The effects of Functional Electrical Stimulation on motor-cognitive interference during gait in people with foot drop following stroke

Doctoral thesis English OPEN
McAdam, J
  • Subject: health_and_wellbeing
    mesheuropmc: human activities

A stroke can impair both motor and cognitive functioning, reducing the automaticity of walking and increasing susceptibility to motor-cognitive interference (MCI). There is also some evidence of an association between susceptibility to MCI and the increased incidence of falls in stroke. Functional Electrical Stimulation (FES) is commonly used for correction of foot drop due to stroke. At the start of the PhD, studies had shown FES increases walking speed. However, questionnaire-based studies found that users rated a reduction in effort and a reduced risk of tripping or falling as the two most important reasons for using FES. In these studies, the term ‘effort’ was not defined, but the results from a qualitative study suggested that the questionnaire respondents may have been referring to both physical and mental components. Based on this evidence the following research question was posed “Does FES reduce motor-cognitive interference during gait in people with foot drop following stroke?”\ud \ud The question was first examined in a questionnaire study which collated FES user opinion from thirty current users. Respondents identified a statistically significant reduction in concentration required when walking with FES compared with walking without the device. Furthermore, the majority noted that walking without thinking about walking was easier with FES.\ud \ud The second study developed and piloted a dual-task based methodology to assess the impact of FES on MCI during gait. Two participants with foot drop following stroke were evaluated over 14 weeks following first use of FES. In one participant, cognitive task performance was maintained at a similar level when walking with FES, compared with seated performance, and reduced without FES. The effects were less clear in the second participant. However, the study demonstrated the feasibility of the proposed methodology and provided the first quantitative evidence that FES can reduce MCI during gait.\ud \ud In the final study of the thesis, a similar methodology was used to study the effects of MCI in a larger cohort of sixteen established FES users. Outcomes suggest that although FES can reduce the motor-cognitive interference experienced during a dual-task situation in some participants, when analysed as a group, the results did not support the existence of this effect.
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