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Sekiguchi Y, Honda K, Izumi SI. Effect of Walking Adaptability on an Uneven Surface by a Stepping Pattern on Walking Activity After Stroke. Front Hum Neurosci 2022; 15:762223. [PMID: 35058764 PMCID: PMC8764227 DOI: 10.3389/fnhum.2021.762223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Real-world walking activity is important for poststroke patients because it leads to their participation in the community and physical activity. Walking activity may be related to adaptability to different surface conditions of the ground. The purpose of this study was to clarify whether walking adaptability on an uneven surface by step is related to daily walking activity in patients after stroke. We involved 14 patients who had hemiparesis after stroke (age: 59.4 ± 8.9 years; post-onset duration: 70.7 ± 53.5 months) and 12 healthy controls (age: 59.5 ± 14.2 years). The poststroke patients were categorized as least limited community ambulators or unlimited ambulators. For the uneven surface, the study used an artificial grass surface (7 m long, 2-cm leaf length). The subjects repeated even surface walking and the uneven surface walking trials at least two times at a comfortable speed. We collected spatiotemporal and kinematic gait parameters on both the even and uneven surfaces using a three-dimensional motion analysis system. After we measured gait, the subjects wore an accelerometer around the waist for at least 4 days. We measured the number of steps per day using the accelerometer to evaluate walking activity. Differences in gait parameters between the even and uneven surfaces were calculated to determine how the subjects adapted to an uneven surface while walking. We examined the association between the difference in parameter measurements between the two surface properties and walking activity (number of steps per day). Walking activity significantly and positively correlated with the difference in paretic step length under the conditions of different surface properties in the poststroke patients (r = 0.65, p = 0.012) and step width in the healthy controls (r = 0.68, p = 0.015). The strategy of increasing the paretic step length, but not step width, on an uneven surface may lead to a larger base of support, which maintains stability during gait on an uneven surface in poststroke patients, resulting in an increased walking activity. Therefore, in poststroke patients, an increase in paretic step length during gait on an uneven surface might be more essential for improving walking activity.
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Affiliation(s)
- Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
- *Correspondence: Yusuke Sekiguchi,
| | - Keita Honda
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
- Department of Physical Medicine and Rehabilitation, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
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Smith AD, Prokopiusova T, Jones R, Burge T, Rasova K. Functional electrical stimulation for foot drop in people with multiple sclerosis: The relevance and importance of addressing quality of movement. Mult Scler 2020; 27:653-660. [PMID: 32833562 DOI: 10.1177/1352458520923958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Impaired mobility is common in people with multiple sclerosis (MS). Changes in gait have different causes and require individualised gait rehabilitation. A common and often early cause of mobility impairment is footdrop, inability to lift the foot during the swing phase of gait, with increased risk of falls, effortful walking and fatigue. Using literature review, we have characterised published data on footdrop treatment in MS, specifically functional electrical stimulation (FES) to better understand the reported outcomes relevant to the user. We discuss the strengths and weaknesses of FES and how far it meets the needs of people with footdrop. Physiotherapy combined with FES may further enhance the benefits of FES. MS studies emphasise the value of maintaining activity levels in early MS but discussion on how to achieve this is lacking. We emphasise the value of qualitative measures to broaden our understanding and improve treatment and adherence and identify areas for further research. Supplementary video material illustrates key features of MS gait and its correction using FES and physiotherapy.
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Affiliation(s)
| | - Terezie Prokopiusova
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Rosemary Jones
- The Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Tania Burge
- The Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Kamila Rasova
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Prokopiusova T, Pavlikova M, Markova M, Rasova K. Randomized comparison of functional electric stimulation in posturally corrected position and motor program activating therapy: treating foot drop in people with multiple sclerosis. Eur J Phys Rehabil Med 2020; 56:394-402. [PMID: 32383574 DOI: 10.23736/s1973-9087.20.06104-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Functional electric stimulation (FES) is recommended for foot drop in multiple sclerosis, although little is known about its therapeutic effect. AIM The aim of this study is to evaluate a therapeutic effect immediately and two months after program termination (persistent and delayed effect) of a new approach using FES in combination with correcting the patients' postural system. More specifically, we evaluate the effects of this approach on the patients' clinical functions and compared it with individual physiotherapy. DESIGN Parallel randomized blind trial. SETTING Two-month-long treatments, functional electric stimulation in posturally corrected position (group 1) and neuroproprioceptive facilitation and inhibition physiotherapy called motor program activating therapy (group 2). POPULATION Forty-four subjects with multiple sclerosis. METHODS Primary outcomes: gait (the 2-Minute Walk Test; Timed 25-Foot Walk test; Multiple Sclerosis Walking Scale-12) and balance (by e.g. Berg Balance Scale [BBS], the Activities-Specific Balance Confidence Scale [ABC], Timed Up-and-Go Test [TUG]). SECONDARY OUTCOMES mobility, cognition, fatigue and subjects' perceptions (e.g. Multiple Sclerosis Impact Scale [MSIS], Euroqol-5 dimensions-5 levels [EQ-5D-5L]). RESULTS Group 1 showed immediate therapeutic effect in BBS (P=0.008), ABC (P=0.04) and EQ-5D-5L (self-care, P=0.019, mobility P=0.005). The improvement in EQ-5D-5L persisted and in TUG-cognitive we documented a delayed effect (P=0.005). Group 2 showed an immediate improvement in BBS (P=0.025), MSIS (P=0.043) and several aspects of daily life (the effect on health today was significantly higher than in group 1, significant difference between groups P=0.038). CONCLUSIONS FES in the posturally corrected position has an immediate therapeutic effect on balance and patients' perceptions comparable to motor program activating therapy, and higher persistent and even delayed therapeutic effect. CLINICAL REHABILITATION IMPACT The study results point to the importance of correcting the patients' posture when applying FES, the possibility to treat foot drop by individual physiotherapy and the activation of the patients' auto reparative processes.
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Affiliation(s)
- Terezie Prokopiusova
- Department of Rehabilitation, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic
| | - Marketa Pavlikova
- Department of Rehabilitation, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic.,Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - Magdalena Markova
- Department of Rehabilitation, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic
| | - Kamila Rasova
- Department of Rehabilitation, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic -
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Mendes LA, Lima INDF, Souza T, do Nascimento GC, Resqueti VR, Fregonezi GAF. Motor neuroprosthesis for promoting recovery of function after stroke. Cochrane Database Syst Rev 2020; 1:CD012991. [PMID: 31935047 PMCID: PMC6984639 DOI: 10.1002/14651858.cd012991.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Motor neuroprosthesis (MN) involves electrical stimulation of neural structures by miniaturized devices to allow the performance of tasks in the natural environment in which people live (home and community context), as an orthosis. In this way, daily use of these devices could act as an environmental facilitator for increasing the activities and participation of people with stroke. OBJECTIVES To assess the effects of MN for improving independence in activities of daily living (ADL), activities involving limbs, participation scales of health-related quality of life (HRQoL), exercise capacity, balance, and adverse events in people after stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (searched 19 August 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (August 2019), MEDLINE (1946 to 16 August 2019), Embase (1980 to 19 August 2019), and five additional databases. We also searched trial registries, databases, and websites to identify additional relevant published, unpublished, and ongoing trials. SELECTION CRITERIA Randomized controlled trials (RCTs) and randomized controlled cross-over trials comparing MN for improving activities and participation versus other assistive technology device or MN without electrical stimulus (stimulator is turned off), or no treatment, for people after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and assessed risk of bias of the included studies. Any disagreements were resolved through discussion with a third review author. We contacted trialists for additional information when necessary and performed all analyses using Review Manager 5. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included four RCTs involving a total of 831 participants who were more than three months poststroke. All RCTs were of MN that applied electrical stimuli to the peroneal nerve. All studies included conditioning protocols to adapt participants to MN use, after which participants used MN from up to eight hours per day to all-day use for ambulation in daily activities performed in the home or community context. All studies compared the use of MN versus another assistive device (ankle-foot orthosis [AFO]). There was a high risk of bias for at least one assessed domain in three of the four included studies. No studies reported outcomes related to independence in ADL. There was low-certainty evidence that AFO was more beneficial than MN on activities involving limbs such as walking speed until six months of device use (mean difference (MD) -0.05 m/s, 95% confidence interval (CI) -0.10 to -0.00; P = 0.03; 605 participants; 2 studies; I2 = 0%; low-certainty evidence); however, this difference was no longer present in our sensitivity analysis (MD -0.07 m/s, 95% CI -0.16 to 0.02; P = 0.13; 110 participants; 1 study; I2 = 0%). There was low to moderate certainty that MN was no more beneficial than AFO on activities involving limbs such as walking speed between 6 and 12 months of device use (MD 0.00 m/s, 95% CI -0.05 to 0.05; P = 0.93; 713 participants; 3 studies; I2 = 17%; low-certainty evidence), Timed Up and Go (MD 0.51 s, 95% CI -4.41 to 5.43; P = 0.84; 692 participants; 2 studies; I2 = 0%; moderate-certainty evidence), and modified Emory Functional Ambulation Profile (MD 14.77 s, 95% CI -12.52 to 42.06; P = 0.29; 605 participants; 2 studies; I2 = 0%; low-certainty evidence). There was no significant difference in walking speed when MN was delivered with surface or implantable electrodes (test for subgroup differences P = 0.09; I2 = 65.1%). For our secondary outcomes, there was very low to moderate certainty that MN was no more beneficial than another assistive device for participation scales of HRQoL (standardized mean difference 0.26, 95% CI -0.22 to 0.74; P = 0.28; 632 participants; 3 studies; I2 = 77%; very low-certainty evidence), exercise capacity (MD -9.03 m, 95% CI -26.87 to 8.81; P = 0.32; 692 participants; 2 studies; I2 = 0%; low-certainty evidence), and balance (MD -0.34, 95% CI -1.96 to 1.28; P = 0.68; 692 participants; 2 studies; I2 = 0%; moderate-certainty evidence). Although there was low- to moderate-certainty evidence that the use of MN did not increase the number of serious adverse events related to intervention (risk ratio (RR) 0.35, 95% CI 0.04 to 3.33; P = 0.36; 692 participants; 2 studies; I2 = 0%; low-certainty evidence) or number of falls (RR 1.20, 95% CI 0.92 to 1.55; P = 0.08; 802 participants; 3 studies; I2 = 33%; moderate-certainty evidence), there was low-certainty evidence that the use of MN in people after stroke may increase the risk of participants dropping out during the intervention (RR 1.48, 95% CI 1.11 to 1.97; P = 0.007; 829 participants; 4 studies; I2 = 0%). AUTHORS' CONCLUSIONS Current evidence indicates that MN is no more beneficial than another assistive technology device for improving activities involving limbs measured by Timed Up and Go, balance (moderate-certainty evidence), activities involving limbs measured by walking speed and modified Emory Functional Ambulation Profile, exercise capacity (low-certainty evidence), and participation scale of HRQoL (very low-certainty evidence). Evidence was insufficient to estimate the effect of MN on independence in ADL. In comparison to other assistive devices, MN does not appear to increase the number of falls (moderate-certainty evidence) or serious adverse events (low-certainty evidence), but may result in a higher number of dropouts during intervention period (low-certainty evidence).
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Affiliation(s)
- Luciana A Mendes
- Federal University of Rio Grande do NortePneumoCardioVascular Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH) & Department of Biomedical EngineeringNatalRio Grande do NorteBrazil59078‐970
| | - Illia NDF Lima
- Federal University of Rio Grande do NorteFaculty of Health Sciences of TrairiSanta CruzRio Grande do NorteBrazil59200‐000
| | - Tulio Souza
- Federal University of Rio Grande do NorteDepartment of Physical TherapyNatalBrazil59078‐970
| | - George C do Nascimento
- Federal University of Rio Grande do NorteDepartment of Biomedical EngineeringCaixa Postal 1524 ‐ Campus Universitário Lagoa NovaDepartamento de Engenharia BiomédicaNatalRio Grande do NorteBrazil59078‐970
| | - Vanessa R Resqueti
- Federal University of Rio Grande do NortePneumoCardioVascular Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH) & Department of Physical TherapyCampus Universitario Lagoa NovaCaixa Postal 1524NatalRio Grande do NorteBrazil59078‐970
| | - Guilherme AF Fregonezi
- Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH)PneumoCardioVascular LabNatalRio Grande do NorteBrazil59078‐970
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Effects of passive Bi-axial ankle stretching while walking on uneven terrains in older adults with chronic stroke. J Biomech 2019; 89:57-64. [DOI: 10.1016/j.jbiomech.2019.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 11/17/2022]
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Hausmann J, Sweeney-Reed CM, Sobieray U, Matzke M, Heinze HJ, Voges J, Buentjen L. Functional electrical stimulation through direct 4-channel nerve stimulation to improve gait in multiple sclerosis: a feasibility study. J Neuroeng Rehabil 2015; 12:100. [PMID: 26577467 PMCID: PMC4650371 DOI: 10.1186/s12984-015-0096-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 11/06/2015] [Indexed: 11/13/2022] Open
Abstract
Background Gait dysfunction due to lower limb central paralysis, frequently involving drop foot, is a common cause of disability in multiple sclerosis and has been treated with transcutaneous functional electrical stimulation (FES). We provide here the first report of 4-channel semi-implantable FES of the peroneal nerve which has been successfully used for rehabilitation in patients following stroke. Methods FES was implemented via a 4-channel semi-implantable closed-loop system (ActiGait®, ©Ottobock), generating dorsiflexion in drop foot. Walking distance, gait symmetry (temporospatial gait analyses, Vicon Motion Systems®), gait velocity (10 m walking test) and quality of life (SF-36 questionnaire) were measured to evaluate the therapeutic benefit of this system in two patients with progressive MS. Results Walking distance increased from 517 to 1884 m in Patient 1 and from 52 to 506 m in Patient 2. Gait velocity did not change significantly in Patient 1 and increased from 0.6 to 0.8 m/s in Patient 2. Maximum deviations of center of mass from the midline to each side changed significantly after 3 months of stimulation compared to baseline, decreasing from 15 to 12 mm in Patient 1 and from 47 to 37 mm in Patient 2. Both patients experienced reduced pain and fatigue and benefits to quality of life. Adverse events did not occur during the observation period. Conclusion We conclude that implantable 4-channel FES systems are not only feasible but present a promising new alternative for treating central drop foot in MS patients.
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Affiliation(s)
- Janet Hausmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Catherine M Sweeney-Reed
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. .,Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Uwe Sobieray
- German Center for Neurodegenerative Diseases (DZNE), Site Magdeburg, Leipziger Str. 44, Magdeburg, Germany.
| | - Mike Matzke
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Jürgen Voges
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Lars Buentjen
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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Popa L, Taylor P. Functional electrical stimulation may reduce bradykinesia in Parkinson's disease: A feasibility study. J Rehabil Assist Technol Eng 2015; 2:2055668315607836. [PMID: 31191918 PMCID: PMC6531801 DOI: 10.1177/2055668315607836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/04/2015] [Indexed: 11/21/2022] Open
Abstract
Objectives This feasibility study investigated the effect of combined upper and lower
limb functional electrical stimulation (FES) to reduce bradykinesia in
Parkinson’s disease (PD). Method Eleven people with PD and Hoehn and Yahr score 2–3 used FES to assist
dorsiflexion and hand opening or fine hand movements for 2 weeks. Outcome
measures were the nine-hole peg test, box and block test, 10 m walking test,
Tinetti balance scale, modified Parkinson’s disease quality of life
questionnaire (PDQL), SPES/SCOPA scale, and compliance. All tests were
carried out without FES. Comparisons were tested using the Student paired
t-test. Results Two participants dropped out due to difficulty in using the equipment. Mean
walking speed increased by 0.29 m s−1
(p = 0.002), step length by 0.09 m
(p = 0.007), and cadence by 19.8 steps min−1
(p = 0.045). Tinetti balance score increased by 2.9
(p = 0.006). There was an increase in the box and block
test of 5.1 (p = 0.025). The PD symptoms score of the PDQL
improved by 4.9 (p = 0.013) and a reduction in SPES/SCOPA
score of 5.7 (p = 0.005) indicated a reduced impact of
PD. Conclusions FES produced clinically meaningful improvements in gait and upper limb
function. Some participants found using both interventions challenging and
we would recommend that their introduction be staggered.
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Affiliation(s)
- Livia Popa
- The National Clinical FES Centre, Salisbury District Hospital, UK
| | - Paul Taylor
- The National Clinical FES Centre, Salisbury District Hospital, UK
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Nolan KJ, Yarossi M, Mclaughlin P. Changes in center of pressure displacement with the use of a foot drop stimulator in individuals with stroke. Clin Biomech (Bristol, Avon) 2015; 30:755-61. [PMID: 26003198 DOI: 10.1016/j.clinbiomech.2015.03.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Center of pressure measured during gait can provide information about underlying control mechanisms and the efficacy of a foot drop stimulator. This investigation evaluated changes in center of pressure displacement in individuals with stroke with and without a foot drop stimulator. METHODS Individuals with stroke-related foot drop (n=11) using a foot drop stimulator and healthy controls (n=11). Walking speed and bilateral center of pressure variables: 1) net displacement; 2) position and maximum displacement; and 3) mean velocity during walking. FINDINGS On the affected limb with the foot drop stimulator as compared to the affected limb without the foot drop stimulator: 1) increased anterior/posterior maximum center of pressure excursion 8% during stance; 2) center of pressure at initial contact was 6% more posterior; 3) medial/lateral mean, maximum and minimum center of pressure position during stance all significantly decreased; 4) anterior/posterior net displacement increased during stance and single support; and 5) anterior/posterior velocity of the center of pressure increased during stance. INTERPRETATION Individuals with stroke using a foot drop stimulator contacted the ground more posterior at initial contact and utilized more of the anterior/posterior plantar surface of the foot on the affected limb during stance. With the foot drop stimulator there was a shift in center of pressure toward the medial side possibly indicating an improvement in equinovarus gait where there is a tendency to load the lateral foot throughout stance. For individuals with stroke a foot drop stimulator can improve displacement of the center of pressure which indicates improved forward progression and stability during walking.
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Affiliation(s)
- Karen J Nolan
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA.
| | - Mathew Yarossi
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, USA; Graduate School of Biomedical Sciences, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Patrick Mclaughlin
- College of Health and Biomedicine/ISEAL, Victoria University, Melbourne, Australia
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Prenton S, Kenney LP, Stapleton C, Cooper G, Reeves ML, Heller BW, Sobuh M, Barker AT, Healey J, Good TR, Thies SB, Howard D, Williamson T. Feasibility study of a take-home array-based functional electrical stimulation system with automated setup for current functional electrical stimulation users with foot-drop. Arch Phys Med Rehabil 2014; 95:1870-7. [PMID: 24845222 DOI: 10.1016/j.apmr.2014.04.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/11/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the feasibility of unsupervised community use of an array-based automated setup functional electrical stimulator for current foot-drop functional electrical stimulation (FES) users. DESIGN Feasibility study. SETTING Gait laboratory and community use. PARTICIPANTS Participants (N=7) with diagnosis of unilateral foot-drop of central neurologic origin (>6mo) who were regular users of a foot-drop FES system (>3mo). INTERVENTION Array-based automated setup FES system for foot-drop (ShefStim). MAIN OUTCOME MEASURES Logged usage, logged automated setup times for the array-based automated setup FES system and diary recording of problems experienced, all collected in the community environment. Walking speed, ankle angles at initial contact, foot clearance during swing, and the Quebec User Evaluation of Satisfaction with Assistive Technology version 2.0 (QUEST version 2.0) questionnaire, all collected in the gait laboratory. RESULTS All participants were able to use the array-based automated setup FES system. Total setup time took longer than participants' own FES systems, and automated setup time was longer than in a previous study of a similar system. Some problems were experienced, but overall, participants were as satisfied with this system as their own FES system. The increase in walking speed (N=7) relative to no stimulation was comparable between both systems, and appropriate ankle angles at initial contact (N=7) and foot clearance during swing (n=5) were greater with the array-based automated setup FES system. CONCLUSIONS This study demonstrates that an array-based automated setup FES system for foot-drop can be successfully used unsupervised. Despite setup's taking longer and some problems, users are satisfied with the system and it would appear as effective, if not better, at addressing the foot-drop impairment. Further product development of this unique system, followed by a larger-scale and longer-term study, is required before firm conclusions about its efficacy can be reached.
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Affiliation(s)
| | | | | | | | - Mark L Reeves
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | | | | | - Anthony T Barker
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Jamie Healey
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Timothy R Good
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
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Roche A, Laighin GÓ, Coote S. Surface-applied functional electrical stimulation for orthotic and therapeutic treatment of drop-foot after stroke – a systematic review. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328809x405946] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kluding PM, Dunning K, O’Dell MW, Wu SS, Ginosian J, Feld J, McBride K. Foot Drop Stimulation Versus Ankle Foot Orthosis After Stroke. Stroke 2013; 44:1660-9. [DOI: 10.1161/strokeaha.111.000334] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Patricia M. Kluding
- From the Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS (P.M.K.); Department of Rehabilitation Sciences, College of Allied Health Sciences, and Division of Biostatistics and Epidemiology, College of Medicine, University of Cincinnati, Cincinnati, OH (K.D.); Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (M.W.O.); Department of Biostatistics, University of Florida,
| | - Kari Dunning
- From the Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS (P.M.K.); Department of Rehabilitation Sciences, College of Allied Health Sciences, and Division of Biostatistics and Epidemiology, College of Medicine, University of Cincinnati, Cincinnati, OH (K.D.); Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (M.W.O.); Department of Biostatistics, University of Florida,
| | - Michael W. O’Dell
- From the Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS (P.M.K.); Department of Rehabilitation Sciences, College of Allied Health Sciences, and Division of Biostatistics and Epidemiology, College of Medicine, University of Cincinnati, Cincinnati, OH (K.D.); Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (M.W.O.); Department of Biostatistics, University of Florida,
| | - Samuel S. Wu
- From the Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS (P.M.K.); Department of Rehabilitation Sciences, College of Allied Health Sciences, and Division of Biostatistics and Epidemiology, College of Medicine, University of Cincinnati, Cincinnati, OH (K.D.); Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (M.W.O.); Department of Biostatistics, University of Florida,
| | - Jivan Ginosian
- From the Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS (P.M.K.); Department of Rehabilitation Sciences, College of Allied Health Sciences, and Division of Biostatistics and Epidemiology, College of Medicine, University of Cincinnati, Cincinnati, OH (K.D.); Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (M.W.O.); Department of Biostatistics, University of Florida,
| | - Jody Feld
- From the Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS (P.M.K.); Department of Rehabilitation Sciences, College of Allied Health Sciences, and Division of Biostatistics and Epidemiology, College of Medicine, University of Cincinnati, Cincinnati, OH (K.D.); Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (M.W.O.); Department of Biostatistics, University of Florida,
| | - Keith McBride
- From the Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS (P.M.K.); Department of Rehabilitation Sciences, College of Allied Health Sciences, and Division of Biostatistics and Epidemiology, College of Medicine, University of Cincinnati, Cincinnati, OH (K.D.); Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (M.W.O.); Department of Biostatistics, University of Florida,
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Abstract
BACKGROUND AND PURPOSE Examining participant-perceived change in walking provides insight into whether changes were meaningful for participants. This study examined the relationships between change scores in standardized walking outcomes and ratings of perceived change following exercise poststroke. METHODS Self- and fast-paced gait speed and Six-Minute Walk Test (6MWT) distance were assessed in 22 participants (age 67 ± 10.3 years, 1.8 ± 0.9 years poststroke) before and after a 3-month exercise program. Perceived changes were evaluated using a 15-point Likert scale. Correlation analyses between measured and perceived changes were performed. Subgroups of low and high baseline scores were compared for differences in measured and perceived changes. RESULTS Six-Minute Walk Test change was correlated with perceived change (ρ = 0.52, P = 0.01), greater 6MWT change was demonstrated among participants who perceived improvement compared to those who did not (difference 34.4 m, 95% CI: 17.2-51.6, P = 0.04). After controlling for measured change, participants with low baseline 6MWT distances perceived less change than those who walked high distances at baseline (P = 0.006) even when relative change was equivalent. DISCUSSION AND CONCLUSIONS A global rating scale using meaningful and context-specific questions was used to determine the relationship between measured and participant-perceived changes in 6MWT distance. A meaningful difference in 6MWT change was observed between participants who did and those who did not perceive improvement. Individuals with lower baseline scores may require larger changes in walking distance to perceive that a change has occurred. This study contributes to a growing body of evidence about the relationships between perceived and measured changes in function and is a step in determining thresholds for perceived change in walking after stroke.
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Effect of peroneal electrical stimulation versus an ankle-foot orthosis on obstacle avoidance ability in people with stroke-related foot drop. Phys Ther 2012; 92:398-406. [PMID: 22135711 DOI: 10.2522/ptj.20100405] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Walking ability of people with foot drop in the chronic phase after stroke is better with functional electrical stimulation (FES) of the peroneal nerve than without an orthotic device. However, the literature is not conclusive on whether peroneal FES also is better than an ankle-foot orthosis (AFO) in this regard. OBJECTIVE This study aimed to identify potential benefits of peroneal FES over an AFO with respect to the ability to negotiate a sudden obstacle. DESIGN The study design was a within-subject comparison between FES and AFO using repeated measures. METHODS Twenty-four community-dwelling people with stroke (mean age=52.6 years, SD=12.7) who regularly used a polypropylene AFO were fitted with a transcutaneous FES device. The participants' obstacle avoidance ability was tested after 2 and 8 weeks. They had to avoid 30 obstacles that were suddenly dropped on a treadmill in front of the affected leg while walking with either FES or an AFO. The obstacle avoidance success rates were determined. RESULTS Success rates were higher with FES than with an AFO, especially after adjustment for individual leg muscle strength. Participants with relatively low muscle strength (Motricity Index score <64) were most likely to benefit from FES regarding obstacle avoidance ability. LIMITATION Further work is needed to determine whether the results may be generalized to other groups of people with stroke. CONCLUSIONS Peroneal FES seems to be superior to an AFO with regard to obstacle avoidance ability in community-dwelling people with stroke. The observed gains in obstacle avoidance ability appear to be clinically most relevant in the people with relatively low leg muscle strength.
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Recent Findings Regarding the Efficacy of Functional Electrical Stimulation in Patients With Chronic Hemiplegia and Multiple Sclerosis: A Narrative Literature Review. ACTA ACUST UNITED AC 2010. [DOI: 10.1097/jpo.0b013e3181e90370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Compression is the most common cause of damage to the fibular head, the site of most peroneal nerve injuries which cause foot drop. Compression injuries can be caused by prolonged immobility and habitual leg-crossing. A review of the literature does not reveal the existence of a nationwide study that investigates the prevalence of compression-caused foot drop, nor does the literature contain encouragement to arrange medical practices to prevent its occurrence (e.g., soft substrates for sitting, frequent reminders for the patient to uncross the legs). Treatments for foot drop do not appear to be strongly scientifically based and they do not incorporate the use of sensory integration, specifically use of the visual sense, during rehabilitation. Finally, compression-caused foot drop may be preventable, a conclusion that could ultimately have important implications in the context of Medicare and Medicaid reimbursement.
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Gait in individuals with chronic hemiparesis: one-year follow-up of the effects of a neuroprosthesis that ameliorates foot drop. J Neurol Phys Ther 2009; 33:104-10. [PMID: 19556919 DOI: 10.1097/npt.0b013e3181a33624] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE Foot drop is a common cause of gait impairment in individuals with hemiparesis. The objective of this study was to determine the short-term and long-term effects on functional gait of a neuroprosthesis that provides functional electrical stimulation (FES) to correct footdrop. METHODS Sixteen individuals (mean age, 55.0 +/- 14.6 years) with chronic hemiparesis (mean years since insult, 5.3 +/- 4.8) were assessed immediately before receiving the neuroprosthesis and two months and one year after using the device. Both follow-up assessments were conducted with FES operating; the one-year follow-up also assessed gait without FES. Outcome measures were gait velocity on an even surface during a 10-m walk, during a six-minute walk, over obstacles, and over a carpet. Foot switches used during the six-minute walk determined stance time, stride time variability, and gait asymmetry. The effect of time and the one-year carryover effect on gait without FES were determined, with significance set at P = 0.05. RESULTS The neuroprosthesis had a significant short-term and long-term effect on most measured variables. Thus, mean 10-m walk gait velocity improved in two months from 0.67 m/sec to 0.86 m/sec and continued to increase to 1.06 m/sec by the one-year assessment. A carryover effect on gait velocity and stance time without FES were also noted. The 10-m gait velocity without the neuroprosthesis increased by 23.8% by the one-year follow-up assessment. CONCLUSIONS The neuroprosthesis appears to improve gait performance, and gains were further enhanced over time and carried over to gait even without FES. These results suggest orthotic and therapeutic effects on footdrop after prolonged use of the neuroprosthesis.
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Effects of a Foot Drop Neuroprosthesis on Functional Abilities, Social Participation, and Gait Velocity. Am J Phys Med Rehabil 2009; 88:14-20. [DOI: 10.1097/phm.0b013e3181911246] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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