Can FES Improve Standing and Walking After Stroke?

Could continuous FES help improve walking after stroke? A recent study suggests it might. Researchers found that targeting the gluteus medius and tibialis anterior during functional tasks may support better gait performance, transfers, and spasticity outcomes. Here’s what clinicians need to know.

Study Snapshot

Article: The Effects of Functional Electrical Stimulation of Hip Abductor and Tibialis Anterior Muscles on Standing and Gait Characteristics in Patients with Stroke

Authors: Sami S. AlAbdulwahab, et al

Published: March 25, 2025

Summary: The authors of this study explored the use of continuous and simultaneous stimulation of the gluteus medius and tibialis anterior (TA) muscles to elicit isometric contractions during various functional tasks (standing, sit to stands, walking) in patients with chronic stroke.

You can find the full article here

Methods

The study recruited fourteen male participants with chronic stroke (first-time stroke, cognitively intact, ability to walk independently with or without assistance aids for greater than 3 minutes). They utilized both “short and long-term FES management programs” to both the glute med and TA muscles of the affected lower extremity using a two-channel portable FES device and 5cm square electrodes in a constant mode (frequency=35 Hz, pulse width= 80 μsec, and sufficient amplitude to produce “visible and minimal continuous isometric contractions.”

For baseline assessment, participants were assessed twice on two consecutive days on:

• Spasticity of the hip adductor and plantarflexor muscles (Modified Ashworth Scale/MAS)
• 5TSTS
• 10MWT (self-selected speed)
• Temporospatial gait parameters via C-mill; participants walked at a self-selected speed for 3-5 minutes

For the short-term protocol, the continuous FES to the glute med and TA was delivered under the following four conditions:

• During passive abduction and passive ankle dorsiflexion
• With the participant supine, stimulation to both the glute med and TA was applied until an “obvious and comfortable isometric contraction” was shown, and this was maintained for two minutes.
• With the continuous FES on, the participant was passively moved into hip abduction and ankle dorsiflexion through the available ROM; 30 seconds x3, while the average grading of the MAS was noted.
• During bouts of the Five Time Sit to Stand Test (5TSTS)
• With the stimulation on and again set to achieve an isometric contraction of glute med and TA, a 5TSTS was conducted, followed by two minutes of rest.
• During bouts of a 10 Meter Walk Test
• Following the previous conditions, the stimulation was turned on and the 10MWT was assessed five times, followed by a two minute rest period.
• While walking on a C-mill treadmill (a treadmill with embedded force plate to collect data on temporal-spatial gait characteristics).

The long-term protocol, again incorporating continuous and simultaneous FES to the glute med and TA, consisted of at-home use while walking for three bouts daily of 15 minutes per session, with at least 3 hours between sessions, for one week. Caregivers were provided education to assist on the FES device setup.

The day after the long-term protocol was completed, the participants were evaluated on baseline measures.

Results

The authors provided tables for baseline measurements and results from the short and long term protocols, but only included a narrative analysis for the following gait parameters:

• From the short-term part of the study, there was a 37.9% increase in gait speed, 30.5% increase in step length, 28.8% increase in stride length.
• Results from the long-term study indicated a 33.6% increase in gait speed, 41.6% increase in step length, and 36.5% increase in stride length.

Other assessments presented in the baseline and results tables are as follows:

Assessment (Mean with SD)	Baseline Day 1 (without FES)	Baseline Day 2 (without FES)	Results from Short-term FES Protocol (FES on)	Results from Long-term Protocol: Without FES	Results from Long-term Protocol: With FES
MAS plantarflexors	2.78 ± 0.80	2.78 ± 0.80	1.71 ± 0.72	1.92 ± 0.91	0.85 ± 0.77
MAS hip adductors	2.00 ± 0.55	2.00 ± 0.55	1.00 ± 0.55	1.00 ± 0.55	0.35 ± 0.63
5TSTS	21.29 ± 2.39	19.77 ± 2.00	15.63 ± 2.69	17.59 ± 3.33	13.41 ± 2.20
10MWT (in seconds)	31.00 ± 11.42	30.78 ± 11.11	22.48 ± 0.21	21.49 ± 10.06	20.58 ± 9.97

The authors commented that the use of continuous FES to the glute med and TA muscles during various functional activities is feasible with a nearly immediate positive effect on the outcomes assessed.

They suggested their approach to FES was effective because it boosted motor unit recruitment—including both type I and type II fibers—augmenting the firing rates needed for smoother, stronger contractions during gait and sit-to-stand. They argued that this extra activation helped offset the common post-stroke weakness in hip abductors and dorsiflexors, leading to immediate gains in gait speed, step and stride length, and functional mobility. They also highlighted the observed reduction in spasticity, which they attribute to reciprocal inhibition triggered by stimulating the agonist muscles (TA and glute med), thereby dampening overactivity in the plantarflexors and hip adductors. The authors referenced a number of other studies in which the TA and glute med were stimulated during gait and mobility tasks, however none of those papers utilized the continuous FES of the present study.

The authors acknowledged limitations of this study, including the small sample size (n=14), a lack of 3D gait analysis, and the lack of a control group due to recruitment issues. Additionally, the study did not conduct any longer-term followup to determine retention of acquired gains. And while the authors did not comment on this, notably all participants in this study were male.

Finally, the authors did not discuss the impact of continuous FES on opposing muscle groups and potential consequences of limiting the action of the hip adductors (important for pelvic stabilization and hip control) and the ankle plantarflexors (crucial for forward propulsion) on gait quality in the short or long term.

Bottom Line

The use of continuous FES to the TA and glute med muscles may be beneficial for patients with chronic stroke to improve gait, transfers, and spasticity, though larger clinical trials with longer-term followup are needed to determine whether improvements are short-lived.

Do you have a patient interested in continuing FES therapy at home?

At MYOLYN, we’re committed to making FES cycling more accessible. Our Home Plus system includes a dedicated trunk channel, so patients can continue targeting abdominal muscles at home to support respiratory health and posture. Our team will work directly with your patient to explore every available funding source and help them get the system they need.