Abstract
Background and Purpose: Stroke is the third leading cause of disability with approximately 65% of all survivors experiencing ambulatory deficits to some degree (Morris & Schroeder, 2011). Due to the increased risk of disability, potential effect on functional mobility and quality of life, and the complications that may occur secondary to impaired mobility, implementation of effective stroke interventions are critical to an individual’s successful recovery. One such intervention is functional electrical stimulation (FES). A considerable amount of research exists discussing the influence of FES on gait in conjunction with application of a physical therapy program. The results achieved from these studies support FES as an effective intervention for post-stroke rehabilitation. At approximately three to twelve months a stroke is considered chronic, in which the focus of therapy transitions from neuroplastic change/neural repair to greater emphasis on compensatory strategies, such as FES use, for improved performance of activities of daily living (ADL) and greater level of independence. However, most research is based on subjects less than two years post-CVA because many researchers experience challenges in recruiting subjects within the chronic post-stroke phase due to factors such as transportation issues, social withdraw, limitations by stroke-related complications, and concomitant therapy during clinical trials (Cramer et al., 2017). This case report, however, describes outcomes based on a participant in the chronic post stroke recovery phase with FES application over a six-year span without complications present in most stroke-related literature. Accordingly, the objective of this case report is to describe the development and application of FES as an adjuvant to physical therapy treatment for a patient presenting with foot drop two years post-stroke and assessing patient outcomes post-intervention. This intervention case report is a retrospective analysis of a physical therapy program implemented by a practicing clinician describing use of functional electrical stimulation (FES) for an individual at least two years post cerebrovascular accident (CVA). This report describes FES application as a co intervention to gait training, therapeutic exercises for the lower extremities, and posture/body mechanics retraining as it relates to increased functional mobility. The subject is a 78-year-old female recovering from a right hemorrhagic stroke with development of left-sided hemiparesis with left foot drop. Case Description: The patient began physical therapy in 2012 and intermittently proceeded with treatment through 2018, with each treatment period lasting between six to nine weeks, two sessions per week. FES was used concurrently during gait training, therapeutic activities, therapeutic exercises, posture/biomechanics retraining and patient education, with a primary focus on improving functional mobility. The technology was applied throughout the majority of the 6-year span when receiving PT in accordance with the subject’s tolerance to electrical stimulation per treatment session. Outcomes: Patient outcomes were assessed using the 30-second chair-to-stand test (30s CST), timed-up and go (TUG), Romberg balance assessment, and the 6-minute walk test (6MWT). Over the duration of treatment, the subject demonstrated improvements in cardiovascular and muscular endurance, walking distance, standing balance, and development of a safer and more functional gait pattern. Discussion: The results of this case report reveal successful outcomes with the execution of a physical therapy rehabilitation program combined with FES application. Implementation of a multimodal approach to treatment with FES co-intervention may 4 produce lasting effects over time through neuroplastic changes and strengthening of corticospinal connections within the brain.