scholarly journals Surface electrical stimulation for foot drop: Control aspects and walking performance

2008 ◽  
Vol 18 (2) ◽  
pp. 47-52 ◽  
Author(s):  
Richard Stein ◽  
Robert Rolf ◽  
Dirk Everaert ◽  
Jacques Bobet ◽  
Suling Chong
Keyword(s):  
Electrical Stimulation ◽  
Walking Speed ◽  
Control Strategies ◽  
Gait Pattern ◽  
Foot Drop ◽  
Therapeutic Effects ◽  
Ankle Foot Orthosis ◽  
The Central Nervous System ◽  
Walking Performance ◽  
Over 40 Years

Use of electrical stimulation to correct foot drop in hemiplegia was proposed over 40 years ago. Recently, improved control strategies have been developed and implemented in commercially available devices. In this article we review the control methods that have been used and present some results from a multi-center clinical trial. A foot-drop stimulator improves the gait pattern and results in an immediate increase in walking speed. In this sense it acts like an ankle-foot orthosis and this immediate increase will be referred to as an orthotic effect. Prolonged use of a foot drop stimulator over a period of months results in further, large increases in walking speed both with the stimulator on and off. Evidence indicates that a part of this increase results from daily use that strengthens residual cortico-spinal connections. Therefore the improvement over time will be referred to as a therapeutic effect. We found that people with non-progressive and progressive conditions of the central nervous system have an orthotic benefit, as well as a therapeutic up to 3 months of use. In generally non-progressive conditions such as stroke, further therapeutic increases are seen up to at least 11 months of use. In disorders such as multiple sclerosis, the progression of the disease eventually overcomes the early therapeutic effects. In conclusion, many individuals can benefit from commercially available foot-drop stimulators with improved control strategies and cosmetic design.

scholarly journals Long-Term Therapeutic and Orthotic Effects of a Foot Drop Stimulator on Walking Performance in Progressive and Nonprogressive Neurological Disorders

2009 ◽  
Vol 24 (2) ◽  
pp. 152-167 ◽  
Author(s):  
Richard B. Stein ◽  
Dirk G. Everaert ◽  
Aiko K. Thompson ◽  
Su Ling Chong ◽  
Maura Whittaker ◽  
...  
Keyword(s):  
Therapeutic Effect ◽  
Walking Speed ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Therapeutic Effects ◽  
Cost Index ◽  
Mean Values ◽  
Before And After ◽  
Walking Performance ◽  
Change In Mean

Background. Stimulators applying functional electrical stimulation (FES) to the common peroneal nerve improve walking with a foot drop, which occurs in several disorders. Objective. 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. Methods . 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. Results. 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. Conclusions. 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.

A randomized trial to investigate the effects of functional electrical stimulation and therapeutic exercise on walking performance for people with multiple sclerosis

2009 ◽  
Vol 15 (4) ◽  
pp. 493-504 ◽  
Author(s):  
CL Barrett ◽  
GE Mann ◽  
PN Taylor ◽  
P Strike
Keyword(s):  
Multiple Sclerosis ◽  
Electrical Stimulation ◽  
Randomized Trial ◽  
Functional Electrical Stimulation ◽  
Walking Speed ◽  
Single Channel ◽  
Home Exercise ◽  
Therapeutic Effects ◽  
Group Randomized Trial ◽  
Walking Performance

Background Functional electrical stimulation (FES), is a means of producing a contraction in a paralyzed or weak muscle to enable function through electrical excitation of the innervating nerve. Objective This two-group randomized trial assessed the effects of single channel common peroneal nerve stimulation on objective aspects of gait relative to exercise therapy for people with secondary progressive multiple sclerosis (SPMS). Methods Forty-four people with a diagnosis of SPMS and unilateral dropped foot completed the trial. Twenty patients were randomly allocated to a group receiving FES and the remaining 24 to a group receiving a physiotherapy home exercise program for a period of 18 weeks. Results The exercise group showed a statistically significant increase in 10 m walking speed and distance walked in 3 min, relative to the FES group who showed no significant change in walking performance without stimulation. At each stage of the trial, the FES group performed to a significantly higher level with FES than without for the same outcome measures. Conclusion Exercise may provide a greater training effect on walking speed and endurance than FES for people with SPMS. FES may provide an orthotic benefit when outcome is measured using the same parameters. More research is required to investigate the combined therapeutic effects of FES and exercise for this patient group.

Does Functional Electrical Stimulation for Foot Drop Strengthen Corticospinal Connections?

2009 ◽  
Vol 24 (2) ◽  
pp. 168-177 ◽  
Author(s):  
Dirk G. Everaert ◽  
Aiko K. Thompson ◽  
Su Ling Chong ◽  
Richard B. Stein
Keyword(s):  
Electrical Stimulation ◽  
Therapeutic Effect ◽  
Functional Electrical Stimulation ◽  
Peroneal Nerve ◽  
Walking Speed ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Walking Performance ◽  
The Common

Background. Long-term use of a foot-drop stimulator applying functional electrical stimulation (FES) to the common peroneal nerve improves walking performance even when the stimulator is off. This “therapeutic” effect might result from neuroplastic changes. Objective. To determine the effect of long-term use of a foot-drop stimulator on residual corticospinal connections in people with central nervous system disorders. Methods. Ten people with nonprogressive disorders (eg, stroke) and 26 with progressive disorders (eg, multiple sclerosis) used a foot-drop stimulator for 3 to 12 months while walking in the community. Walking performance and electrophysiological variables were measured before and after FES use. From the surface electromyogram of the tibialis anterior muscle, we measured the following: (1) motor-evoked potential (MEP) from transcranial magnetic stimulation over the motor cortex, (2) maximum voluntary contraction (MVC), and (3) maximum motor wave (Mmax) from stimulating the common peroneal nerve. Results. After using FES, MEP and MVC increased significantly by comparable amounts, 50% and 48%, respectively, in the nonprogressive group and 27% and 17% in the progressive group; the changes were positively correlated ( R2 = .35; P < .001). Walking speed increased with the stimulator off (therapeutic effect) by 24% ( P = .008) and 7% ( P = .014) in the nonprogressive and progressive groups, respectively. The changes in Mmax were small and not correlated with changes in MEP. Conclusions. The large increases in MVC and MEP suggest that regular use of a foot-drop stimulator strengthens activation of motor cortical areas and their residual descending connections, which may explain the therapeutic effect on walking speed.

scholarly journals A foot drop compensation device based on surface multi-field functional electrical stimulation—Usability study in a clinical environment

2019 ◽  
Vol 6 ◽  
pp. 205566831986214
Author(s):  
Eukene Imatz-Ojanguren ◽  
Gema Sánchez-Márquez ◽  
Jose Ramón Asiain-Aristu ◽  
Joxean Cueto-Mendo ◽  
Edurne Jaunarena-Goicoechea ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Brain Injury ◽  
Functional Electrical Stimulation ◽  
Foot Drop ◽  
Average Score ◽  
Therapeutic Effects ◽  
Usability Study ◽  
Clinical Environment ◽  
System Usability Scale ◽  
Clinical Environments

Introduction Functional electrical stimulation applies electrical pulses to the peripheral nerves to artificially achieve a sensory/motor function. When applied for the compensation of foot drop it provides both assistive and therapeutic effects. Multi-field electrodes have shown great potential but may increase the complexity of these systems. Usability aspects should be checked to ensure their success in clinical environments. Methods We developed the Fesia Walk device, based on a surface multi-field electrode and an automatic calibration algorithm, and carried out a usability study to check the feasibility of integrating this device in therapeutic programs in clinical environments. The study included 4 therapists and 10 acquired brain injury subjects (8 stroke and 2 traumatic brain injury). Results Therapists and users were “very satisfied” with the device according to the Quebec User Evaluation of Satisfaction with Assistive Technology scale, with average scores of 4.1 and 4.2 out of 5, respectively. Therapists considered the Fesia Walk device as “excellent” according to the System Usability Scale with an average score of 85.6 out of 100. Conclusions This study showed us that it is feasible to include surface multi-field technology while keeping a device simple and intuitive for successful integration in common neurorehabilitation programs.

scholarly journals THERAPEUTIC EFFECTS OF ANKLE JOINT TAPING COMBINED WITH FUNCTIONAL ELECTRICAL STIMULATION FOR THE CORRECTION OF POST STROKE FOOT DROP

2015 ◽  
Vol 4 (2) ◽  
pp. 15-20
Author(s):  
Amna Aamir Khan ◽  
Hassan Abbas ◽  
Rabbia Naseer Ahmed ◽  
Maria Salman
Keyword(s):  
Electrical Stimulation ◽  
Ankle Joint ◽  
Functional Electrical Stimulation ◽  
Ankle Dorsiflexion ◽  
Foot Drop ◽  
Manual Muscle Testing ◽  
Therapeutic Effects ◽  
Post Stroke ◽  
Muscle Testing ◽  
Significant Difference

OBJECTIVE Post stroke foot is inability to lift foot at ankle joint due to paralysis of ankle dorsiflexor muscles. It is a common problem faced by stroke survivors. To determine the effect of ankle joint taping combined with functional electrical stimulation on post stroke foot drop. METHODS It was an experimental study. 10 stroke patients with foot drop were enlisted for the study by convenience sampling and randomized into two groups. The group A or treatment group (n-5) received kinesiotaping of ankle joint and functional electrical stimulation while group B or control group (n-5) received functional electrical stimulation only. Clinical assessment was done before and after study. Outcome measures were Manual Muscle Testing, active ankle dorsiflexion and time up and go test. RESULTS Improvement was recorded in both kinesiotaping of ankle joint with functional electrical stimulation and functional electrical stimulation groups for MMT and active range of ankle dorsiflexion and there was no significant improvement in time up and go test. But statistically non-significant difference between both groups is observed (Z=-2.000, p=0.46). CONCLUSIONS These results indicate that there is no clear benefit of ankle joint taping combined with functional electrical stimulation for correction of post stroke foot drop. Keywords: Foot Drop, Functional Electrical Stimulation, Ankle Joint Taping, Kinesiotaping, Dorsiflexion, Manual Muscle Testing

scholarly journals Five-Year Follow-up of a Longitudinal Cohort Study of the Effectiveness of Functional Electrical Stimulation for People with Multiple Sclerosis

2018 ◽  
Vol 20 (5) ◽  
pp. 224-230 ◽  
Author(s):  
Tamsyn Street ◽  
Christine Singleton
Keyword(s):  
Multiple Sclerosis ◽  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Joint Pain ◽  
Walking Speed ◽  
Foot Drop ◽  
Longitudinal Cohort ◽  
Significant Difference

Abstract Background: Few studies have examined the long-term consequences of using peroneal nerve functional electrical stimulation (FES) for people with multiple sclerosis (MS). This study examines orthotic effects on a longitudinal cohort and explores additional benefits of FES on self-reported measures such as joint pain. Methods: One hundred forty-five people with foot drop and MS were included (mean age, 52 [range, 28–74] years). Orthotic effects, unassisted walking speed, and clinically important differences (ie, ≥0.05 and ≥0.10 m/s) were derived from walking speed over 10 m. Visual analogue scales examined joint pain, walking effort, trips, confidence, and quality of life. Measures were taken on day 1, after 6 months, and at 2, 3, 4, and 5 years. Results: A significant difference was found overall for walking with FES compared with walking without FES for the 5-year period (P &lt; .001). Despite a significant decline in overall unassisted walking speed at baseline (0.58 m/s) compared with 5 years later (0.46 m/s) (P &lt; .001), participants achieved an orthotic effect with (0.52 m/s) versus without (0.46 m/s) FES after 5 years (P &lt; .001). A significant decrease in joint pain was found after 6 months compared with day 1 (P = .004), which was maintained after 5 years (P &lt; .001). Conclusions: Despite progression of MS, long-term users of FES still benefit from an orthotic effect after using FES for 5 years. The study highlights the need for further work to assess the perceived benefits of FES regarding the experience of joint pain.

Design of Myocontrolled Neuroprosthesis

2014 ◽  
pp. 275-303 ◽  
Author(s):  
Emilia Ambrosini ◽  
Simona Ferrante ◽  
Alessandro Pedrocchi
Keyword(s):  
Electrical Stimulation ◽  
Muscle Activity ◽  
Voluntary Movement ◽  
Control Strategies ◽  
Point Of View ◽  
Therapeutic Effects ◽  
Emg Signal ◽  
Stimulation Parameters ◽  
Neurological Patients ◽  
Clinical Environments

Recent studies suggest that the therapeutic effects of Functional Electrical Stimulation (FES) are maximized when the patterned electrical stimulation is delivered in close synchrony with the attempted voluntary movement. FES systems that modulate stimulation parameters based on the residual volitional muscle activity would assure this combination. However, the development of such a system might be not trivial, both from a hardware and a software point of view. This chapter provides an extensive overview of devices and filtering solutions proposed in the literature to estimate the residual volitional EMG signal in the presence of electrical stimulation. Different control strategies to modulate FES parameters as well as the results of the first studies involving neurological patients are also presented. This chapter provides some guidelines to help people who want to design innovative myocontrolled neuroprostheses and might favor the spread of these solutions in clinical environments.

Functional electrical stimulation using microstimulators to correct foot drop: a case study

2004 ◽  
Vol 82 (8-9) ◽  
pp. 784-792 ◽  
Author(s):  
D J Weber ◽  
R B Stein ◽  
K M Chan ◽  
G E Loeb ◽  
F J.R Richmond ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Peroneal Nerve ◽  
Walking Speed ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Cost Index ◽  
Cord Injury ◽  
Stimulation Of

This paper presents a case study that tested the feasibility and efficacy of using injectable microstimulators (BIONs®) in a functional electrical stimulation (FES) device to correct foot drop. Compared with surface stimulation of the common peroneal nerve, stimulation with BIONs provides more selective activation of specific muscles. For example, stimulation of the tibialis anterior (TA) and extensor digitorum longus (EDL) muscles with BIONs produces ankle flexion without excessive inversion or eversion of the foot (i.e., balanced flexion). Efficacy was assessed using a 3-dimensional motion analysis of the ankle and foot trajectories during walking with and without stimulation. Without stimulation, the toe on the affected leg drags across the ground. BION stimulation of the TA muscle and deep peroneal nerve (which innervates TA and EDL) elevates the foot such that the toe clears the ground by 3 cm, which is equivalent to the toe clearance in the less affected leg. The physiological cost index (PCI) measured effort during walking. The PCI equals the change in heart rate (from rest to activity) divided by the walking speed; units are beats per metre. The PCI is high without stimulation (2.29 ± 0.37, mean ± SD) and greatly reduced with surface (1.29 ± 0.10) and BIONic stimulation (1.46 ± 0.24). Also, walking speed increased from 9.4 ± 0.4 m/min without stimulation to 19.6 ± 2.0 m/min with surface and 17.8 ± 0.7 m/min with BIONic stimulation. These results suggest that FES delivered by a BION is an alternative to surface stimulation and provides selective control of muscle activation.Key words: FES, BION, foot drop, stroke, spinal cord injury.

scholarly journals Improvement in overactive bladder symptoms in patients using functional electrical stimulation of the common peroneal nerve for walking

2018 ◽  
Vol 32 (10) ◽  
pp. 1357-1362
Author(s):  
Nicola Hare ◽  
Petros Georgopoulos ◽  
Kate E Philips ◽  
Joanne E Johnson ◽  
Coralie Seary ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Electrical Stimulation ◽  
Overactive Bladder ◽  
Functional Electrical Stimulation ◽  
Walking Speed ◽  
Motor Neurone ◽  
Foot Drop ◽  
Overactive Bladder Symptoms ◽  
Bladder Symptoms ◽  
Multiple Sclerosis Patients

Objective: Functional electrical stimulation is used to improve walking speed and reduces falls in people with upper motor neurone foot-drop. Following anecdotal observations of changes in bladder symptoms, an observational study was performed to explore this association further. Design: A total of 47 consecutive patients attending for setup with functional electrical stimulation during a six-month period were asked to complete a questionnaire assessing bladder symptoms (ICIQ-OAB (International Consultation on Incontinence Questionnaire Overactive Bladder)) at baseline and three  months during routine appointments. Subjects: In all, 35 (75%) had multiple sclerosis and the other 12 subjects had a total of 9 diagnoses including 3 with stroke. Other conditions included cerebral palsy, motor neurone disease, hereditary spastic paraparesis, meningioma and spinocerebellar ataxias. Results: Improvement in overactive bladder symptoms was not significant in the whole cohort, however, was significant in patients with multiple sclerosis ( n  =  35; mean change in ICIQ-OAB score 1.0, P  =  0.043). Specifically, significant improvements were seen in urgency and urge incontinence in multiple sclerosis patients. There was a significant negative correlation of moderate strength within the multiple sclerosis cohort between baseline walking speed and subsequent change in ICIQ-OAB score (correlation coefficient of r  =  −0.40, P  =  0.046). Thus, greater changes in bladder symptoms were seen with lower baseline walking speeds. Conclusion: The results of this exploratory study suggest that functional electrical stimulation use does improve overactive bladder symptoms in people with multiple sclerosis. Further exploration is needed to study this association and explore whether the mechanism is similar to that of percutaneous tibial nerve stimulation, a recognized treatment for the overactive bladder.

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