Comparison of the effect of bicycle functional electrical stimulation and conservative rehabilitation application on functional status and muscle characteristics in stroke patients

Aim: In this study, we evaluate and compare the effectiveness of conservative rehabilitation(CR) and the current lower extremity functional electrical stimulation(FES) applied in addition to CR on daily life activities, motor recovery, walking distance, mobilization, balance, fatigue, muscle strength and the effects on ultrasound muscle characteristics in stroke patients. Materials and Methods: This study was planned as a prospective randomized controlled, evaluator blind. 3 months to 5 years have passed since the stroke; thirty hemiplegic patients, aged between 21 and 85 years, who had a cerebrovascular event for the first time, who could walk short distances with support or with the help of a device, and who scored 24 or more on the mini-mental test, were included. The patients were divided into 2 groups. The 1st group was treated with CR alone for 6 weeks, and the 2nd group was treated with cycling FES with biofeedback effect 3 days a week for 4 weeks, in addition to the CR treatment. All participants were evaluated twice, before and after treatment (6th week). Motor recovery status of the participants was evaluated by Brunnstrom recovery staging(BRS) and Fugl-Meyer lower extremity evaluation(FME); balance levels with Berg Balance Scale(BBS); ambulation status with Functional Ambulation Classification(FAC), activities of daily living with Barthel index(BI); spasticity levels with Modified Ashworth Scale(MAS); fatigue levels with the Fatigue Severity Scale(FSS); walking distances with 6-minute walk test(6mnWT); Knee extensor and knee flexor muscle strengths(KEMS,KEFMS) were evaluated with a manual dynamometer. Pennate angle(PA) and rectus femoris muscle thickness(RFT) of the rectus femoris muscle of the affected side were evaluated by ultrasonography. Results: As a result of the study, a statistically significant difference was detected in BBS, FAC, BI, FME, 6minWT, KEMS, RFT scores after treatment compared to before treatment in both groups. There was a statistically significant difference in KFMS, FSS, Brunnstrom lower extremity and PA values after treatment compared to before treatment only in Group 2. There was no statistically significant difference in MAS values after treatment compared to before treatment in both groups. In the intergroup evaluations, no significant superiority of the two groups was detected. Conclusion: Conservative rehabilitation practices and bicycle FES therapy that we use in stroke rehabilitation contribute significantly to the improvement of the functional status of patients. However, although the groups could not be superior to each other at the end of the treatment, it is noteworthy that there was an increase in DFKG, rectus femoris PA values and an improvement in fatigue severity in the cycling FES group at the end of the treatment. We think that future studies with the bicycle FES device, which includes multi-center, long-term follow-up results, consists of a large number of stroke patient groups, and uses different doses, will contribute to the literature. Keywords:Stroke, Conservative rehabilitation, Cycling functional electrical stimulation