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
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    • "Through electrical stimulation of the ankle dorsiflexors and evertors during the swing phase and early stance phase of gait, foot clearance, heel loading and roll off are almost normally regulated . The use of FES does not limit passive or active ankle movements and, thus, promotes normal sensory feedback, dynamic balance (especially on uneven terrain), and push-off (Fatone et al., 2009; Kottink et al., 2004; Ring et al., 2009). Three recent, large randomised controlled trials (Bethoux et al., 2014; Everaert et al., 2013; Kluding et al., 2013) have shown that surface-based peroneal FES is at least as effective as an AFO for improving walking velocity and various other aspects of balance and mobility in people with drop foot in the chronic phase of stroke. "
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    ABSTRACT: Purpose: To investigate whether an implantable functional electrical stimulation (FES) system of the common peroneal nerve (ActiGait®) improves relevant aspects of gait in chronic stroke patients with a drop foot typically using an ankle-foot orthosis (AFO). Methods: Ten community-dwelling patients participated, of whom eight patients could be analysed. Gait quality (kinematic, kinetic, and spatiotemporal characteristics) during a 10-meter comfortable walk test, normalised net energy expenditure during a 6-minute walk test, participation (physical activity and stroke impact) and user satisfaction were tested before implantation and at various moments after FES-system activation up to 26 weeks. Results: Walking with FES yielded increased maximum paretic ankle plantarflexion (FES: -0.12; AFO: -4.79°, p < 0.01), higher paretic peak ankle power (FES: 1.46; AFO: 0.98 W/kg, p < 0.05) and better step length symmetry (FES: 14.90; AFO: 21.45% , p < 0.05). User satisfaction was higher for FES, but was unrelated to objective gait improvements. Energy expenditure and participation did not change. Conclusion: Implantable FES improved the use of residual ankle plantarflexion motion, ankle power of the paretic leg and step length symmetry compared to using an AFO, however, not resulting in decreased energy expenditure or improved participation. User satisfaction was highest with FES, but this was not related to the observed gait improvements.
    Full-text · Article · Oct 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).
    Full-text · Article · Jul 2014 · Stroke Research and Treatment
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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.
    Full-text · Article · Jul 2014 · Neurorehabilitation
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