Functional Electrical Stimulation Combined With Visual Feedback Balance Training for Persons With Chronic Stroke: A Case Series

Objectives Falls are common in people with chronic stroke, leading to injuries and reduced independence. Developing interventions to improve balance control and reduce falls is a research priority. Functional electrical stimulation (FES) combined with visual feedback balance training (VFBT) is a novel intervention that targets balance deficits common after stroke. We aimed to evaluate the preliminary efficacy of FES+VFBT in improving balance control, balance confidence, lower limb sensory function, and strength among individuals ≥1 year post-stroke. Design Single-subject design case series. Setting Rehabilitation center in Toronto, Canada. Participants N=10 participants with chronic stroke (5 men and 5 women). Interventions Eighteen FES+VFBT sessions over 6 weeks. Main Outcome Measures Assessments were conducted 3 times at baseline and once at mid-point, post-intervention, and at 6- and 12-week follow-up time points. Outcomes included the Berg Balance Scale (BBS), Activity-Specific Balance Confidence Scale, isometric strength of lower limb and trunk muscles, and lower limb sensory function. Analyses included the 2SD band method and analysis of variance or Friedman test, as appropriate, followed by post hoc testing. Results Improvements in BBS scores were observed for 8 participants, with group-level improvement ( Q =23.07, p <.01). Strength increased significantly in the following muscle groups: nonaffected lateral trunk flexors, bilateral hip flexors, extensors, abductors, and adductors, nonaffected knee flexors, and bilateral knee extensors. No significant group changes were observed in balance confidence or sensory function. Conclusions FES+VFBT improved balance control and strength, suggesting that further investigation of this intervention for people poststroke is warranted.