Conjunct Effects of Supported Standing and Functional Electrical Stimulation on Strength and Functional Mobility in Acute Stroke: A Randomized Clinical Trial
Supported Standing and Electrical Stimulation in Stroke
Keywords:Functional Electrical Stimulation, Stroke, Supported Standing
Background: After an acute stroke, many patients face difficulty while performing activities of daily living. Supported standing is used for the early mobilization of patients with stroke. The use of functional electrical stimulation is an adjunct component of rehabilitation to augment the strength of lower limbs resulting in better trunk control during functional mobility. Combined effects of electrical stimulation with early weight-bearing exercises can be an effective treatment as compared to typical conventional post-stroke rehabilitation. Objective: To evaluate the conjunct effects of supported standing and functional electrical stimulation on strength and functional mobility in acute stroke. Methods: A single-blinded randomized clinical trial was conducted from March to September 2021. Participants aged between 30 to 65 years, both gender, after fulfilling the inclusion criteria were allocated randomly into two groups (32 patients per group). The conventional therapy included positioning, ROM exercises and bed mobility exercises along with supporting standing on tilt tables initially and later on standing frames and walkers for 30 minutes/day five times per week, for almost six weeks while the experimental group received functional electrical stimulation in standing position on the tilt table in addition to conventional therapy. The trial was registered in the Iranian Registry of Clinical Trials and was approved by the ethics committee of Riphah International University. The data was analyzed using SPSS version 24 and for descriptive analysis, mean and standard deviation were used for numerical continuous variables while categorical variables were presented by frequencies, percentages and median (IQR). Independent sample t-test was applied for the comparison between both groups in quantitative variables, whereas the
chi-square test and Fisher Exact test were used for qualitative variables at baseline (Table I). Non-parametric Mann-Whitney U test and Wilcoxon Signed Rank test was applied to assess the average difference between and within group comparison. Results: The findings showed that the score of all scales were statistically significant for both within and between the groups (p-value<0.001). Conclusion: It was concluded that supported standing technique along with functional electrical stimulation and conventional physical therapy was found to be more effective in improving functional mobility, balance and strength among acute stroke patients rather than standard physical therapy alone.
. Nomani AZ, Nabi S, Badshah M, Ahmed S. Review of acute ischaemic stroke in Pakistan: progress in management and future perspectives. Stroke and vascular neurology 2017; 2(1).
Ferrarello F, Deluca G, Pizzi A, et al. Passive standing as an adjunct rehabilitation intervention after stroke: a randomized controlled trial. Archives of Physiotherapy 2015; 5(1): 1-8.
Logan A, Freeman J, Kent B, et al. Standing Practice In Rehabilitation Early after Stroke (SPIRES): a functional standing frame programme (prolonged standing and repeated sit to stand) to improve function and quality of life and reduce neuromuscular impairment in people with severe sub-acute stroke—a protocol for a feasibility randomised controlled trial. Pilot and feasibility studies 2018; 4(1): 1-18.
Rakesh RD, Hegde M, Chippala P. EFFECT OF SUPPORTED STANDING ON FUNCTIONAL ABILITY IN PATIENTS WITH ACUTE STROKE: A SINGLE-BLINDED RANDOMIZED CONTROLLED TRIAL. International Journal of Current Research and Review 2015; 7(19): 65.
Sackley CM. The relationships between weight-bearing asymmetry after stroke, motor function and activities of daily living. Physiotherapy Theory and Practice 1990; 6(4): 179-85.
Bernhardt J, English C, Johnson L, Cumming TB. Early mobilization after stroke: early adoption but limited evidence. Stroke 2015; 46(4): 1141-6.
Rocco A, Pasquini M, Cecconi E, et al. Monitoring after the acute stage of stroke: a prospective study. Stroke 2007; 38(4): 1225-8.
TARASOVÁ M. BB, NOSAVCOVOVÁ E., AL FADHLI A. K., POSPÍŠIL P.,, KONEČNÝ L. PM, FIŠER B., DOBŠÁK P., SIEGELOVÁ J. effectIVeness OF physiotherapy in acute Phase of
stroke. SCRIPTA MEDICA (BRNO) – 81 (3): 185–194, October 2008 october2008.
Kunkel D, Pickering RM, Burnett M, et al. Functional electrical stimulation with exercises for standing balance and weight transfer in acute stroke patients: a feasibility randomized controlled trial. Neuromodulation: Technology at the Neural Interface 2013; 16(2): 168-77.
Kim M-Y, Kim J-H, Lee J-U, Yoon N-M, Kim B, Kim J. The effects of functional electrical stimulation on balance of stroke patients in the standing posture. Journal of Physical Therapy Science 2012; 24(1): 77-81.
Newman M, Barker K. The effect of supported standing in adults with upper motor neurone disorders: a systematic review. Clinical rehabilitation 2012; 26(12): 1059-77.
Paleg G, Livingstone R. Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions. BMC musculoskeletal disorders 2015; 16(1): 1-16.
Sakpal T. Sample size estimation in clinical trial. Perspectives in clinical research 2010; 1(2): 67-.
Kudlac M, Sabol J, Kaiser K, Kane C, Phillips RS. Reliability and validity of the Berg balance scale in the stroke population: a systematic review. Physical & Occupational Therapy in Geriatrics 2019; 37(3): 196-221.
Reese NB. Muscle and Sensory Testing-E-book: Elsevier Health Sciences; 2020.
Yan T, Hui-Chan CW, Li LS. Functional electrical stimulation improves motor recovery of the lower extremity and walking ability of subjects with first acute stroke: a randomized placebo-controlled trial. Stroke 2005; 36(1): 80-5.
Zheng X, Chen D, Yan T, et al. A randomized clinical trial of a functional electrical stimulation mimic to gait promotes motor recovery and brain remodeling in acute stroke. Behavioural Neurology 2018; 2018.
Shin HE, Kim M, Lee D, et al. Therapeutic effects of functional electrical stimulation on physical performance and muscle strength in post-stroke older adults: a review. Annals of Geriatric Medicine and Research 2022; 26(1): 16-24.
Dunning K, Black K, Harrison A, McBride K, Israel S. Neuroprosthesis peroneal functional electrical stimulation in the acute inpatient rehabilitation setting: a case series. Physical therapy 2009; 89(5): 499-506.
Kim E, Min K, Song C. The Effects of Balance Training with Functional Electrical Stimulation on Balance and Gait in patients with chronic stroke. Physical Therapy Rehabilitation Science 2021; 10(1): 55-63.
Marquez-Chin C, Popovic MR. Functional electrical stimulation therapy for restoration of motor function after spinal cord injury and stroke: a review. Biomedical engineering online 2020; 19(1): 1-25.
Hu C, Wang T, Leung KW, Li L, Tong RK-Y. Muscle Electrical Impedance Properties and Activation Alteration After Functional Electrical Stimulation-Assisted Cycling Training for Chronic Stroke Survivors: A Longitudinal Pilot Study. Frontiers in neurology 2021; 12: 746263-.
Ambrosini E, Parati M, Peri E, et al. Changes in leg cycling muscle synergies after training augmented by functional electrical stimulation in subacute stroke survivors: a pilot study. Journal of neuroengineering and rehabilitation 2020; 17(1): 1-14.
Santos GF, Jakubowitz E, Pronost N, Bonis T, Hurschler C. Predictive simulation of post-stroke gait with functional electrical stimulation. Scientific reports 2021; 11(1): 1-12.
Mitsutake T, Sakamoto M, Horikawa E. The effects of electromyography-triggered neuromuscular electrical stimulation plus tilt sensor functional electrical stimulation training on gait performance in patients with subacute stroke: a randomized controlled pilot trial. International Journal of Rehabilitation Research 2019; 42(4): 358-64.
Rao N, Zielke D, Keller S, et al. Pregait balance rehabilitation in acute stroke patients. International Journal of Rehabilitation Research 2013; 36(2): 112-7.
Baltz M, Lietz HL, Trott-Sausser I, Kalpakjian C, Brown D. Tolerance of a tilt table protocol in an in-patient stroke unit setting: A pilot study. Journal of neurologic physical therapy: JNPT 2013; 37(1): 9.
Allison R, Dennett R. Pilot randomized controlled trial to assess the impact of additional supported standing practice on functional ability post stroke. Clinical rehabilitation 2007; 21(7): 614-9.
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