Kinematic and kinetic benefits of implantable peroneal nerve stimulation in people with post-stroke drop foot using an ankle-foot orthosis

Berenpas, Frank; Schiemanck, Sven K.; Beelen, Anita; Nollet, Frans; Weerdesteyn, Vivian; Geurts, Alexander C. H.

doi:10.3233/rnn-180822

Cited by 16 publications

(22 citation statements)

References 24 publications

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“…Previous studies have also outlined the benefits of surface electrical stimulation on gait and quality of life in patients with drop foot [20, 21]. Electrical stimulation has been shown to be superior to ankle foot orthoses regarding knee stability, ankle dorsal extension power, propulsion [22] the ability to negotiate a sudden obstacle [23] and based on patients’ preferences [19, 24]. However, literature is inconclusive on whether functional electrical stimulation should always be preferred over ankle foot orthoses [15] and both seem to be equally effective regarding increases in walking speed and activity level [19, 24].…”

Section: Introductionmentioning

confidence: 99%

The long-term effects of an implantable drop foot stimulator on gait in hemiparetic patients

et al. 2019

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Drop foot is a frequent abnormality in gait after central nervous system lesions. Different treatment strategies are available to functionally restore dorsal extension during swing phase in gait. Orthoses as well as surface and implantable devices for electrical stimulation of the peroneal nerve may be used in patients who do not regain good dorsal extension. While several studies investigated the effects of implanted systems on walking speed and gait endurance, only a few studies have focussed on the system’s impact on kinematics and long-term outcomes. Therefore, our aim was to further investigate the effects of the implanted system ActiGait on gait kinematics and spatiotemporal parameters for the first time with a 1-year follow-up period. 10 patients were implanted with an ActiGait stimulator, with 8 patients completing baseline and follow-up assessments. Assessments included a 10-m walking test, video-based gait analysis and a Visual Analogue Scale (VAS) for health status. At baseline, gait analysis was performed without any assistive device as well as with surface electrical stimulation. At follow-up patients walked with the ActiGait system switched off and on. The maximum dorsal extension of the ankle at initial contact increased significantly between baseline without stimulation and follow-up with ActiGait (p = 0.018). While the spatio-temporal parameters did not seem to change much with the use of ActiGait in convenient walking speed, patients did walk faster when using surface stimulation or ActiGait compared to no stimulation at the 10-m walking test at their fastest possible walking speed. Patients rated their health better at the 1-year follow-up. In summary, a global improvement in gait kinematics compared to no stimulation was observed and the long-term safety of the device could be confirmed.

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Section: Introductionmentioning

confidence: 99%

The long-term effects of an implantable drop foot stimulator on gait in hemiparetic patients

et al. 2019

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“…Previous studies have shown good intra-and interexaminer reliability of the gastrocnemius medialis (GM) muscle PA evaluated with USI in poststroke patients, and the PA measured by USI was clinically useful assessment of rehabilitation effects in poststroke patients (Cho, Cho, Yoo, Lee, & Lee, 2018;Cho, Lee, & Lee, 2014). Spastic hemiplegia patients usually present with foot-drop and their ankle dorsiflexion was impaired, which is associated with the increased muscle tone of the calf muscles (Berenpas et al, 2018;Singer, Dunne, & Allison, 2001;Soltani, Rahimi, Naimi, Khademi, & Saeedi, 2014). Spastic foot-drop would also increase plantar load distribution of the forefoot on the affected side (Berenpas et al, 2018;Soltani et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Spastic hemiplegia patients usually present with foot‐drop and their ankle dorsiflexion was impaired, which is associated with the increased muscle tone of the calf muscles (Berenpas et al, ; Singer, Dunne, & Allison, ; Soltani, Rahimi, Naimi, Khademi, & Saeedi, ). Spastic foot‐drop would also increase plantar load distribution of the forefoot on the affected side (Berenpas et al, ; Soltani et al, ). The lateral gastrocnemius, GM, and the soleus consist of the triceps surae muscle group, and determine the plantar flexors of the ankle.…”

Section: Introductionmentioning

confidence: 99%

Contralateral seventh cervical nerve transfer can affect the pennation angle of the lower limb in spastic hemiplegia patients: An observational case series study

Chen

Qiu

et al. 2019

Brain and Behavior

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IntroductionWe previously reported transferring seventh cervical (C7) nerve from unaffected side to affected side in patients with spastic hemiplegia due to chronic cerebral injury, to improve function and reduce spasticity of paralyzed upper limb. In the clinics, some patients also reported changes of spasticity in their lower limb, which could not be detected by routine physical examinations. Pennation angle of muscle can indirectly reflect the condition of spasticity. The purpose of this study was to evaluate whether this upper limb procedure may affect spasticity of lower limb, using ultrasonography to detect changes of muscle pennation angle (PA).MethodsTwelve spastic hemiplegia patients due to cerebral injury including stroke, cerebral palsy, and traumatic brain injury, who underwent C7 nerve transfer procedure, participated in this study. B‐mode ultrasonography was used to measure PA of the gastrocnemius medialis (GM) muscle at rest preoperatively and postoperatively. The plantar load distribution of the lower limbs was evaluated using a Zebris FDM platform preoperatively and postoperatively.ResultsThe PA of the GM was significantly smaller on the affected side than that of unaffected side before surgery. On the affected side, the postoperative PA was significantly larger than preoperative PA. On the unaffected side, the postoperative PA was not significantly different compared to preoperative PA. The postoperative plantar load distribution of the affected forefoot was significantly smaller than preoperative load distribution, which was consistent with ultrasonography results.ConclusionsThis study indicates that C7 nerve transfer surgery for improving upper limb function can also affect muscle properties of lower limb in spastic hemiplegia patients, which reveals a link between the upper and lower limbs. The interlimb interactions should be considered in rehabilitation physiotherapy, and the regular pattern and mechanism need to be further studied.

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“…However, it is not well-tolerated in all patients [10]. In recent years, gait improvement has been achieved using functional electrical stimulation (FES) [1, 10, 16, 23, 25], which combines the orthotic benefits of an AFO with a more physiological approach that involves muscle contraction and the related sensory feedback [10, 25]. Transcutaneous FES (tcFES) of the peroneal nerve has been associated with significantly reduced falls compared to intensive physiotherapy [7].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, a systematic review of FES in MS patients indicates increased gait speed using FES [19]. Semi-implantable FES (siFES) of the peroneal nerve has been found to increase gait speed and improve gait patterns compared with a baseline without stimulation [6, 10, 17], compared to orthotic devices [1, 23], and also compared to tcFES [17]. The findings of a systematic review, including predominantly chronic stroke patients, however, did not suggest a difference between tcFES and siFES in terms of walking speed [13].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot

Buentjen

Kupsch

Galazky

et al. 2019

J NeuroEngineering Rehabil

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Background Central drop foot is a common problem in patients with stroke or multiple sclerosis (MS). For decades, it has been treated with orthotic devices, keeping the ankle in a fixed position. It has been shown recently that semi-implantable functional electrical stimulation (siFES) of the peroneal nerve can lead to a greater gait velocity increase than orthotic devices immediately after being switched on. Little is known, however, about long-term outcomes over 12 months, and the relationship between quality of life (QoL) and gait speed using siFES has never been reported applying a validated tool. We provide here a report of short (3 months) and long-term (12 months) outcomes for gait speed and QoL. Methods Forty-five consecutive patients (91% chronic stroke, 9% MS) with central drop foot received siFES (Actigait®). A 10 m walking test was carried out on day 1 of stimulation (T1), in stimulation ON and OFF conditions, and repeated after 3 (T2) and 12 (T3) months. A 36-item Short Form questionnaire was applied at all three time points. Results We found a main effect of stimulation on both maximum ( p < 0.001) and comfortable gait velocity (p < 0.001) and a main effect of time ( p = 0.015) only on maximum gait velocity. There were no significant interactions. Mean maximum gait velocity across the three assessment time points was 0.13 m/s greater with stimulation ON than OFF, and mean comfortable gait velocity was 0.083 m/s faster with stimulation ON than OFF. The increase in maximum gait velocity over time was 0.096 m/s, with post hoc testing revealing a significant increase from T1 to T2 ( p = 0.012 ) , which was maintained but not significantly further increased at T3. QoL scores showed a main effect of time ( p < 0.001), with post hoc testing revealing an increase from T1 to T2 (p < 0.001), which was maintained at T3 (p < 0.001). Finally, overall absolute QoL scores correlated with the absolute maximum and comfortable gait speeds at T2 and T3, and the increase in overall QoL scores correlated with the increase in comfortable gait velocity from T1 to T3. Pain was reduced at T2 (p < 0.001) and was independent of gait speed but correlated with overall QoL (p < 0.001). Conclusions Peroneal siFES increased maximal and comfortable gait velocity and QoL, with the greatest increase in both over the first three months, which was maintained at one year, suggesting that 3 months is an adequate follow-up time. Pain after 3 months correlated with QoL and was independent of gait velocity, suggesting pain as an independent outcome measure in siFES for drop foot.

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Kinematic and kinetic benefits of implantable peroneal nerve stimulation in people with post-stroke drop foot using an ankle-foot orthosis

Abstract: This study substantiates the evidence that implantable peroneal FES as a treatment for post-stroke drop foot may be superior over AFO in terms of knee stability, ankle plantarflexion power, and propulsion.

Cited by 16 publications

References 24 publications

The long-term effects of an implantable drop foot stimulator on gait in hemiparetic patients

The long-term effects of an implantable drop foot stimulator on gait in hemiparetic patients

Contralateral seventh cervical nerve transfer can affect the pennation angle of the lower limb in spastic hemiplegia patients: An observational case series study

Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot

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