The effectiveness of functional electrical stimulation (FES), biofeedback and exercise therapy on various parameters of lower limb muscle strength, kinematics of gait and balance in stroke patients: a comparative study

Document Type : Original Articles


1 Physical Therapis, Department of Physical Therapy, Isfahan University of Medical, Isfahan, Iran.

2 Associated ProF. MD, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran.

3 Student of Physical Therapy, Department of Physical Therapy, Isfahan University of Medical Sciences, Isfahan, Iran.



Introduction: Stroke is the most important cause of disability among adults. Although most stroke patients regain the ability to walk independently, many will have persisting problems with mobility due to impaired balance, motor weakness and decreased walking velocity. It seems imperative to use effective therapeutic methods in order to improve disability conditions of stroke patients.Materials and Methods: In this nonrandomized clinical study-carried out from 2009 to 2010 in Isfahan-Iran- thirty patients with an average age of 60.1 years who were at least at six months poststroke were divided into three treatment groups. The subjects in each group underwent 12 therapeutic sessions which were held three times a week. Berg Balance Scale, Manual Muscle Testing and Motion Analyzer System were respectively used for measuring balance, muscle strength and gait. To compare the subjects’ status in different stages of treatment and across three aforementioned groups, Paired-t and ANOVA tests were applied on all data of interest.Results: With regard to improvement of balance, there was a significant difference between FES and Exercise Therapy groups (P = 0.00) and between the FES and Biofeedback groups (P = 0.01) in both before- and after- treatment phases of the study. However, Exercise Therapy and Biofeedback groups did not show any significant difference (P = 0.23). Considering the improvement of quadriceps muscle strength, FES and Exercise Therapy groups significantly differed before and after therapy (P = 0.017). The FES and Biofeedback groups (P = 0.01) were also observed to have a significant difference but again, Biofeedback and Exercise Therapy groups (P = 0.98) did not show any significant difference. Upon walking evaluation, A meaningful difference between the three groups was only noticed in stride length and step length after the treatment (PGSt2 = 0.017, PGSL2 = 0.017).Conclusion: According to the results of this study, among various treatment methods suggested for stroke patients, biofeedback was more effective and the functional electrical stimulation was less effective than others.Keywords: Stroke, Muscle strength, Gait, Balance, Functional electrical stimulation, Biofeedback and exercise therapy.