Brammatha A^1,2, M.K.Franklin Shaju³, Kannabiran B⁴, Edmund M. D'Couto ⁵

¹Ph.D. Scholar, R V S College of Physiotherapy, The Tamil Nadu Dr. M. G. R. Medical University, Chennai, India
²Professor, K M C H College of Physiotherapy, Coimbatore, (Affiliated to The Tamil Nadu Dr. M. G. R. Medical University), Coimbatore, India
³Principal & Professor, R V S College of Physiotherapy. (Affiliated to The Tamil Nadu Dr. M. G. R. Medical University), Coimbatore, India
⁴Professor, R V S College of Physiotherapy. (Affiliated to The Tamil Nadu Dr. M. G. R. Medical University), Coimbatore, India
⁵HOD (PMR), Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, India

*Corresponding Author:Brammatha A, Professor, K M C H College of Physiotherapy, Coimbatore, Affiliated to The Tamil Nadu Dr. M. G. R. Medical University, Chennai, India.

Received: June 16, 2025; Published: June 27, 2025

Abstract

Functional Electrical Stimulation Training (FEST) during specific tasks can improve motor performance after stroke due to activity-dependent plasticity and brain remodeling. Functional electrical stimulation (FES) can be used to initiate lower limb muscle contractions and has been widely applied in lower limb rehabilitation. The purpose of this study was to find the effects of functional electrical stimulation and Cycling on the lower limb motor recovery, balance and walking on acute stroke in-patients. The study included 12 individuals diagnosed with acute stroke who fulfilled selection criteria and were randomly divided into experimental group that received functional electrical stimulation during various task training, and a control group that received only standard conventional exercises, with 6 subjects in each group. The study used a before–after study design. FES was incorporated into the task training for 45 minutes 5 days per week for 2 weeks. Pretest and Post test was assessed using outcome measures Fugl-Meyer Assessment Scale, Berg Balance Scale and Functional ambulation category for changes in lower limb motor recovery performance, functional balance and independence in walking.

Results show that in Fugl-Meyer Assessment Scale-Lower extremity, the experimental group scores ranged from 16.7 ± 3.72 to 26.05 ± 1.70 and the control group scores ranged from 16.3 ± 3.24 to 16.8 ± 3.76, which showed significant differences (p < .05) only in the FES Cycling group, and there was also significant difference between the groups (p < .05). The Berg Balance Scale scores and Functional ambulation category showed significant differences within experimental group alone (p < .05), but showed no significant difference between the groups (p > .05). The study concludes that the Functional electrical stimulation therapy with Cycling for 2 weeks along with standard exercises may be suggested as an effective therapy for improving lower extremity motor performance for acute stroke in-patients. Future studies should focus on using various control systems, sensors and for longer duration in order to harness the benefits of early intervention and neural plasticity.

Keywords: Functional Electrical Stimulation Cycling; FESC; FES; Lower limb Cycling; Stroke; Hemiplegia; Physiotherapy

References

1. Behera DK., et al. “Analyzing stroke burden and risk factors in India using data from the Global Burden of Disease Study”. Scientific Reports1 (2024).
2. Foley N., et al. “Chapter 9: Mobility and the lower extremity”. Evidence-Based Review of Stroke Rehabilitation. Canadian Partnership for Stroke Recovery. London, Ontario, Canada (2016): 1-175.
3. Shelialah Pereira., et al. “Functional Electrical Stimulation for Improving Gait in Persons With Chronic Stroke”. Top Stroke Rehabilitation6 (2012): 491-498.
4. Winstein C., et al. “Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American heart association/American stroke association”. Stroke (2016): 47.
5. Glanz M., et al. “Functional electrostimulation in poststroke rehabilitation: a meta-analysis of the randomized controlled trials”. Archives of Physical Medicine and Rehabilitation6 (1996): 549-553.
6. Robbins SM., et al. “The therapeutic effect of functional and transcutaneous electric stimulation on improving gait speed in stroke patients: a meta-analysis”. Archives of Physical Medicine and Rehabilitation 87 (2006): 853-859.
7. Bauer P., et al. “Functional electrical stimulation-assisted active cycling--therapeutic effects in patients with hemiparesis from 7 days to 6 months after stroke: a randomized controlled pilot study”. Archives of Physical Medicine and Rehabilitation 2 (2015): 188-196.
8. Elisabetta Peri., et al. “Can FES-augmented active cycling training improve locomotion in post-acute elderly stroke patients?” European Journal of Translational Myology3 (2016): 187-192.
9. Alon G., et al. “Intensive training of subjects with chronic hemiparesis on a motorized cycle combined with functional electrical stimulation (FES): a feasibility and safety study”. Physiotherapy Research International 2 (2011): 81-91.
10. Ambrosini E., et al. “Cycling induced by electrical stimulation improves muscle activation and symmetry during pedaling in hemiparetic patients”. IEEE Trans. Neural Syst. Rehabil. Eng. 20 (2012): 320-330.
11. Ambrosini E., et al. “Cycling induced by electrical stimulation improves motor recovery in post-acute hemiparetic patients: a randomized controlled trial”. Stroke 42 (2011): 1068-1073.
12. Ambrosini E., et al. “Neuro-Mechanics of Recumbent Leg Cycling in Post-Acute Stroke Patients”. Annals of Biomedical Engineering11 (2016): 3238-3251.
13. CV Shendkar., et al. “Therapeutic effects of functional electrical stimulation on gait, motor recovery, and motor cortex in stroke survivors”. Hong Kong Physiotherapy Journal 33 (2015): 10e20.
14. Shen Cuiling., et al. “Effects of MOTOmed movement therapy on the mobility and activities of daily living of stroke patients with hemiplegia: a systematic review and meta-analysis”. Clinical Rehabilitation 32 (2018): 1569-1580.
15. Duncan PW., et al. “Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident”. Physical Therapy10 (2083): 1606-1610.
16. Fugl-Meyer A., et al. “The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance”. Scandinavian Journal of Rehabilitation Medicine 1 (1975): 13-31.
17. J Moore and J Raad. “Measurement Characteristics and Clinical Utility of the Berg Balance Scale Among Individuals With Stroke”. Archives of Physical Medicine and Rehabilitation1 (2013): 217-218.
18. Kyung Lim Joa. “Outcome Measurement in Balance Problems: Berg Balance Scale”. Annals of Rehabilitation Medicine (2024).
19. Holden M K., et al. “Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness". Physical Therapy1 (1984): 35-40.
20. Mehrholz J., et al. “Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke”. Archives of Physical Medicine and Rehabilitation 88 (2007): 1314-1319.
21. “Functional Ambulation Category”. Shirley Ryan AbilityLab.
22. Z Mahmoudi., et al. “The Effects of Electrical Stimulation of Lower Extremity Muscles on Balance in Stroke Patients: A Systematic Review of Literatures”. Journal of Stroke and Cerebrovascular Diseases8 (2021): 105793.
23. T Yan., et al. “Functional Electrical Stimulation Improves Motor Recovery of the Lower Extremity and Walking Ability of Subjects With First Acute Stroke”. Stroke1 (2005): 80-85.

Citation

Citation: Brammatha A., et al. “Effect of Functional Electrical Stimulation with Lower limb Cycling on Lower Limb Motor Recovery, Balance and Ambulation among Individuals with Hemiparetic Middle Cerebral Artery Stroke.Acta Scientific Neurology 8.7 (2025): 47-54.

Copyright

Copyright: © 2025 Brammatha A., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.