[Show abstract][Hide abstract] ABSTRACT: Stimulators applying functional electrical stimulation (FES) to the common peroneal nerve improve walking with a foot drop, which occurs in several disorders.
To compare the orthotic and therapeutic effects of a foot drop stimulator on walking performance of subjects with chronic nonprogressive (eg, stroke) and progressive (eg, multiple sclerosis) disorders.
Subjects with nonprogressive (41) and progressive (32) conditions used a foot drop stimulator for 3 to 12 months while walking in the community. Walking speed was measured with a 10-m test and a 4-minute figure-8 test; physiological cost index (PCI) and device usage were also measured. The subjects were tested with FES on and off (orthotic effect) before and after (therapeutic effect) stimulator use.
After 3 months of FES use, the nonprogressive and progressive groups had a similar, significant orthotic effect (5.0% and 5.7%, respectively, P < .003; percentage change in mean values) and therapeutic effect with FES off (17.8% and 9.1%, respectively, P < .005) on figure-8 walking speed. Overall, PCI showed a decreasing trend (P = .031). The therapeutic effect on figure-8 speed diverged later between both groups to 28.0% (P < .001) and 7.9% at 11 months. The combined therapeutic plus orthotic effect on figure-8 speed at 11 months was, respectively, 37.8% (P < .001) and 13.1% (P = .012); PCI decreased 18.2% (P = .038) and 6.5%, respectively.
Subjects with progressive and nonprogressive disorders had an orthotic benefit from FES up to 11 months. The therapeutic effect increased for 11 months in nonprogressive disorders but only for 3 months in progressive disorders. The combined effect remained significant and clinically relevant.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To systematically review the evidence for the efficacy of different rehabilitation strategies on functional ambulation following spinal cord injury (SCI). METHODS: A keyword literature search of original articles was used to identify published literature evaluating the effectiveness of any treatment or therapy on functional ambulation in people with SCI. The rigor and quality of each study were scored on standardized scales by two independent reviewers. RESULTS: The search yielded 160 articles, of which 119 were excluded for not meeting our inclusion criteria. The remaining 41 articles covered various strategies for improving gait: bodyweight supported treadmill training (BWSTT) (n=12), functional electrical stimulation (FES) (n=7), braces/orthoses (n=10), or a combination of these (n=12). There is strong evidence from randomized controlled trials that functional ambulation outcomes following body-weight supported treadmill training (BWSTT) are comparable to an equivalent intensity of overground gait training in sub-acute SCI. In chronic SCI, evidence from pre-test/post-test studies shows that BWSTT may be effective in improving functional ambulation. Pre-test/post-test or post-test only studies provide evidence that FES may augment functional ambulation in sub-acute/chronic SCI while braces may afford particular benefits to people with complete SCI to stand up and ambulate with assistive devices. CONCLUSIONS: Rehabilitation strategies that facilitate repeated practice of gait offer the greatest benefits to functional ambulation in sub-acute or chronic SCI. Supportive devices may augment functional ambulation particularly in people with incomplete SCI.
Topics in Spinal Cord Injury Rehabilitation 05/2007; 13(1):32-57. DOI:10.1310/sci1301-32
[Show abstract][Hide abstract] ABSTRACT: To test the efficacy and acceptance of a footdrop stimulator controlled by a tilt sensor.
A nonrandomized, test-retest study of 26 subjects with footdrop of more than 1 year's duration, resulting from various central nervous system disorders, was performed in 4 centers for at least 3 months. Speed of walking in a straight line, speed around a figure of 8, and physiological cost index (PCI) were measured with and without the device. Hours/day and steps/day using the device were recorded.
All but 2 subjects used the tilt sensor at home, rather than a foot switch. Walking speed increased by 15% after 3 months (n = 26; P < 0.01), 32% after 6 months (n = 16; P < 0.01), and 47% after 12 months (n = 8; P < 0.05), while PCI decreased. The number of steps taken per day of use increased significantly over time, and increased speed was directly correlated with usage. Walking speed also increased with the stimulator off, but to a lesser extent, indicating a training effect. Subject feedback from a questionnaire indicated satisfaction with the stimulator.
Both efficacy and acceptance of the stimulator were good in a population of subjects with chronic footdrop.
[Show abstract][Hide abstract] ABSTRACT: To compare the effect of functional electric stimulation (FES) with that of a hinged ankle-foot orthosis (AFO) for assisting foot clearance, gait speed, and endurance and to determine whether there is added benefit in using FES in conjunction with the hinged AFO in persons with incomplete spinal cord injury (SCI).
Within-subject comparison of walking under 4 conditions: AFO, FES, AFO and FES, and no orthosis. A plastic hinged AFO was used for all AFO conditions.
Tertiary rehabilitation center.
Nineteen subjects with incomplete SCI.
The self-selected gait speed, 6-minute walk distance, and foot clearance values were compared between conditions.
Gait speed increased with FES ( P <.05) and with the AFO ( P =.06). Six-minute walk distance also increased with the AFO ( P <.05). No difference was found between the 2 forms of orthoses in either gait speed or endurance. The greatest increase in gait speed and endurance from the no-orthosis condition occurred with the combined AFO and FES condition. Foot clearance improved with FES but not with AFO. Subjects whose gait speed increased with FES had weaker hip flexors, knee flexors, and ankle dorsiflexors than those who did not benefit from FES.
Both FES and the hinged AFO promote walking and FES is only superior to the AFO in increasing foot-clearance values. The hinged AFO and FES together may offer advantages over either device alone.
Archives of Physical Medicine and Rehabilitation 10/2004; 85(10):1718-23. DOI:10.1016/j.apmr.2004.02.015 · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prospective analysis of relationships.
(1) To quantify the relationship between individual lower extremity muscle strength and functional walking measures and (2) to determine whether a multiple regression model incorporating lower extremity muscle strength could predict the performance of functional walking measures in persons with incomplete spinal cord injury (ISCI) living in the community.
Tertiary rehabilitation center, Vancouver, Canada.
In all, 22 subjects with ISCI participated. The relationship between functional walking measures (gait speed, 6-min-walk distance, and ambulatory capacity) and muscle strength (manual tests of hip flexors/extensors/abductors, knee flexors/extensors, ankle dorsiflexors/plantarflexors, and great toe extensors) were measured by Pearson's correlation and regression procedures.
For both the more and less affected sides, hip flexors, hip extensors, and hip abductors produced the highest correlations with the three functional measures. The less affected hip flexor strength explained more than 50% of the variance in gait speed and 6-min-walk distance while the less affected hip extensor strength explained up to 64% of the variance in ambulatory capacity. For all three functional measures, the strength of the less affected limb was more important than that of the more affected limb.
Lower extremity muscle strength, in particular that of hip flexors, hip extensors, and hip abductors, is an important determinant of functional walking performance.
[Show abstract][Hide abstract] ABSTRACT: To test the long-term benefits of several noninvasive systems for functional electrical stimulation (FES) during walking.
Forty subjects (average years since injury, 5.4) were studied in four centers for an average time of 1 year. Gait parameters were tested for all subjects with and without FES. Thus, subjects served as their own controls, since the specific effect of using FES could be separated from improvements resulting from other factors (e.g., training).
Subjects used the devices in the community, but were tested in a university or hospital setting.
Subjects with spinal cord injury (n = 31) were compared to subjects with cerebral damage (n = 9).
Gait parameters (speed, cycle time, stride length). Acceptance was studied by means of a questionnaire.
Some initial improvement in walking speed (average increase of >20%) occurred, and continuing gains were seen (average total improvement, 45%). The largest relative gains were seen in the slowest walkers (speeds of <0.3 m/sec). Acceptance of the FES systems was good and improved systems have been developed using feedback from the subjects.
Based on the improvements in speed and the acceptance of these FES systems, a greatly increased role for FES in treating gait disorders is suggested.
Archives of Physical Medicine and Rehabilitation 05/1999; 80(5):495-500. DOI:10.1016/S0003-9993(99)90188-0 · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Twenty-four subjects with foot drop due to various neurological disorders were studied. All but 2 chose to use a tilt sensor, rather than a traditional foot switch to control the stimulation. Walking speed increased from 28 to 34 m/min around a 10 m, figure of 8 after 3 months of FES. Fourteeen subjects have been studied for 6 months and show an increase of 27% and 7 subjects for 12 months with an increase of 51%. Physiological cost index (PCI) decreased, but not significantly with this sample size. The stimulator also records the hours of use per day and the number of steps taken per day. The number of steps/day of use increased over a study period of 100 days. A satisfaction questionnaire indicated a high degree of acceptance of the stimulator.
[Show abstract][Hide abstract] ABSTRACT: As part of a multi-centre trial to investigate the effects of a common peroneal nerve foot drop stimulator, 24 subjects with stroke, incomplete spinal cord injury and traumatic brain injury were assessed for suitability for the WalkAide2. Of the 24 subjects who participated in the study, 6 are reported on who, in the opinion of the investigators, derived significant benefit from use of the device. Data is presented on clinical presentation, initial assessment findings, gait speed and usage patterns. Additionally, clinical observations and rationale around the fitting of a Functional Electrical Stimulation (FES) program for foot-drop may help clinical investigators and researchers in future design and prescription of FES devices for neurological conditions.