Neuromuscular stimulation helps restore walking ability in chronic stoke patients From: VA Research Currents - March 2006 Functional neuromuscular stimulation (FNS)- a method of electrical stimulation that uses electrodes implanted in weak or paralyzed muscles and connected to an external controller worn on a belt - can significantly enhance the walking ability of chronic stroke patients, reported VA researchers and colleagues in the January issue of Stroke. Senior author Janis J. Daly, PhD, MS, and her team at the Cleveland VA Medical Center and Case Western Reserve University studied 32 men and women who had suffered a stroke more than a year earlier. One group was treated four times weekly with a regimen of what are considered the best available stroke therapies: bodyweight- support treadmill training, overground walking, and coordination exercises. The therapies were individualized for each patient. The other group received the same treatment, but with the addition of FNS, applied to eight electrodes implanted at key points in weak or paralyzed leg muscles. The electrodes are placed during a half-day outpatient procedure, with patients under conscious sedation. The electrodes are removed when the course of FNS therapy has ended. After 12 weeks, the 29 patients remaining in the trial were assessed primarily with the Tinetti gait scale, which measures components such as gait initiation, trunk alignment, step continuity and swing-limb floor clearance. Nine of those in the FNS group had gains of 2 to 6 points, while only two participants in the non-FNS group had a gain of 2 or more points.There were 53 reports of functional milestones for the FNS group - such as being able to walk a mile or do errands - compared to only 11 in the non-FNS group. "We showed that coordinated gait components can be regained in response response to FNS by chronic stroke survivors with otherwise persistent gait deficits," said Daly, director of VA’s Stroke Motor Control and Motor Learning Laboratory; associate director of education at the Cleveland FES Center; and an associate-rank professor in the department of neurology at Case Western Reserve University School of Medicine. Daly described other functional and quality-of-life milestones for FNS patients that were reported in the recent Stroke article. "One patient was able to return to work as a fifth-grade elementary teacher," she said. "Prior to our study, she had not been able to do that. Conventional therapies had failed her in that regard." Daly cited another patient who progressed from being wheelchair-dependent in an assistedliving environment to being ambulatory in his own home and community. Studies such as Daly’s are increasingly challenging the notion that stroke survivors are unable to recover movement or coordination after more than six months or so. Scientists believe therapies such as FNS may help the brain "rewire" itself, even up to more than a year after stroke, with undamaged neurons taking over functions that had previously been handled by other parts of the brain and nervous system. Previous research by Daly's group has shown that such gains can be maintained for at least six months after treatment. She hopes to conduct further studies to document longer-term benefits, which she said she has seen often in former FNS patients who visit her clinic. According to Daly, the potential benefits of FNS outweigh the expense - about $4,960 in incremental costs per patient - and the system could be feasible in the future for routine use in rehabilitation settings. "Any experienced therapist could learn how to use the system," said the researcher, who has designed templates to guide clinicians in tailoring the stimulation pattern for each muscle. A second senior author on the study was Robert L. Ruff, MD, PhD, chief of neurology for VA and acting director of VA's Rehabilitation Research and Development (RR&D) Service. The work was funded by RR&D. From: http://www.research.va.gov/resources/pubs/docs/va_research_currents_march_06.pdf For more information about the newsletter, call VA Research and Development Communications at 410/962-1800, ext. 223, or e-mail research.publications@va.gov.