Predictive simulation of post-stroke gait with functional electrical stimulation

Abstract Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical stimulation (FES) improves drop foot gait although the mechanistic basis for this effect is not well understood. To answer this question, we evalu...

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Autores principales:	Gilmar F. Santos, Eike Jakubowitz, Nicolas Pronost, Thomas Bonis, Christof Hurschler
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/00ac3cc2e7fd44bf997aece27423c8a3
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spelling	oai:doaj.org-article:00ac3cc2e7fd44bf997aece27423c8a32021-11-08T10:55:26ZPredictive simulation of post-stroke gait with functional electrical stimulation10.1038/s41598-021-00658-z2045-2322https://doaj.org/article/00ac3cc2e7fd44bf997aece27423c8a32021-11-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-00658-zhttps://doaj.org/toc/2045-2322Abstract Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical stimulation (FES) improves drop foot gait although the mechanistic basis for this effect is not well understood. To answer this question, we evaluated the gait of a post-stroke patient walking with and without FES by inverse dynamics analysis and compared the results to an optimal control framework. The effect of FES and cause-effect relationship of changes in knee and ankle muscle strength were investigated; personalized muscle–tendon parameters allowed the prediction of pathologic gait. We also predicted healthy gait patterns at different speeds to simulate the subject walking without impairment. The passive moment of the knee played an important role in the estimation of muscle force with knee hyperextension, which was decreased during FES and knee extensor strengthening. Weakening the knee extensors and strengthening the flexors improved SKG. During FES, weak ankle plantarflexors and strong ankle dorsiflexors resulted in increased ankle dorsiflexion, which reduced drop foot. FES also improved gait speed and reduced circumduction. These findings provide insight into compensatory strategies adopted by post-stroke patients that can guide the design of individualized rehabilitation and treatment programs.Gilmar F. SantosEike JakubowitzNicolas PronostThomas BonisChristof HurschlerNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Gilmar F. Santos Eike Jakubowitz Nicolas Pronost Thomas Bonis Christof Hurschler Predictive simulation of post-stroke gait with functional electrical stimulation
description	Abstract Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical stimulation (FES) improves drop foot gait although the mechanistic basis for this effect is not well understood. To answer this question, we evaluated the gait of a post-stroke patient walking with and without FES by inverse dynamics analysis and compared the results to an optimal control framework. The effect of FES and cause-effect relationship of changes in knee and ankle muscle strength were investigated; personalized muscle–tendon parameters allowed the prediction of pathologic gait. We also predicted healthy gait patterns at different speeds to simulate the subject walking without impairment. The passive moment of the knee played an important role in the estimation of muscle force with knee hyperextension, which was decreased during FES and knee extensor strengthening. Weakening the knee extensors and strengthening the flexors improved SKG. During FES, weak ankle plantarflexors and strong ankle dorsiflexors resulted in increased ankle dorsiflexion, which reduced drop foot. FES also improved gait speed and reduced circumduction. These findings provide insight into compensatory strategies adopted by post-stroke patients that can guide the design of individualized rehabilitation and treatment programs.
format	article
author	Gilmar F. Santos Eike Jakubowitz Nicolas Pronost Thomas Bonis Christof Hurschler
author_facet	Gilmar F. Santos Eike Jakubowitz Nicolas Pronost Thomas Bonis Christof Hurschler
author_sort	Gilmar F. Santos
title	Predictive simulation of post-stroke gait with functional electrical stimulation
title_short	Predictive simulation of post-stroke gait with functional electrical stimulation
title_full	Predictive simulation of post-stroke gait with functional electrical stimulation
title_fullStr	Predictive simulation of post-stroke gait with functional electrical stimulation
title_full_unstemmed	Predictive simulation of post-stroke gait with functional electrical stimulation
title_sort	predictive simulation of post-stroke gait with functional electrical stimulation
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/00ac3cc2e7fd44bf997aece27423c8a3
work_keys_str_mv	AT gilmarfsantos predictivesimulationofpoststrokegaitwithfunctionalelectricalstimulation AT eikejakubowitz predictivesimulationofpoststrokegaitwithfunctionalelectricalstimulation AT nicolaspronost predictivesimulationofpoststrokegaitwithfunctionalelectricalstimulation AT thomasbonis predictivesimulationofpoststrokegaitwithfunctionalelectricalstimulation AT christofhurschler predictivesimulationofpoststrokegaitwithfunctionalelectricalstimulation
_version_	1718442489591889920

Predictive simulation of post-stroke gait with functional electrical stimulation

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