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Effects of Feedback Stimulation Training and Cyclical Electrical Stimulation on Knee Extension in Hemiparetic Patients

Ms. Winchester was a physical therapist, Rancho Los Amigos Hospital, 7601 East Imperial Hwy, Downey, CA 90242, and a graduate student at University of Southern California at the time of the study. She is currently Senior Physical Therapist, Stroke/Head Injury Service, Dallas Rehabilitation Institute, 7850 Brookhollow Rd, Dallas, TX 75235.
Ms. Montgomery is Supervisor II, Adult Neurology Service, Department of Physical Therapy, Rancho Los Amigos Hospital, Downey, CA 90242.
Dr. Bowman is Director of Neuromuscular Engineering, Rancho Los Amigos Rehabilitation Engineering Center, Downey, CA 90242.
Dr. Hislop is Professor and Chairman, Department of Physical Therapy, University of Southern California, Downey, CA 90242.

Positional feedback stimulation training and cyclical electrical stimulation were used in combination as a treatment for facilitating knee extension in hemiparetic patients. Forty adult hemiparetic patients who demonstrated minimal active control of their quadriceps femoris muscles were randomly assigned to control or study groups. The control patients received a program of physical therapy, and the study patients received the positional feedback stimulation training in addition to their therapy program. The stimulation training provided the patient with immediate auditory and visual feedback of his changing joint angle while he voluntarily extended his knee. When the patient reached a near maximal extension effort, electrical stimulation of the quadriceps femoris muscle was automatically triggered, completing the patient's available range of motion in extension. The stimulation training was supplemented with two hours of cyclical electrical stimulation daily. At the end of four weeks, analysis revealed a statistically significant increase in knee extension torque and active synergistic range of motion in the study group. No change was noted in their ability to extend their knees using isolated quadriceps femoris muscle control. This study suggests that positional feedback stimulation training is effective when used to augment a facilitation program for improving knee extension control in hemiparetic patients.

Key Words: Electric stimulation • Electrotherapy • Hemiplegia • Physical therapy • Rehabilitation

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