Treadmill training augmented with real-time visualisation feedback and function electrical stimulation for gait rehabilitation after stroke : a feasibility study

Motor rehabilitation typically requires patients to perform task-specific training, in which biofeedback can be instrumental for encouraging neuroplasticity after stroke. Treadmill training augmented with real-time visual feedback and functional electrical stimulation (FES) may have a beneficial synergistic effect on this process. This study aims to develop a multi-channel FES (MFES) system with stimulation triggers based on the phase of gait cycle, determined using a 3D motion capture system. A feasibility study was conducted to determine whether this enhanced treadmill gait training systemis suitable for stroke survivors in clinical practice. The real-time biomechanical visual feedback system with computerised MFES was developed using six motion-capture cameras installed around a treadmill.;This system was designed to stimulate the pretibial muscle for correcting foot drop problems, gastro-soleus for facilitating push-off, and quadriceps and hamstring for improving knee stability. Dynamic avatar movement and step length/ratio were displayed on a monitor, providing patients with real-time visual biofeedback. Participants received up to 20 minutes of enhanced treadmill training once or twice per week for 6 weeks. Training programme, pre- and post-training ability, and adverse events of each participant were recorded. Feedback was also collected from participants and physiotherapists regarding their experience. Eight out of ten participants fully completed their programme.;In total, 67 training sessions were carried out. All participants had a good attendance rate. The number and duration of training sessions ranged from 5 to 20, and 11 to 20 minutes, respectively. The MFES system successfully improved gait patterns during training, and feedback from participants and physiotherapists regarding their experience of the research intervention was overwhelmingly positive. In conclusion, this enhanced treadmill gait training system is feasible for use in gait rehabilitation after stroke. However, a well-designed clinical trial with a larger sample size is needed to determine clinical efficacy on gait recovery.Motor rehabilitation typically requires patients to perform task-specific training, in which biofeedback can be instrumental for encouraging neuroplasticity after stroke. Treadmill training augmented with real-time visual feedback and functional electrical stimulation (FES) may have a beneficial synergistic effect on this process. This study aims to develop a multi-channel FES (MFES) system with stimulation triggers based on the phase of gait cycle, determined using a 3D motion capture system. A feasibility study was conducted to determine whether this enhanced treadmill gait training systemis suitable for stroke survivors in clinical practice. The real-time biomechanical visual feedback system with computerised MFES was developed using six motion-capture cameras installed around a treadmill.;This system was designed to stimulate the pretibial muscle for correcting foot drop problems, gastro-soleus for facilitating push-off, and quadriceps and hamstring for improving knee stability. Dynamic avatar movement and step length/ratio were displayed on a monitor, providing patients with real-time visual biofeedback. Participants received up to 20 minutes of enhanced treadmill training once or twice per week for 6 weeks. Training programme, pre- and post-training ability, and adverse events of each participant were recorded. Feedback was also collected from participants and physiotherapists regarding their experience. Eight out of ten participants fully completed their programme.;In total, 67 training sessions were carried out. All participants had a good attendance rate. The number and duration of training sessions ranged from 5 to 20, and 11 to 20 minutes, respectively. The MFES system successfully improved gait patterns during training, and feedback from participants and physiotherapists regarding their experience of the research intervention was overwhelmingly positive. In conclusion, this enhanced treadmill gait training system is feasible for use in gait rehabilitation after stroke. However, a well-designed clinical trial with a larger sample size is needed to determine clinical efficacy on gait recovery

Treadmill training augmented with real-time visualisation feedback and function electrical stimulation for gait rehabilitation after stroke : a feasibility study

Background:  Stroke rehabilitation often uses the motor relearning concept that require patients to perform active practice of skill-specific training and to receive feedback. Treadmill training augmented with real-time visualisation feedback and functional electrical stimulation may have a beneficial synergistic effect on motor recovery. This study aims to determine the feasibility of this kind of enhanced treadmill training for gait rehabilitation among patients after stroke. Methods:  A system for dynamic visualisation of lower-limb movement based on 3-dimensional motion capture and a computer timed functional electrical stimulation system was developed. Participants received up to 20-min enhanced treadmill training instead of their over-ground gait training once or twice a week for 6 weeks at Coathill hospital, Lanarkshire, United Kingdom. Number of training sessions attended, and training duration were used to assess feasibility. Ankle kinematics in the sagittal plane of walking with and without functional electrical stimulation support of the pre-tibial muscles were also compared and used to confirm the functional electrical stimulation was triggered at the targeted time Results:  Six patients after stroke participated in the study. The majority of participants were male (5/6) with a age range from 30 to 84 years and 4/6 had left hemiplegia. All participants suffered from brain infarction and were at least 3 months after stroke. Number of training sessions attended ranged from 5 to 12. The duration of training sessions ranged from 11 to 20 min. No serious adverse events were reported. The computerised functional electrical stimulation to the pre-tibial muscles was able to reduce plantar flexion angle during the swing phase with statistical significance (p= 0.015 at 80%;p= 0.008 at 90 and 100% of the gait cycle).Conclusions:It is safe and feasible to use treadmill gait training augmented with real-time visual feedback and computer-controlled functional electrical stimulation with patients after stroke in routine clinical practice. Trial registration: NCT03348215. Registered 20 November 2017