Home-based neuromuscular electrical stimulation (NMES) program for chronic post-stroke lower limb spasticity: A single-arm pilot study

Abstract

Background & Objectives: Post-stroke spasticity often leads to gait abnormalities, posing challenges for patients. Non-invasive neuromuscular electrical stimulation (NMES) offers a promising avenue for treatment. Despite the availability of portable NMES devices, there is a gap in understanding patient perceptions and outcomes of home-based NMES programs targeting lower limb spasticity post-stroke. This single-arm pilot study aimed to assess the impact of a home-based NMES program on spastic ankle plantar flexors and the feasibility of the program. Primary objectives focused on spasticity levels, ankle range of motion (ROM), dorsiflexor strength, walking speed, and lower-extremity function, while secondary objectives included retention rates, adherence rates, and patient feedback.

Methods: Participants with plantar flexor spasticity rated Modified Ashworth Scale (MAS) 1+ to 3 received 20-minute NMES sessions daily, 5 days/week, for 4 weeks alongside conventional rehabilitation. Primary objectives were assessed using the MAS, Medical Research Council (MRC) scale, 10 meter walk test (10MWT), and Fugl-Meyer Assessment of Lower Extremities (FMA-LE), while secondary objectives were evaluated using structured questionnaires.

Results: Ten participants were recruited, and nine completed the study with high adherence rates. All completers adhered to 20 sessions, except for one patient who completed 80% of the sessions. Positive feedback was received, and no adverse effects were reported. Significant improvements were noted in ankle ROM (5.56 degrees ± 3.38, p-value = 0.002) and spasticity (MAS reduction of 0.55 ± 0.93, p-value = 0.013). However, other functional outcomes did not show any significant improvement.

Conclusion: The home-based NMES program proved feasible and was well received by chronic stroke patients, demonstrating notable enhancements in ankle range of motion (ROM) and, to some extent, improvements in spasticity levels. Larger randomized controlled trials are warranted to further validate its potential benefits and effectiveness.