New tendencies of determination of the amplitude and temporal programs of functional electrical stimulation of muscles in patients with stroke

Authors of this article consider problem of necessity of search of the new tendencies of the amplitude and temporal programs of functional electrical stimulation (FES) of muscles in patients with stroke. On the basis of the received data in 39 patients with stroke authors conclude, that necessity of search of new tendencies is determined by two reasons: by early rehabilitation of patients and rather frequent application of functional electrical stimulation of muscles in some period after botulinotherapy. Authors suppose, that application of FES of muscles in the early restorative period after the stroke must be limited because of a number of reasons, and the following reasons seem to be the most essential: impossibility of receiving the visible contraction of muscles during the trial session, presence of ataxia, the similar electromyographic pattern (EMG-pattern) of muscles-antagonists, approximately the same affection of both of the lower extremities during the first month after the stroke. Authors also point out, that though application of botulinotherapy considerably decreases spasticity of muscles, and also pain and discomfort in the shank and foot, nevertheless, the certain worsening of walking takes place in 3-4 weeks after application of botulinotherapy, in particular, diminution of the value of the main flexion at a knee joint (KJ), aggravation of recurvation at a KJ, greater decrease of duration of the stance phase and increase of duration of the swing phase in the paretic lower extremity. That’s why authors suggest some changes should be made in choice of movements, needing correction and muscles, needing stimulation, and also in the amplitude and temporal programs of electrical stimulation of muscles during walking. The essence of these changes consists in the fact, that is expedient to carry out stimulation of not only of the paretic muscles, but also of those muscles, which were exposed by botulinotherapy (muscles-targets). Authors point out that combined application of botulinotherapy and functional electrical stimulation of muscles leads to remarkable improvement of the biomechanical structure of walking, namely, to elimination of recurvation at a KJ, to the essential increase of the main flexion at a KJ, to decrease of equinus at an ankle joint (AJ) and considerable growth of the first dorsal flexion, to rise of supportability of more affected lower extremity and increase of the push function of less affected lower extremity, what leads to the essential gain of the mean walking velocity.