Although the differences were relatively small, previous research findings indicate that even such small improvements in gait speed selleck chemicals Enzastaurin are sufficient to detect real clinical changes in patients following a stroke [22]. Thus, for example, Perera et al. [23] estimated a change of 0.04�C0.06m/sec in gait speed as a small meaningful change. In addition to the changes in gait velocity, after six weeks, the gait asymmetry index was improved with peroneal and thigh FES as compared to peroneal FES alone. Gait asymmetry is a measure of interlimb coordination, which is not necessarily related to gait velocity, but provides insight regarding the underlying mechanisms that control gait [19, 24, 25]. Additionally, gait asymmetry is a measure that is not easily modified by conventional physical rehabilitation approaches [5, 26].

In contrast to gait asymmetry, the other measure of gait dynamics, namely, the single-limb stance percentage, was not significantly different between the two FES conditions at T2 (after six weeks). This may be due to the enhanced results that were achieved with peroneal FES alone at the six-week test. While at the beginning of the study a comparison of the no stimulation versus peroneal FES conditions did not yield significant results, such a comparison was found to be significant after six weeks (see Figure 3).Our protocol included two points of evaluation (i.e., immediately after fitting and after six weeks of adaptation). In studies involving foot-drop stimulation, it has been shown that a period of four to eight weeks is necessary to achieve an optimal orthotic effect [4, 27].

Our findings are consistent with previous studies by showing improved orthotic effect with the peroneal and thigh FES after the adaptation period. The two-minute gait speed and obstacle course gait velocity were enhanced at T2 and a clear trend of training effect was found for the single-limb stance percentage. It is possible that longer use with the dual-channel system may result in additional gains in gait performance, as demonstrated in previous studies with peroneal FES [6].Many factors may have contributed to the results presented in this study. Given that walking speed has been shown to be positively correlated with knee flexion during swing [28], it is possible that the enhanced gait speed observed in our study Brefeldin_A resulted from improved knee flexion. The hamstrings/quadriceps FES during stance may have provided the patients with greater confidence in shifting weight to the hemiparetic side, leading to a more symmetrical gait. An additional factor that may have contributed to the results is the ability to tailor the temporal parameters of the electrical stimulation according to the needs of the individual subject.