +1 216 791 3800x4129; fax: +1 216 229 8509. E-mail address: jjd17@case.edu (J.J. Daly). Journal of the Neurological Sciences 255 (2004) 105– 115 www.elsevier.com/locate/jns