Effects of Functional Electrical Stimulation of the hamstring muscles in stroke patients with a Stiff Knee Gait: An explorative prospective cohort study

Abstract

Introduction: A Stiff Knee Gait (SKG) is a common problem in stroke patients. A SKG is defined as a diminished knee flexion during swing phase. Most common cause of SKG is an overactivity of the rectus femoris muscle. Activation of hamstring muscles could increase knee flexion during swing. Therefore Functional Electrical Stimulation (FES) of the hamstring muscles could improve SKG.

Objective: To determine the effect of FES of the hamstring muscles in stroke patients with a SKG.

Methods: Seventeen stroke patients presenting with a SKG were included in this study. After a pre-test there was a training period of five weeks, which has been completed with a post-test. Statistical analysis was done by a paired t-test.

Results: This study showed that FES of the hamstring muscles in stroke patients improved knee flexion, hip flexion, walking speed, stride length, step length and cadence measured with three-dimensional gait analysis. There is no improvement in VAS and Duncan-Ely score.

Discussion: FES improves knee flexion during swing significantly. FES of the hamstring muscles could decrease spasticity of the RF via reciprocal inhibition, which is a possible cause for the improvement in knee flexion during swing. The lack of a control group and a randomisation procedure are limitations of this study.

Conclusion: This study demonstrates that FES of the hamstring muscles seems to be effective in stroke patients presenting with a SKG. There were no adverse events reported. To make definitive recommendations, a randomized controlled trial with a large sample size should be carried out.