functional electrical stimulation and cycling in stroke ... group 14, cycling and fes... ·...

Results Background Analysis Results Clinical Relevance Purpose Methods Functional Electrical Stimulation and Cycling in Stroke Rehabilitation: A Systematic Review S. Babiarz, SPT, K. Haynes, SPT, M. Mazich, SPT, H. Zhang, SPT, A. Goode, PT, DPT, PhD, R. Clendaniel, PT, PhD L Conclusions Acknowledgements / References Stroke is a leading cause of serious long-term disability and a source of significant financial burden in the United States. Hemiparesis is one of the most common lasting impairments following a stroke, which can result in severe deficits in gait and balance and consequently, negatively impact functional capacity and quality of life. Current strategies for stroke rehabilitation include treadmill training, cycling, and functional electrical stimulation (FES). However, the effects of combined cycling and FES as a treatment strategy for stroke rehabilitation remains largely unexplored. To conduct a systematic review on current evidence for the effect of cycling with FES on gait and balance in subacute stroke rehabilitation. ● Systematic Review performed following PRISMA guidelines. ● Electronic databases included Pubmed, CINAHL, Embase, and Cochrane Figure 1. Search Strategy Table 1. Inclusion and Exclusion Criteria ● FES + Cycling improves some aspects of gait and balance in subacute stroke patients with hemiparesis. ○ Whether FES + Cycling is more effective than Cycling without FES is unclear ● Gait velocity is increased post FES + Cycling intervention. ○ Improvements are not significantly greater than controls ● Balance was improved post FES+ Cycling intervention as demonstrated by increased scores on Berg Balance Scale and Trunk Control Test. ○ Improvements were not significantly greater than controls. ● Following FES + Cycling, subjects improved scores on the Motricity Index (MI) leg subscale. ○ Some studies found significant differences in MI scores between treatment groups while others did not. ● Limitations: ○ Inclusion of only full-text articles printed in English ○ Comparison complicated by the use of varied outcome measures ● Gait velocity and balance are often used as indicators for safe community ambulation, a priority for many stroke survivors. ● Recovery in gait and balance can reduce fall risk in stroke survivors, which can prevent secondary injuries and minimize additional burden of disease. ● Lower extremity cycling in conjunction with electrical stimulation is an effective physical therapy intervention in the recovery of gait and balance following stroke. ● The use of FES + Cycling may accelerate the rate of recovery for patients with hemiparesis, and functional gains are maintained during follow-up assessments. We thank Leila Ledbetter, BS, MLIS, for her assistance in our literature search. References Available on Request. Criteria 1. EligibilityCriteria 2. Random Allocation 3. Concealed Allocation 4. Baseline comparability 5. Blind subjects 6. blindtherapists 7. blind assessors 8. adequate follow-up 9. intention-to-treat analysis 10.between-group comparisons 11.point estimates and variability + Met criteria Good Quality - Did not meet criteria Fair Quality 0% 20% 40% 60% 80% 100% 120% 140% Ambrosini* Bauer** Ferrante Percentage Change in Motricity Index Score Control,Post-training FES, Post-training Control,Follow-up FES, Follow-up *Ambrosini 2011 and 2012 shared the same data for Motricity Index *** *** p < 0.001 ++ p = 0.002 *** ++ -50% 0% 50% 100% 150% 200% 250% 300% 350% 400% 450% Ambrosini*, Speed (m/s) Ferrante**, 50m Walk (m/s) Janssen, 6MWT (m) Lee, 6MWT (m) Percentage Change in Gait Performance Control,Post-training FES, Post-training Control,Follow-up FES, Follow-up 50m Walk: 50 meter walk 6MWT: 6 minute walk test +++ p < 0.001 *** *** *** +++ *Ambrosini 2011 and 2012 shared the same data for Gait Speed ** Change in Median values as Mean values were unavailable 0% 20% 40% 60% 80% 100% 120% Ambrosini 2011, TCT Ferrante, TCT Janssen, BBS Lee, BBS Percentage Change in Balance Performance Control,Post-training FES, Post-training Control,Follow-up FES, Follw-up TCT: Trunk Control Test BBS: Berg Balance Scale **p < 0.001 ** *Lo reported no significant differences in SmartBalance Master outcomes between Control and FES groups Post-Training; no Follow-Up data available **

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Page 1: Functional Electrical Stimulation and Cycling in Stroke ... Group 14, Cycling and FES... · Functional Electrical Stimulation and Cycling in Stroke Rehabilitation: A Systematic Review

ResultsBackground Analysis

Results

ClinicalRelevance

Purpose

Methods

FunctionalElectricalStimulationandCyclinginStrokeRehabilitation:ASystematicReview

S.Babiarz,SPT,K.Haynes,SPT,M.Mazich,SPT,H.Zhang,SPT,A.Goode,PT,DPT,PhD,R.Clendaniel,PT,PhD

Conclusions

Acknowledgements/References

Strokeisaleadingcauseofseriouslong-termdisabilityandasourceofsignificantfinancialburdenintheUnitedStates.Hemiparesisisoneofthemostcommonlastingimpairmentsfollowingastroke,whichcanresultinseveredeficitsingaitandbalanceandconsequently,negativelyimpactfunctionalcapacityandqualityoflife.Currentstrategiesforstrokerehabilitationincludetreadmilltraining,cycling,andfunctionalelectricalstimulation(FES).However,theeffectsofcombinedcyclingandFESasatreatmentstrategyforstrokerehabilitationremainslargelyunexplored.

ToconductasystematicreviewoncurrentevidencefortheeffectofcyclingwithFESongaitandbalanceinsubacutestrokerehabilitation.

● SystematicReviewperformedfollowingPRISMAguidelines.● ElectronicdatabasesincludedPubmed,CINAHL,Embase,andCochraneFigure1.SearchStrategy

Table1.InclusionandExclusionCriteria

● FES+Cyclingimprovessomeaspectsofgaitandbalanceinsubacutestrokepatientswithhemiparesis.○ WhetherFES+CyclingismoreeffectivethanCyclingwithoutFESisunclear

● GaitvelocityisincreasedpostFES+Cyclingintervention.○ Improvementsarenotsignificantlygreaterthancontrols

● BalancewasimprovedpostFES+CyclinginterventionasdemonstratedbyincreasedscoresonBergBalanceScaleandTrunkControlTest.○ Improvementswerenotsignificantlygreaterthancontrols.

● FollowingFES+Cycling,subjectsimprovedscoresontheMotricityIndex(MI)legsubscale.○ SomestudiesfoundsignificantdifferencesinMIscoresbetweentreatment

groupswhileothersdidnot.● Limitations:

○ Inclusionofonlyfull-textarticlesprintedinEnglish○ Comparisoncomplicatedbytheuseofvariedoutcomemeasures

● Gaitvelocityandbalanceareoftenusedasindicatorsforsafecommunityambulation,apriorityformanystrokesurvivors.

● Recoveryingaitandbalancecanreducefallriskinstrokesurvivors,whichcanpreventsecondaryinjuriesandminimizeadditionalburdenofdisease.

● Lowerextremitycyclinginconjunctionwithelectricalstimulationisaneffectivephysicaltherapyinterventionintherecoveryofgaitandbalancefollowingstroke.

● TheuseofFES+Cyclingmayacceleratetherateofrecoveryforpatientswithhemiparesis,andfunctionalgainsaremaintainedduringfollow-upassessments.

WethankLeilaLedbetter,BS,MLIS,forherassistanceinourliteraturesearch.ReferencesAvailableonRequest.

Criteria1. EligibilityCriteria2. RandomAllocation3. ConcealedAllocation4. Baselinecomparability5. Blindsubjects6. blindtherapists7. blindassessors8. adequatefollow-up9. intention-to-treatanalysis10.between-groupcomparisons11.pointestimatesandvariability

+ Metcriteria GoodQuality- Didnotmeetcriteria FairQuality

20%

40%

60%

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100%

120%

140%

Ambrosini* Bauer** Ferrante

PercentageChangeinMotricityIndexScore

Control,Post-training

FES,Post-training