A survey on foot drop and functional electrical stimulation

Abstract

The weakness of the lower leg muscles due to nerve damage or muscle weakness can result in foot drop, a change in gait that manifests as an inability to lift the toes of the foot when walking. Foot drop results in a decreased quality of life, with unassisted movement becoming difficult or impossible. The increased risk of falls is particularly problematic as foot drop often affects the elderly or infirm for whom falling already presents a great danger. Current treatment options include fixed ankle-foot orthosis (AFO) aiming to provide rigid support to the foot if the impairment is mild or surgical intervention and functional electrical stimulation (FES) devices if the weakness is more severe. FES intervention is effective for providing a non-invasive treatment in even severe cases of foot drop. Limitations of current models relate to the non-naturalistic recreation of gait in the affected leg and its unsuitability for patients with extensive peripheral nerve damage. Although there are attempts to enhance integration of sensory information and mimic natural stimulation patterns, the focus on restoring a natural feedback loop is still amiss. Without such a closed loop feedback, restoration of a natural gait pattern is unlikely to occur. We here recommend, integration of motor output from multiple muscles, information about the inputs from higherorder controllers, recorded from the intact leg with a closed loop system to improve the effectiveness of FES.

Comparing the Effects of Functional Electrical Stimulation With and Without Ankle-foot Orthosis on the Balance and Walking Ability of Patients With Multiple Sclerosis

“…The inclusion criteria were as follows: MS patients with a history of drop foot for at least three months [21], age between 20 and 50 years, the experience of using an AFO or FES or both, no history of surgery, trauma, and fracture in lower limbs, no improper posture such as kyphosis and scoliosis, no infection and inflammation of the skin in the ankle area and a score of less than five on the Expanded Disability Status Scale (EDSS). The EDSS is a method of measuring disability in MS and tracking changes in the level of disability over time.…”

Neurologic Assessment and Management of the Multiple Ligament Injured Knee: A Review and Synthesis of Current Evidence

“…40,41 To our knowledge, this technology is being used in those with peripheral nerve injury, such as CPN palsy post knee dislocation, however, no current evidence in this population has been published. 42…”

Augmenting gait in a population exhibiting foot drop with adaptive functional electrical stimulation

“…Various assistive technologies exist to address gait deviations in individuals with foot drop. These include orthoses such as AFOs, assistive devices such as canes and walkers, and functional electrical stimulation (FES) devices [11]. FES devices improve gait by applying low amplitude electrical pulses to skeletal muscles to induce involuntary contraction to replace interrupted pathways from the central nervous system to peripheral neurons.…”

“…FES gait augmentation systems offer numerous benefits over passive orthoses to individuals with impacted mobility [11]. FES gait training has been shown to improve walking speed and duration compared to traditional orthotic gait devices [13].…”