The Orthotic Effect of Functional Electrical Stimulation on the Improvement of Walking in Stroke Patients with a Dropped Foot: A Systematic Review

Roessingh Research and Development, PO Box 310, 7500 AH Enschede, the Netherlands.
Artificial Organs (Impact Factor: 2.05). 07/2004; 28(6):577-86. DOI: 10.1111/j.1525-1594.2004.07310.x
Source: PubMed


Analysis of the available evidence on the improvement of walking in stroke patients with a dropped foot when using peroneus stimulation.
A systematic review was performed to identify trials that investigated the orthotic effect of functional electrical stimulation (FES) on walking in stroke patients with a dropped foot. Two independent raters scored the methodological quality of the included articles. Walking speed and physiological cost index (PCI) were selected as the primary outcome measures. Studies that measured walking speed were pooled and a pooled difference including confidence interval was calculated.
Eight studies were included in the review, of which one was a randomized controlled trial. Methodological score ranged from 8 to 18 out of 19. Six studies measured walking speed. The pooled improvement in walking speed was 0.13 m/s (0.07-0.2) or 38% (22.18-53.8).
The present review suggests a positive orthotic effect of functional electrical stimulation on walking speed.

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Available from: Maarten Ijzerman, Sep 30, 2015
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    • "Foot drop commonly occurs from muscle weakness in the paretic leg and manifests itself as a decrease in dorsiflexion range of motion [2]. For many poststroke survivors, paretic limb foot drop increases the risk of stumbling and falling and decreases functional mobility [2]. It is unclear whether dorsiflexor weakness is solely due to neurological impairment following stroke or whether changes in the muscle architecture are additional contributing factors. "
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    ABSTRACT: Poststroke dorsiflexor weakness and paretic limb foot drop increase the risk of stumbling and falling and decrease overall functional mobility. It is of interest whether dorsiflexor muscle weakness is primarily neurological in origin or whether morphological differences also contribute to the impairment. Ten poststroke hemiparetic individuals were imaged bilaterally using noninvasive medical imaging techniques. Magnetic resonance imaging was used to identify changes in tibialis anterior muscle volume and muscle belly length. Ultrasonography was used to measure fascicle length and pennation angle in a neutral position. We found no clinically meaningful bilateral differences in any architectural parameter across all subjects, which indicates that these subjects have the muscular capacity to dorsiflex their foot. Therefore, poststroke dorsiflexor weakness is primarily neural in origin and likely due to muscle activation failure or increased spasticity of the plantar flexors. The current finding suggests that electrical stimulation methods or additional neuromuscular retraining may be more beneficial than targeting muscle strength (i.e., increasing muscle mass).
    Stroke Research and Treatment 07/2014; 2014:948475. DOI:10.1155/2014/948475
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    • "Research investigating FES in individuals with acute and chronic hemiplegia and FD secondary to stroke indicate that this technology has the potential to restore physiological function and improve community ambulation (Robbins, Houghton, Woodbury, & Brown, 2006; Sabut, Sikdar, Mondal, Kumar, & Mahadevappa, 2010). These results demonstrate the efficacy for FDS utilization in post stroke rehabilitation but they fail to precisely indicate how FDS technology can restore motor function (Everaert et al., 2013; Kesar et al., 2010; Kesar et al., 2009, 2011; Kottink et al., 2004; Stein et al., 2006, 2010; Taylor et al., 1999). "
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    ABSTRACT: BACKGROUND: Functional Electrical Stimulation (FES) applied through a foot drop stimulator (FDS) is a rehabilitation intervention that can stimulate the common peroneal nerve to provide dorsiflexion at the correct timing during gait. OBJECTIVE: To determine if FES applied to the peroneal nerve during walking through a FDS would effectively retrain the electromyographic temporal activation of the tibialis anterior in individuals with stroke. METHODS: Surface electromyography (EMG) were collected bilaterally from the tibialis anterior (TA) while participants (n = 4) walked with and without the FDS at baseline and 4 weeks. Comparisons were made between stimulation timing and EMG activation timing to produce a burst duration similarity index (BDSI). RESULTS: At baseline, participants displayed variable temporal activation of the TA. At 4 weeks, TA activation during walking without the FDS more closely resembled the pre-programmed FDS timing demonstrated by an increase in BDSI scores in all participants (P = 0.05). CONCLUSIONS: Continuous use of FDS during a task specific movement can re-train the neuromuscular system. After 4 weeks of utilization the FDS trained the TA to replicate the programmed temporal activation patterns. These findings begin to establish the FDS as a rehabilitation intervention that may facilitate recovery rather than just compensate for stroke related gait impairments due to foot drop.
    Neurorehabilitation 07/2014; 35(2). DOI:10.3233/NRE-141126 · 1.12 Impact Factor
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    • "Persons with foot drop generally lose the functional ankle dorsiflexion of the affected leg, and thus do not lift the ankles and the toes. As a result, the patients drag the toes of the affected foot on the ground during walking and this becomes a cause of gait disturbance (Kottink et al, 2004; Teasell et al, 2003). "
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    ABSTRACT: The purpose of this study was to investigate the effects of active and passive postural perturbation on ankle dorsiflexor responses in stroke patients. The subjects consisted of 13 stroke patients. Using wireless electromyography, the patients' ankle dorsiflexor muscle responses were measured under the following conditions: active dorsiflexion (AD), active perturbation (AP), and passive perturbation (PP). Tibialis anterior muscle activity increased most significantly during PP of the affected side (). The most significant increase for the non-affected side was in AD (). Tibialis anterior muscle activity was compared under each condition. The affected side showed significant differences between PP and AD and between PP and AP (p.05). The ratios of tibialis anterior muscle activity under PP to that under AD were 3.30 on the affected side and 1.14 on the non-affected side and the difference was significant (p
    11/2013; 20(4). DOI:10.12674/ptk.2013.20.4.047
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