Neuromuscular electrical stimulation (NMES) on the tibialis anterior muscle and the effects on strength and gait mechanics on stroke patients: A systematic review.

Purpose: To establish the effects of neuromuscular electrical stimulation (NMES) on the tibialis anterior muscle (TA) on chronic stroke patients in order to improve gait mechanics. Subjects: 6 Materials & Methods: A systematic search of Pubmed, PEDro, CINAHL, and Cochrane Library was conducted to identify all pertinent randomized control trials (RCTs). RCTs that met the inclusion criteria were then assessed using the 11-point PEDro scale. Studies were assessed by two raters, and articles that scored 6 or above were accepted for review. Results: The initial search yielded 34 articles: 21 were pulled for data extraction, six met selected inclusion and exclusion criteria. PEDro scores for selected articles range from 6 to 9, with a mean score of 6.8. Conclusions: Studies varied widely in parameters of application and prescription of NMES and baseline characteristics of subjects. Research supports the use of NMES to treat impairments of the TA following stroke, such as ankle range of motion and TA strength, as well as functional parameters, such as Fugl-Meyer Assessment scores, obstacle avoidance, and modified Emory Functional Ambulation Profile. However, these results were equivalent to outcomes using ankle-foot orthoses (AFO) or conventional rehabilitation program (CRP). In conclusion, NMES improved gait mechanics in patients with chronic stroke, but was not superior when compared with AFO or CRP. Clinical Relevance: This systematic review demonstrates that NMES improves gait mechanics in chronic stroke patients, however, is no more effective than CRP or AFO interventions