Effects of perturbation-based gait training with and without functional electrical stimulation on reactive balance and neuromuscular coordination after stroke: a randomized controlled trial.

BACKGROUND Falls during walking remain a major cause of disability after stroke. Perturbation-based balance training (PBBT) improves reactive stability, but its effects on gait-related neuromuscular coordination and the added value of functional electrical stimulation (FES) are not well established.

OBJECTIVES To determine whether PBBT, performed with or without task-synchronized FES, improves clinical performance, intermuscular coordination during gait, and reactive balance stability in individuals with chronic stroke.

METHODS In this randomized controlled trial, 35 ambulatory individuals ≥ 6 months post-stroke were allocated to PBBT alone (n = 18) or PBBT combined with FES (n = 17). Participants completed eight sessions over four weeks. Outcomes were assessed at baseline, post-intervention, and 3-month follow-up. Clinical measures included the Mini-BESTest, Timed Up and Go (TUG), Fugl-Meyer Assessment-Lower Extremity, and 10-Meter Walk Test. Neuromuscular coordination was quantified using the Peak Activation Interval (PAI) between vastus lateralis and medial gastrocnemius during gait. Reactive balance stability was assessed using center-of-mass (CoM) stability after balance perturbation. Linear mixed-effects models were used for analysis.

RESULTS Significant main effects of Time were observed across clinical outcomes (p < 0.05), with improvements maintained at follow-up. PAI increased from baseline to post-intervention (β = 7.29, p = 0.003), indicating improved intermuscular timing. CoM stability improved from baseline to post-intervention (β = 0.171, p < 0.001) and remained higher at follow-up (p = 0.009). No significant Group × Time interactions were detected (all p > 0.05).

CONCLUSIONS PBBT improved mobility, gait neuromuscularcoordination, and reactive balance stability in persons with stroke. Theaddition of FES did not provide additional group-level benefit.

CLINICALTRIALS.GOV NCT06237972.