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Published Online
on October 15, 2009

Stroke. 2009
Published online before print October 15, 2009, doi: 10.1161/STROKEAHA.109.560375
A more recent version of this article appeared on December 1, 2009
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Submitted on June 13, 2009
Revised on August 18, 2009
Accepted on September 2, 2009

Functional Electrical Stimulation of Ankle Plantarflexor and Dorsiflexor Muscles. Effects on Poststroke Gait

Trisha M. Kesar PT, PhD*; Ramu Perumal PhD; Darcy S. Reisman PT, PhD; Angela Jancosko PT; Katherine S. Rudolph PT, PhD; Jill S. Higginson PhD; and Stuart A. Binder-Macleod PT, PhD

From the Department of Physical Therapy (T.M.K., D.S.R. K.S.R., S.A.B.-M.), Graduate Program in Biomechanics and Movement Science (R.P., D.S.R., A.J., K.S.R., J.S.H., S.A.B.-M.), and Department of Mechanical Engineering (J.S.H.), University of Delaware, Newark, Del.

* To whom correspondence should be addressed. E-mail: kesar{at}udel.edu.

Background and Purpose—Functional electrical stimulation (FES) is a popular poststroke gait rehabilitation intervention. Although stroke causes multijoint gait deficits, FES is commonly used only for the correction of swing-phase foot drop. Ankle plantarflexor muscles play an important role during gait. The aim of the current study was to test the immediate effects of delivering FES to both ankle plantarflexors and dorsiflexors on poststroke gait.

Methods—Gait analysis was performed as subjects (N=13) with chronic poststroke hemiparesis walked at their self-selected walking speeds during walking with and without FES.

Results—Compared with delivering FES to only the ankle dorsiflexor muscles during the swing phase, delivering FES to both the paretic ankle plantarflexors during terminal stance and dorsiflexors during the swing phase provided the advantage of greater swing-phase knee flexion, greater ankle plantarflexion angle at toe-off, and greater forward propulsion. Although FES of both the dorsiflexor and plantarflexor muscles improved swing-phase ankle dorsiflexion compared with noFES, the improvement was less than that observed by stimulating the dorsiflexors alone, suggesting the need to further optimize stimulation parameters and timing for the dorsiflexor muscles during gait.

Conclusions—In contrast to the typical FES approach of stimulating ankle dorsiflexor muscles only during the swing phase, delivering FES to both the plantarflexor and dorsiflexor muscles can help to correct poststroke gait deficits at multiple joints (ankle and knee) during both the swing and stance phases of gait. Our study shows the feasibility and advantages of stimulating the ankle plantarflexors during FES for poststroke gait.


Key words: functional electrical stimulation • variable-frequency trains • ankle plantarflexors