Functional Electrical Stimulation based Gait training leads to muscle activation and improves strength with an increase in the walking speed in patients with Cerebral Palsy. Use of FES during walking assists the patient in providing stability and mobility as it assists global stabilizers and stimulates prime movers hence, achieving two goals by doing functional-oriented tasks.
PFPS is one of the most frequent causes of anterior knee pain in adolescents and adults. PFPS is defined as pain behind or around the patella caused by stress in the patellofemoral joint that usually provoked by climbing stairs, squatting, and sitting with flexed knees for long periods of time.
Mr. Saurin Dalal aged 44, male patient suffered from Right MCA stroke in Sep 2016 and presented to us in Jan 2017 with difficulty in walking and aim to achieve running ability. On Observation, we found hyperextension on left knee (Knee push back in weight bearing phase) and poor dorsiflexion during swing phase. On examination, undoubtedly, found weak gluts and poor calf muscle recruitment compared to other leg. We had addressed some weakness in Upper limb but his major concern and worry was running ability and poor knee control. We trained him with FES (ODFS PACE) for L. foot-drop for 15 days. ODFS pace helps to correct foot drop and is so advanced that one of its functions allows running as well.
Versatile quality and certain parameters adjustment of this device allows to correct dorsiflexion (lift the foot up) and reduce hyper-extension of knee (push back knee in weight bearing) while in mid-stance. Appropriate facilitation of muscles to support running with FES with precise placement of electrode, with Mr. Dalal, we achieved running with initial phase of 5 minutes to 15 minutes in 15 days.
We noticed improvement with his mobility and ability run without ODFS Pace as well. This means it does not cause dependency but allow muscles to retrain and retain ability to do the task without it too. This case was only 6 months old where his wish to run was fulfilled but we had another who was 3 year old stroke who also has achieved running ability.
That patient was from Jodhpur, RAJDADISA hospital; young male patient having three year old stroke, had similar clinical presentation of poor dorsiflexion and hence difficulty in ground clearance during swing phase. After thorough examination and precise placement of ODFS pace, he was able to run, with speed of 7km/hr on very same day. In following days with proper training with device, he was able to run without the device within few days only. (Video attached below.) Video Link: https://www.youtube.com/watch?v=B2hv0tnqyPo
Why we choose ODFS pace for getting him in Running post Stroke? There are certain functions and parameters out of many which allowed and make possible to running for foot drop patients…. ..ODFS pace allowed followings…
– We are able to set Rising ramp (time in ms) which allowed contraction followed by foot switch activation and timely manner contraction for dorsiflexion.
– It has who functions out of many which are extension time and falling ramp : this two functions allowed contraction biceps femoris and peroneal + Tib Ant. To continue contract and allow eccentric contraction to prevent hyper extension while midstance and push off phase
– Flexibility in positioning of electrode along and polarity to helps with emphasis on contraction of muscles for eg. Strong contraction on Biceps femoris or Tib ant / peroneal – Also, It is biphasic asymmetrical (or symmetrical) waveform with ability to change frequency varies from 20hz to 60hz to help in reduction of fatigue.
Role of ODFS pace and Physiotherapy in early stage in Post-Stroke recovery
It has been always proven that ODFS pace is a very good clinical rehab tool. However, we can explore its versatile quality and use it effectively to improve gait pattern in very early stage of rehabilitation (flaccid or weak). It may even help to prevent post-stroke deficits like foot drop and hence avoid secondary changes in gait pattern e.g. circumduction.
It is also encourages to gain early weight-bearing and push off by allowing good step length. Having good step length encourages ilio-psoas facilitation by gaining effective stretch followed by flexion of hip rather circumduction and will also be supported well by dorsiflexion and hence good ground clearance. This is very much unlike foot drop splint which will fix the foot in dorsiflexion and would not give good reciprocal inhibition which is achieved by FES (ODFS pace).
We have to understand role of current (electrical stimulation) as it is primarily designed to gain functional desired movement rather excessive movement of ankle (in case of dorsiflexion). Current used in the device has many variables to fine tune the current to patient’s need and comfort. It includes symmetrical or asymmetrical biphasic current, amplitude from10ma to 100ma, frequency variable from 20hz to 60hz (variable unit of 5hz), pulse width variation from 3.6microsec to 360microsec (variable unit 1%). These are few of many unique features and functions of ODFS pace which allows smooth, pain less current induced movement. These variables when set appropriately avoids fatigue in muscles allowing endless work achieved by the muscles (e.g. walking for hours).
Here is an example of patient who suffered from massive hemorrhage and presented to us in flaccid stage of rehabilitation at our center.
We started early weight bearing; which always is considered best to relearn and improve walking ability. Initially we started training with AKBK brace along with FES or ES to gain ground clearance. After few days, he started gained good balance in his trunk and good with knee control. We then modified the support to FES or ES to Knee and AFO to ankle to gain same support. We were able to correct his gait pattern and able to reduce use of FES and AFO both. After a couple of weeks of practice he managed to walk independently without aid and was also able to manage stairs (up and down).
Using ODFS pace will not make someone to be dependent on it but help them to be independent with functional ability of particular desired task.