Functional Electrical Stimulation on Improving Foot Drop Gait in Poststroke Rehabilitation: A Review of its Technology and Clinical Efficacy

Abstract

This article presents technical developments in and clinical applications of functional electrical stimulation (FES) in the recovery of gait and motor function in poststroke rehabilitation. We review stroke incidence, stimulator design, brain-computer interface-based FES systems, and clinical applications of FES. Developments in different types of foot drop stimulators are reviewed, including hard-wired and microprocessor-based surface stimulator systems. The replacement of the foot switch by using artificial and "natural" sensors as the primary control in foot drop stimulators is reviewed. In addition, this review evaluates the clinical effects of FES applications in gait, motor control, and functional ability compared to conventional therapy alone during poststroke rehabilitation. The literature suggests the combination of FES and a conventional rehabilitation program has a positive therapeutic effect on the recovery of gait, motor function, energy expenditure, and functional ability in stroke patients. On the basis of our review, we recommend using FES therapy along with a conventional rehabilitation program in the poststroke rehabilitation process. In summary, this article describes the need for rigorous technological development, clinical studies, and collaboration between clinicians and engineers for FES systems. Future research would facilitate the design of costeffective FES systems as well as analysis of FES applications in stroke patients to optimize the rehabilitation process.

Muscle Synergies Facilitate Computational Prediction of Subject-Specific Walking Motions

“…For this reason, researchers and clinicians have explored a variety of neurorehabilitation approaches in search of an effective means to restore post-stroke walking function. These approaches include functional electrical stimulation (FES) (Popovic et al, 1999 ; Kesar et al, 2009 , 2010 ; Sabut et al, 2013 ; Chung et al, 2014 ; O’Dell et al, 2014 ; Pilkar et al, 2014 ; Auchstaetter et al, 2015 ; Chantraine et al, 2016 ), ankle–foot orthoses (AFOs) (Ferreira et al, 2013 ; Tyson et al, 2013 ; Kobayashi et al, 2016 ), exoskeletons (Nilsson et al, 2014 ; Bortole et al, 2015 ; Buesing et al, 2015 ), partial body weight support (Ng et al, 2008 ; Lee et al, 2013 ) and split-belt treadmill training systems (Reisman et al, 2007 ; Malone and Bastian, 2014 ), and robotic gait trainers (Pennycott et al, 2012 ; Mehrholz et al, 2013 ; Bae et al, 2014 ; Hussain, 2014 ; Dundar et al, 2015 ). Each of these approaches has shown varying levels of promise for improving post-stroke walking function.…”

Evaluation of the Efficacy and Robustness of a Second Generation Implantable Stimulator in a Patient With Hemiplegia During 20 Years of Functional Electrical Stimulation of the Common Peroneal Nerve

“…Further improvements will be focused on (a) improving the sealing technology of the electronic circuitry within the ceramic pot, and (b) improving the robustness of lead wires of the external and internal unit to material fatigue. Compared to earlier neuroprostheses to correct DF, current commercial devices using modern technological advancements in stimulation solutions and sensing technologies, as well as control strategies, have made more efficient and reliable devices a reality . For future research on DF neuroprostheses for selective activation of TA, researchers should consider devices with at least two channels to balance the eversion/inversion of the foot, which sometimes can be difficult with only one channel .…”

Innovación y Tecnología en Fisioterapia Futuras herramientas de intervención

“…Este tipo de tecnología cuenta con monitores y sensores de movimiento que permiten tener una visión del rendimiento y adaptabilidad del paciente y tener un proceso controlado de la rehabilitación. (Horak, King, & Mancini, 2015;Needham, Truong, & Fan, 2009;Sabut, Bhattacharya, & Manjunatha, 2013;Taylor & Griffin, 2015;Zahid & Atique, 2016) Segundo, en el deporte se ha utilizado la tecnología en procesos de recuperación e intervención fisioterapéutica. Por ejemplo, los sistemas tecnológicos son utilizados para realizar una retroalimentación del sistema motor y cognitivo, se integra un trabajo global para la estimulación de habilidades sensoriales, paramétricas, sinergísticas y compuestas.…”