The effect of functional electrical stimulation on akinetic gait in patients with Parkinson's disease

Abstract

Impaired gait and postural instability in patients living with Parkinson’s disease (PD) are regarded as the main aspects of the disease that causes disability in their home and work environment. As a progressive neurological movement disorder due to degeneration in the basal ganglia, PD is the second most common neurological disease after stroke and the fourth most common neuro-degenerative disease in the elderly. Functional Electrical Sensory Stimulation (FESS) (Group 1) and Functional Electrical Sensory and Motor Stimulation (FES&MS) (Group 2) was administered to the common peroneal nerve as external cues to facilitate the initiation of taking a step in patients with akinesia. The hypotheses that were tested were: Hypothesis 1 (H1) FESS and FES&MS decrease freezing/akinesia and bradykinesia/hypokinesia during gait in patients suffering from PD. Null Hypothesis (H0) FESS and FES&MS do not decrease freezing/akinesia and bradykinesia/hypokinesia during gait in patients suffering from PD. Hypothesis 2 (H2) FESS and FES&MS decrease freezing/akinesia and bradykinesia/hypokinesia during gait in patients suffering from PD to such an extent that it improves the quality of life of patients. Null Hypothesis 2 (H02) FESS and FES&MS do not decrease freezing/akinesia and bradykinesia/hypokinesia during gait in patients suffering from PD to such an extent that it improves the quality of life of the patients. Hypothesis 3 (H3) FESS decreases freezing/akinesia and bradykinesia/hypokinesia during gait in patients suffering from PD more than FES&MS. Null Hypothesis 3 (H03) FESS does not decrease freezing/akinesia and bradykinesia/hypokinesia during gait in patients suffering from PD more than FES&MS. A single blind, randomized active controlled clinical trial was conducted. Patients with PD who experienced freezing/akinesia and bradykinesia / hypokinesia and met the inclusion and exclusion criteria of the study were allocated randomly into two groups. Ten (10) patients were randomly allocated to each group. The baseline measurement was determined by calculating the average of the measurements at week zero (0) and week two (2). Results of the participants in each group at week fourteen (14) (after twelve (12) weeks of FESS and FES&MS respectively) were compared to their baseline measurement, as well as between Group 1 and Group 2. The FESS and FES&MS was removed at week fourteen (14) and measurements were repeated at week twenty four (24). Parameters of gait that were used in the trial included; the time, speed, number of steps, average step length, Freezing of gait scale and PCI to complete a walking task. The Qol was determined by using the PDQ-39 and the motor part of the UPDRS. From the results obtained the alternative hypotheses H1, H2 and H3 was accepted for Group 1. The null hypothesis H0 and the alternative hypothesis H3 was accepted for Group 2 It can be concluded from the results of this clinical trial that FESS decreases akinetic episodes in patients with PD statistically significantly and clinically improves their Qol. Qol was statistically significantly improved in Group 2 although hypothesis H1 was not accepted for Group 2.