Does cycling with electrical stimulation (ES) improve strength and walking ability in people with an acquired brain injury? A randomised controlled trial

INTERVENTION: Electrical Stimulation (ES) Cycling A 30 min incremental progressive, individualised ES cycling program performed five times a week for four weeks as well as usual care. ES Cycling involves applying a small electrical current through pads attached to the skin over 4 muscle groups on the affected leg. This will be applied from 10‐15 minutes initially increasing to 30 minutes 5 times weekly over a 4 week period. The parameters will be individualized and adjusted according to the participants' comfort levels. It will take approximately 10 minutes to set up a participant on the ES cycle however once set up the therapist will be able to provide one‐to‐one assistance to other people whilst supervising participants. This will allow more people to receive supervised exercise simultaneously. CONDITION: Acquired brain injury PRIMARY OUTCOME: Quadriceps strength will be measured using dynamometry, a hand‐held device which is easy to use and not harmful to the participant. Walking ability will be assessed using the transfers and locomotion items of the Functional Independence Measure (FIM). SECONDARY OUTCOME: Global lower limb strength will be measured with manual muscle testing. Spasticity will be assessed using the Tardieu scale INCLUSION CRITERIA: 1. diagnosis of a first time stroke or any other acquired brain injury that is not progressive resulting in hemiparesis 2. acute event < 6 months before the study onset 3. sufficient cognition to consent (as evaluated by a physician) or consent will be obtained from the next of kin. 4. sufficient communication to indicate yes/no verbally or via gestures possible discomfort. 5. able to sit supported for 40 mins