Advances in neuroprosthetic management of foot drop: a review

Abstract

This paper reviews the technological advances and clinical results obtained in the neuroprosthetic management of foot drop. Functional electrical stimulation has been widely applied owing to its corrective abilities in patients suffering from a stroke, multiple sclerosis, or spinal cord injury among other pathologies. This review aims at identifying the progress made in this area over the last two decades, addressing two main questions: What is the status of neuroprosthetic technology in terms of architecture, sensorization, and control algorithms?. What is the current evidence on its functional and clinical efficacy? The results reveal the importance of systems capable of self-adjustment and the need for closed-loop control systems to adequately modulate assistance in individual conditions. Other advanced strategies, such as combining variable and constant frequency pulses, could also play an important role in reducing fatigue and obtaining better therapeutic results. The field not only would benefit from a deeper understanding of the kinematic, kinetic and neuromuscular implications and effects of more promising assistance strategies, but also there is a clear lack of long-term clinical studies addressing the therapeutic potential of these systems. This review paper provides an overview of current system design and control architectures choices with regard to their clinical effectiveness. Shortcomings and recommendations for future directions are identified.

Peripheral electrical stimulation to reduce pathological tremor: a review

“…FES uses high stimulation intensities to elicit muscle fiber contraction of a sufficiently large population to produce the desired forces opposing tremor. Higher stimulation frequencies are reported to rapidly increase fatigue, and therefore limit this value for FES applications [58]. Conversely, stimulation of afferent pathways allows higher stimulation frequencies with lower stimulation intensities due to the lower rheobase of sensory fibers [48].…”

“…Shorter pulses were preferred for FES applications while longer pulses were preferred for stimulation below motor threshold. Regarding stimulus waveform, biphasic pulses are preferred to restore charge balance in tissues and minimize adverse effects such as skin irritation, but some studies applied monophasic pulses, which could lead to a limited application for a prolonged period of stimulation [58]. Finally, another critical step towards standardizing stimulation strategies is reporting the intensity of stimulation applied.…”

Clinical manifestations, diagnosis, and surgical treatment of compressive common peroneal neuropathy at the level of the fibular head

“…Операция должна рассматриваться как метод выбора в лечении пациентов с невропатией ОМН вне зависимости от сроков с момента появления симптомов поражения нерва. В качестве консервативных методов коррекции пареза разгибателей стопы и улучшения походки могут быть эффективны ортезы и лечебная гимнастика, а также чрескожная электрическая стимуляция паретичных мышц [17].…”

Functional electrical stimulation for restoration of gait and motor recovery after a stroke. Review of scientific literature

“…К сожалению, в системах open-loop отсутствует обратная биологическая связь от мышцы и нерва, т. е. при их использовании остается нерешенной проблема с возникающей мышечной усталостью. Будущие аппараты closed-loop (замкнутая система) предполагают на-личие обратной связи от мышцы и нерва благодаря технологии с использованием электромио-и электронейрографии [24,25,27].…”