The Journal of Korean Physical Therapy

The Korean Society of Physical Therapy (대한물리치료학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of Functional Electrical Stimulation on Balance and Gait Speed of Stroke Patients: A Systematic Review and Meta-Analysis

  • Hyun Jin Jang (Department of Physical Therapy, Nambu University) ;
  • So Yeong Kim (Department of Physical Therapy, Nambu University) ;
  • Jong Yun Chun (Department of Physical Therapy, Nambu University) ;
  • Gi Bbeum Choi (Department of Physical Therapy, Nambu University) ;
  • Woon Su Cho (Department of Physical Therapy, Nambu University) ;
  • Jae Hyun Lim (Department of Physical Therapy, Nambu University)
  • Received : 2024.07.19
  • Accepted : 2024.08.19
  • Published : 2024.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study analyzed the effects of functional electrical stimulation (FES) on the balance and gait speed of stroke patients. Also, the effects were analyzed according to the measurement method and electrical stimulation site. Methods: The selection criteria included randomized controlled trials that measured balance and gait speed using FES in adult stroke patients of any type and excluded studies that had no data, were not in English or Korean, or those for which the full text could not be found. Searches were conducted in PubMed, Cochrane Library, RISS, DBpia, and ScienceON until March 2024, and the risk of bias was assessed using the PEDro scale. The effect size was expressed as the standardized mean difference (SMD) using a random effects model and a 95% confidence interval (CI), and the effect based on the electrical stimulation site was analyzed by subgroup analysis. Results: A total of 577 subjects from 19 studies were included. The results of analyzing the effect of FES showed that it significantly improved Berg Balance Scale (BBS) (SMD=0.42; CI=0.11-0.73; I2=60%) and Timed Up and Go test (TUG) scores (SMD=0.36; CI=0.15-0.57; I2=0%), but not gait speed (SMD=-0.11; CI=-0.46-0.24; I2=37%). In addition, electrical stimulation was found to be more effective when stimulating the ankle than when stimulating various areas, including the ankle. Conclusion: In stroke patients, FES has shown positive effects on balance. Future studies could emphasize interventions combined with FES to achieve better results. Studies conducted with varied stimulation sites are needed to determine the impact of FES on activity levels.

Keywords

References

  1. Doria JW, Forgacs PB. Incidence, implications, andmAnagement of seizures following ischemic and hemorrhagic stroke. Curr Neurol Neurosci Rep. 2019;19(7):37.
  2. Nolan KJ, Yarossi M. Weight transfer analysis in adults with hemiplegia using ankle foot orthosis. Prosthet Orthot Int. 2011;35(1):45-53.
  3. Jaqueline da Cunha M, Rech KD, Salazar AP et al. Functional electrical stimulation of the peroneal nerve improves post-stroke gait speed when combined with physiotherapy. A systematic review and meta-analysis. Ann Phys Rehabil Med. 2021;64(1):101388.
  4. Tyson SF, Crow JL, Connell L et al. Sensory impairments of the lower limb after stroke: a pooled analysis of individual patient data. Top Stroke Rehabil. 2013;20(5):441-9.
  5. Prenton S, Hollands KL, Kenney LPJ et al. Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: a meta-analysis providing direction for future research. J Rehabil Med. 2018;50(2):129-39.
  6. Marquez-Chin C, Popovic MR. Functional electrical stimulation therapy for restoration of motor function after spinal cord injury and stroke: a review. Biomed Eng Online. 2020;19(1):34.
  7. Eraifej J, Clark W, France B et al. Effectiveness of upper limb functional electrical stimulation after stroke for the improvement of activities of daily living and motor function: a systematic review and meta-analysis. Syst Rev. 2017;6(1):40.
  8. Kang KY, Kim TY. Effects of a combined functional electrical stimulation with action observation training for balance and gait performance in stroke patients. J Korean Soc Phys Med. 2016;11(2):93-102.
  9. Howlett OA, Lannin NA, Ada L et al. Functional electrical stimulation improves activity after stroke: a systematic review with meta-analysis. Arch Phys Med Rehabil. 2015;96(5):934-43.
  10. Mahmoudi Z, Mohammadi R, Sadeghi T et al. The effects of electrical stimulation of lower extremity muscles on balance in Stroke patients: a systematic review of literatures. J Stroke Cerebrovasc Dis. 2021;30(8):105793.
  11. Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
  12. Downs S,mArquez J, Chiarelli P. The Berg Balance Scale has high intra-and inter-rater reliability but absolute reliability varies across the scale: a systematic review. J Physiother. 2013;59(2):93-9.
  13. Ortega-Bastidas P, Gomez B, Aqueveque P et al. Instrumented Timed Up and Go Test (iTUG)-more than assessing time to predict falls: a systematic review. Sensors (Basel). 2023;23(7):3426.
  14. Cleland BT, Perez-Ortiz A,mAdhavan S. Walking test procedures influence speed measurements in individuals with chronic stroke. Clin Biomech (Bristol, Avon). 2020;80:105197.
  15. Maher CG, Sherrington C, Herbert RD et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713-21.
  16. Cashin AG, McAuley JH. Clinimetrics: physiotherapy evidence database (PEDro) scale. J Physiother. 2020;66(1):59.
  17. Ambrosini E, Peri E, Nava C et al. A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial. Eur J Phys Rehabil Med. 2020;56(1):24-33.
  18. Ha SY, Han JH, Ko YJ et al. Ankle exercise with functional electrical stimulation affects spasticity and balance in stroke patients. J Exerc Rehabil. 2020;16(6):496-502.
  19. Lee K. Balance training with electromyogram-triggered functional electrical stimulation in the rehabilitation of stroke patients. Brain Sci. 2020;10(2):80.
  20. Sharif F, Ghulam S,mAlik AN et al. Effectiveness of functional electrical stimulation (FES) versus conventional electrical stimulation in gait rehabilitation of patients with stroke. J Coll Physicians Surg Pak. 2017;27(11):703-6.
  21. Tong RK, Ng MF, Li LS. Effectiveness of gait training using an electromechanical gait trainer, with and without functional electric stimulation, in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2006;87(10):1298-304.
  22. Shim J, Hwang S, Ki K et al. Effects of EMG-triggered FES during trunk pattern in PNF on balance and gait performance in persons with stroke. Restor Neurol Neurosci. 2020;38(2):141-50.
  23. Bae YH, Ko YJ, Chang WH et al. Effects of robot-assisted gait training combined with functional electrical stimulation on recovery of locomotor mobility in chronic stroke patients: a randomized controlled trial. J Phys Ther Sci. 2014;26(12):1949-53.
  24. Hong J, Lee H. The effect of task oriented exercise and abdominal muscle contraction using FES on abdominal muscle thickness and balance of stroke patients. Arch Orthop Sports Phys Ther. 2018;14(2):117-26.
  25. Wang GS, Yoon SW, Cho WS et al. Effect of the combined use of FES and over ground walking with partial bodyweight support on walking and balance competency in patients with chronic strokes. J Kor Acad Clin Elec. 2012;10(1):15-22.
  26. 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. 2013;16(2):168-77.
  27. Dujovic SD,mAlesevic J,mAlesevic N et al. Novel multi-pad functional electrical stimulation in stroke patients: a single-blind randomized study. NeuroRehabilitation. 2017;41(4):791-800.
  28. Lee SY, Kang SY, Im SH et al. The effects of assisted ergometer training with a functional electrical stimulation on exercise capacity and functional ability in subacute stroke patients. Ann Rehabil Med. 2013;37(5):619-27.
  29. Lee HJ, Cho KH, Lee WH. The effects of body weight support treadmill training with power-assisted functional electrical stimulation on functional movement and gait in stroke patients. Am J Phys Med Rehabil. 2013;92(12):1051-9.
  30. Koh S, Choi W, Lee S. The effects of stair climbing training with functional electrical stimulation on muscle strength, balance, and gait in patients with chronic stroke. Phys Ther Rehabil Sci. 2021;10(1):32-9.
  31. Cho MK, Kim JH, Chung Y et al. Treadmill gait training combined with functional electrical stimulation on hip abductor and ankle dorsiflexor muscles for chronic hemiparesis. Gait Posture. 2015;42(1):73-8.
  32. Hwang DY, Lee HJ, Lee GC et al. Treadmill training with tilt sensor functional electrical stimulation for improving balance, gait, and muscle architecture of tibialis anterior of survivors with chronic stroke: a randomized controlled trial. Technol Health Care. 2015;23(4):443-52.
  33. Jeon GY, Choi WJ, Lee SW. The effect of a combined functional electrical stimulation with progressive speed treadmill training for gait and balance performance in stroke survivors. J Spec Edu Rehbail Sci. 2014;53(3):365-83.
  34. Hong J, Lee H. The effects of FES on balance and gait ability in patients of stroke patients. J Korean Soc Integrative Med. 2019;7(2):95-109.
  35. Lee SH, Lee SW, Shin WS et al. The effects of gait training with functional electrical stimulation on recovery of function in hemiplegia. Journal of Sport and Leisure Studies. 2009;38(2):981-91.
  36. Nagai MK,mArquez-Chin C, Popovic MR. Why is functional electrical stimulation therapy capable of restoring motor function following severe injury to the central nervous system? Medicine. 2016:479-98.
  37. Glanz M, Klawansky S, Stason W et al. Functional electrostimulation in poststroke rehabilitation: a meta-analysis of the randomized controlled trials. Arch Phys Med Rehabil. 1996;77(6):549-53.
  38. Combs S, Miller EW, Forsyth E. Motor and functional outcomes of a patient post-stroke following combined activity and impairment level training. Physiother Theory Pract. 2007;23(4):219-29.
  39. Shariat A, Najafabadi MG, Ansari NN et al. The effects of cycling with and without functional electrical stimulation on lower limb dysfunction in patients post-stroke: a systematic review with meta-analysis. NeuroRehabilitation. 2019;44(3):389-412.
  40. Aaron SE, Vanderwerker CJ, Embry AE et al. FES-assisted cycling improves aerobic capacity and locomotor function postcerebrovascular accident. Med Sci Sports Exerc. 2018;50(3):400-6.
  41. Wang J, Zhao L, Gao Y et al. The difference between the effectiveness of body-weight-supported treadmill training combined with functional electrical stimulation and sole body-weight-supported treadmill training for improving gait parameters in stroke patients: a systematic review and meta-analysis. Front Neurol. 2022;13:1003723.
  42. 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.
  43. Everaert DG, Thompson AK, Chong SL et al. Does functional electrical stimulation for foot drop strengthen corticospinal connections? Neurorehabil Neural Repair. 2010;24(2):168-77.
  44. Galvao WR, Castro Silva LK, Formiga MF et al. Cycling using functional electrical stimulation therapy to improve motor function and activity in post-stroke individuals in early subacute phase: a systematic review with meta-analysis. Biomed Eng Online. 2024;23(1):1.
  45. Yang YR, Mi PL, Huang SF et al. Effects of neuromuscular electrical stimulation on gait performance in chronic stroke with inadequate ankle control - A randomized controlled trial. PLoS One. 2018;13(12):e0208609.
  46. Yang CY, Kim TJ, Lee JH et al. The effect of functional electrical stimulation on the motor function of lower limb in hemiplegic patients. Ann Rehabil Med. 2009;33(1):29-35.
  47. Ring H, Treger I, Gruendlinger L et al. Neuroprosthesis for footdrop compared with an ankle-foot orthosis: effects on postural control during walking. J Stroke Cerebrovasc Dis. 2009;18(1):41-7.