Proper foot placement is vital for maintaining balance during walking, requiring the integration of multiple sensory signals with motor commands. Disruption of brain structures post-stroke likely alters the processing of sensory information by motor centers, interfering with precision control of foot placement and walking function for stroke survivors. In this study, we examined whether somatosensory stimulation, which improves functional movements of the paretic hand, could be used to improve foot placement of the paretic limb. Foot placement was evaluated before, during, and after application of somatosensory electrical stimulation to the paretic foot during a targeted stepping task. Starting from standing, twelve chronic stroke participants initiated movement with the non-paretic limb and stepped to one of five target locations projected onto the floor with distances normalized to the paretic stride length. Targeting error and lower extremity kinematics were used to assess changes in foot placement and limb control due to somatosensory stimulation. Significant reductions in placement error in the medial–lateral direction (p = 0.008) were observed during the stimulation and post-stimulation blocks. Seven participants, presenting with a hip circumduction walking pattern, had reductions (p = 0.008) in the magnitude and duration of hip abduction during swing with somatosensory stimulation. Reductions in circumduction correlated with both functional and clinical measures, with larger improvements observed in participants with greater impairment. The results of this study suggest that somatosensory stimulation of the paretic foot applied during movement can improve the precision control of foot placement.
Stroke Stepping Electrical stimulation Foot Hip circumduction Balance Motor control
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This work was supported by an award from the American Heart Association, #10PRE4050015. Additional support was provided by the Ralph and Marion C. Falk Medical Trust. This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number 8KL2TR000056. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Turnbull GI, Charteris J, Wall JC (1995) A comparison of the range of walking speeds between normal and hemiplegic subjects. Scand J Rehabil Med 27:175–182PubMedGoogle Scholar
Tyson SF, Sadeghi-Demneh E, Nester CJ (2013) The effects of transcutaneous electrical nerve stimulation on strength, proprioception, balance and mobility in people with stroke: a randomized controlled cross-over trial. Clin Rehabil 27:785–791. doi:10.1177/0269215513478227PubMedCrossRefGoogle Scholar