Background: On a global scale, ischemic stroke is amongst the most common causes of death and acquired disability. 30% of patients have a moderate to severe disability from the stroke. Leg paresis with resulting gait difficulty is a highly prevalent impairment after stroke, making gait training a highly prioritised goal for rehabilitation. In principle, rehabilitation can commence anywhere in time post stroke, since early efforts with physical activity increases the gained level of functionality and neuroplasticity. Previous studies have shown that neuromuscular electrical stimulation (NMES) of the peripheral sensorimotor system can facilitate voluntary movement, increase muscle strength and heighten levels of functionality, including walking ability. However, the effect of NMES combined with physical activity in the acute phase of rehabilitation has been more or less unknown. The effect of the intervention is measured with the 6 Minute Walk Test and the 10 Meter Walk Test, both of which have so far not been tested reliably for this patient group; the same goes for the Fugl-Meyer Assessment which so far has not been translated into Danish.
Purpose: To investigate whether the combination of NMES and physical activity can improve walking ability with ischemic stroke patients in the acute phase of rehabilitation. Further, to research the clinimetric proportions in reliability and agreement for the 6 Minute Walk Test and the 10 Meter Walk Test with stroke patients in the acute phase. And finally to translate the Fugl- Meyer Assessment into Danish language and culture.
Method: In Study I, the 6 Minute Walk Test and the 10 Meter Walk Test were reliability test- retested on a day to day basis with 40 stroke patients in the acute phase. In Study II, the aim was to implement an eight-step, standardised translation and cross-cultural adaptation procedure to make a Danish version of the Fugl-Meyer Assessment. In Study III, 50 acute stroke patients were randomly distributed into two groups of 25; one group with physical activity combined with NMES and one group with physical activity alone. The participants trained daily for the first 14 days post stroke. Concerning the 6 Minute Walk Test as the primary outcome measured 90 days post stroke.
Results: Study I showed good reliability for both the 6 Minute Walk Test and the 10 Meter Walk Test, but also substantial degrees of measurement error. In Study II, a translation into Danish of the Fugl-Meyer Assessment was successfully implemented with good agreement. In Study III, there was no statistically significant improved effect on physical training using NMES compared to physical training alone, measured 90 days post stroke.
Conclusion: Measurement of gait speed in the acute phase shows a substantial variation of results on a day to day basis. Further, the current NMES protocol including physical training shows to be feasible, safe and tolerated and at least as effective as physical activity alone. The results are applicable to patients with mild to moderate ischemic stroke and the ability to walk with or without assistive devices. Another outcome of the present dissertation is the translation of the Fugl-Meyer Assessment, now publicly available free of charge, including video documentation on how to run the test; the Fugl-Meyer Assessment can thus now be used consistently in Danish rehabilitation efforts, which is recommended by international researcher in the field.