Novel Treatment Protocol
Population
Our intervention will target patients who meet the inclusion criteria for FES, as listed in Figure 18, and who do not have any other cognitive deficits
Duration of Training
The intervention should last 12 weeks as therapeutic effects on functional mobility and walking speed have been found in studies using PNS during gait for 12-30 weeks (Knutson et al., 2015). The BWSTT with FES will done for 30 minutes three days a week. For walking training, the duration of exercise in the literature is stated to be between 20-45 minutes, indicating that 30 minutes is feasible (Yana et al., 2017). As noted from a meta-analysis by Abbasian and Rastegar (2017), duration/volume of treadmill exercise training is a crucial factor in treadmill-training rehabilitation following stroke. Regardless of intensity, treadmill training duration/volume of >500 minutes is required to obtain beneficial effects (Yana et al., 2017). Our training program greatly surpasses this, ensuring long-term effects. The mental practice will also be done 3 times a week, directly before the physical training sessions. Providing mental rehearsal of the same task being practiced physically at a time that is proximal to the occurence of the physical practice sessions is integral in the efficacy of the intervention (Page and Peters, 2014). The mental practice (MP) sessions will last 20 minutes. It has been found that the dosage of MP is not important, as MP given for 20, 40, and 60 minutes are all better than no MP at all (Page et al., 2011).
Two types of practice exists: massed practice (break between practice trials is less than a few seconds) and distributed practice (break between practice trials is greater than a few seconds) (Tresilian, 2012). It has been noted that during continuous tasks (e.g. walking), where there is a build-up of fatigue likes states, distributed practice schedules lead to better skill acquisition compared to massed practice schedules (Tresilian, 2012). As such, the 30 minute BWSTT with FES will be done in blocks of 10 minutes. In between each 10 minute block will be a 2 minute rest period. During the physical training sessions, the velocity of the treadmill will remain constant and faster than the individuals normal overground walking speed. Although varied practice is said to be more advantageous than constant practice as it helps with schema development, a study by Sullivan et al. (2002) found that stroke patients who walked on the treadmill at a velocity that was faster than their initial self-selected overground walking velocity had greater improvements than those who walked at slower speeds or at variable speeds.
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- Stroke Lower Limb Paresis Fatin Hawarri