Article

The objective of this work was to quantify the effects of a fully
implanted pulse generator to activate or augment actions of hip, knee, and ankle
muscles after stroke. DESIGN: The subject was a 64-year-old man with left
hemiparesis resulting from hemorrhagic stroke 21 months before participation. He
received an 8-channel implanted pulse generator and intramuscular stimulating
electrodes targeting unilateral hip, knee, and ankle muscles on the paretic side.
After implantation, a stimulation pattern was customized to assist with hip,
knee, and ankle movement during gait.The subject served as his own concurrent and
longitudinal control with and without stimulation. Outcome measures included 10-m
walk and 6-minute timed walk to assess gait speed, maximum walk time, and
distance to measure endurance, and quantitative motion analysis to evaluate
spatial-temporal characteristics. Assessments were repeated under 3 conditions:
(1) volitional walking at baseline, (2) volitional walking after training, and
(3) walking with stimulation after training.
RESULTS: Volitional gait speed
improved with training from 0.29 m/s to 0.35 m/s and further increased to 0.72
m/s with stimulation. Most spatial-temporal characteristics improved and
represented more symmetrical and dynamic gait. CONCLUSIONS:
These data suggest
that a multijoint approach to implanted neuroprostheses can provide clinically
relevant improvements in gait after stroke. TO CLAIM CME CREDITS: Complete the
self-assessment activity and evaluation online at
http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this
article, the reader should be able to do the following: (1) Describe the
rationale for evaluating a multijoint implanted neuroprosthesis to
improvewalkingafter stroke; (2)Understand the study design and conclusions that
can be inferred as a result of the design; and (3) Discuss the statistical
significance and clinical relevance of changes between (a) volitional walking at
baseline, (b) volitional walking after training, and (c) walking with stimulation
after training. LEVEL: Advanced ACCREDITATION:: The Association of Academic
Physiatrists is accredited by the Accreditation Council for Continuing Medical
Education to provide continuing medical education for physicians. The Association
of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA
Category 1 Credit(s). Physicians should only claim credit commensurate with the
extent of their participation in the activity.

Langue : ANGLAIS