OBJECTIVE: To investigate the therapeutic effects of combining electric stimulation (ES) with active ankle dorsiflexion while standing on a rocker board in subjects with plantarflexor spasticity after stroke. DESIGN: Randomized controlled trial. SETTING: A rehabilitation medical center. PARTICIPANTS: Subjects (N = 15) with spastic foot after stroke. INTERVENTIONS: Subjects were randomly assigned to an experimental or a control group. The experimental group received ES of ankle dorsiflexors in concert with a motor training paradigm that required the subject to dorsiflex the ankles in response to a cue while standing on a rocker board. After 30 minutes of this exercise, subjects received ambulation training focusing on ankle control for 15 minutes. The control group received general range of motion and strength exercises for 30 minutes, followed by 15 minutes of ambulation training focusing on ankle control. Sessions occurred 3 times a week for 4 weeks. MAIN OUTCOME MEASURES: Dynamic spasticity of plantarflexors, dorsiflexor muscle strength, balance performance, gait kinematics, and functional gait performance as assessed by the Emory Functional Ambulation Profile (EFAP) were used as outcome measurements. RESULTS: The experimental group demonstrated a greater decrease in dynamic ankle spasticity at a comfortable gait speed (p = 0.049), a greater improvement in spatial gait symmetry p = 0.015), and a greater improvement in functional gait ability as indicated by the EFAP (p = 0.015) than the control group. CONCLUSIONS: Our results suggest that repeated ES with volitional ankle movements can decrease dynamic ankle spasticity in subjects with stroke. Furthermore, such improvement parallels better gait symmetry and functional gait performance.

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