A feasibility study to investigate the clinical application of functional electrical stimulation (FES), for dropped foot, during the sub-acute phase of stroke – A randomized controlled trial

Salisbury, Lisa; Shiels, J.; Todd, Iain C.; Dennis, Martin

doi:10.3109/09593985.2012.674087

Cited by 26 publications

(33 citation statements)

References 28 publications

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“…SP extracted data using a predesigned pro forma; trial details extracted related to the characteristics of the included studies, participant and intervention details. Missing data and/or aspects that required clarification were requested from trial authors (14,16,44,45), by SP (Appendix I). KH reviewed the extracted data for accuracy.…”

Section: Methodsmentioning

confidence: 99%

Functional electrical stimulation versus ankle foot orthoses for foot-drop: A meta-analysis of orthotic effects

Prenton¹,

Hollands²,

Kenney³

2016

J Rehabil Med

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Data suggest that, in contrast to assumptions that predict FES superiority, ankle foot orthoses have equally positive combined-orthotic effects as FES on key walking measures for foot-drop caused by stroke. However, further long-term, high-quality RCTs are required. These should focus on measuring the mechanisms-of-action; whether there is translation of improvements in impairment to function, plus detailed reporting of the devices used across diagnoses. Only then can robust clinical recommendations be made.

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Section: Methodsmentioning

confidence: 99%

Functional electrical stimulation versus ankle foot orthoses for foot-drop: A meta-analysis of orthotic effects

Prenton¹,

Hollands²,

Kenney³

2016

J Rehabil Med

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“…Called neuroprostheses (25,193), these devices often are designed to correct specific deficits, such as foot drop (27,217,245) and hand grasp weakness (47,249,267). Other devices, such as the Parastep (71), use multichannel stimulators to activate leg muscles for standing and walking (184,238,239,242).…”

Section: Peripheral Nerve Stimulationmentioning

confidence: 99%

Electrical Stimulation and Motor Recovery

Young

2015

Cell Transplant

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In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons that fire together, wire together." This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory. INTRODUCTIONIn the past decade, several prominent laboratories have shown axonal regeneration in animal spinal cord injury (SCI) models, but locomotor recovery did not follow regeneration (277). For example Lu et al. (159,160) and He's group (156,282) regenerated many axons that synapsed with neurons in the lower spinal cord, but the animals did not recover walking. To explain the lack of locomotor recovery, the investigators assume that insufficient numbers of regenerated axons have formed synapses with appropriate neurons in the lower spinal cord to support locomotion. Another explanation for the lack of locomotor recovery after complete SCI and regeneration is that the animals did not learn to use their newly regrown connections.Regenerated fibe...

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“…Recently, inexpensive, wearable, commercially-available sensors have become a more viable option for independent home-based poststroke rehabilitation [11,12]. A systematic review by Powell et al [13] identified a number of wearable lower-limb devices that have been trialed, such as robotics [14-16], virtual reality [16], functional electrical stimulation (FES) [17,18], electromyographic biofeedback (EMG-BFB) [19,20], and transcutaneous electrical nerve stimulation [21]. Of the identified trials exploring improvements in the International Classification of Functioning (ICF) domain of activities and participation, only 1 [21] found significant improvements.…”

Section: Introductionmentioning

confidence: 99%

A Personalized Self-Management Rehabilitation System for Stroke Survivors: A Quantitative Gait Analysis Using a Smart Insole

Davies¹,

Parker²,

McCullagh³

et al. 2016

JMIR Rehabil Assist Technol

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BackgroundIn the United Kingdom, stroke is the single largest cause of adult disability and results in a cost to the economy of £8.9 billion per annum. Service needs are currently not being met; therefore, initiatives that focus on patient-centered care that promote long-term self-management for chronic conditions should be at the forefront of service redesign. The use of innovative technologies and the ability to apply these effectively to promote behavior change are paramount in meeting the current challenges.ObjectiveOur objective was to gain a deeper insight into the impact of innovative technologies in support of home-based, self-managed rehabilitation for stroke survivors. An intervention of daily walks can assist with improving lower limb motor function, and this can be measured by using technology. This paper focuses on assessing the usage of self-management technologies on poststroke survivors while undergoing rehabilitation at home.MethodsA realist evaluation of a personalized self-management rehabilitation system was undertaken in the homes of stroke survivors (N=5) over a period of approximately two months. Context, mechanisms, and outcomes were developed and explored using theories relating to motor recovery. Participants were encouraged to self-manage their daily walking activity; this was achieved through goal setting and motivational feedback. Gait data were collected and analyzed to produce metrics such as speed, heel strikes, and symmetry. This was achieved using a “smart insole” to facilitate measurement of walking activities in a free-living, nonrestrictive environment.ResultsInitial findings indicated that 4 out of 5 participants performed better during the second half of the evaluation. Performance increase was evident through improved heel strikes on participants’ affected limb. Additionally, increase in performance in relation to speed was also evident for all 5 participants. A common strategy emerged across all but one participant as symmetry performance was sacrificed in favor of improved heel strikes. This paper evaluates compliance and intensity of use.ConclusionOur findings suggested that 4 out of the 5 participants improved their ability to heel strike on their affected limb. All participants showed improvements in their speed of gait measured in steps per minute with an average increase of 9.8% during the rehabilitation program. Performance in relation to symmetry showed an 8.5% average decline across participants, although 1 participant improved by 4%. Context, mechanism, and outcomes indicated that dual motor learning and compensatory strategies were deployed by the participants.

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A feasibility study to investigate the clinical application of functional electrical stimulation (FES), for dropped foot, during the sub-acute phase of stroke – A randomized controlled trial

Cited by 26 publications

References 28 publications

Functional electrical stimulation versus ankle foot orthoses for foot-drop: A meta-analysis of orthotic effects

Functional electrical stimulation versus ankle foot orthoses for foot-drop: A meta-analysis of orthotic effects

Electrical Stimulation and Motor Recovery

A Personalized Self-Management Rehabilitation System for Stroke Survivors: A Quantitative Gait Analysis Using a Smart Insole

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