A model of hemiplegic spasticity based on electromyographical and biomechanical parameters measured during passive muscle stretching is presented. Two components of spasticity can be distinguished--phasic and tonic. This classification depends on the pattern of stretch reflex activity which can be either phasic or tonic as well as on the muscle stretch/tension characteristic. Stretch reflex, as a control loop, is in phasic spasticity characterized by increased sensitivity to velocity of stretching. In tonic spasticity, sensitivity to length of stretching is increased. After the injury, phasic spasticity appears first and invokes monosynaptic reflex pathways. The intensity of tonic spasticity increases with the duration of disability and hence causes changes in muscle fiber biomechanical properties. The model mentioned above has been used to evaluate the effects of FES on spasticity. Hemiplegic patients with implanted peroneal nerve stimulator for gait correction were followed up for one year starting a week before implantation. Long-term use of FES resulted in decrease of tonic spasticity in both ankle joint antagonistic muscle groups. In stimulated tibialis anterior muscle, the phasic type of spasticity increased. To obtain the correlation between changes in spasticity and functional abilities of patients, the maximal voluntary isometric contraction of both muscle groups was also measured. An improvement in voluntary strength was also observed. This can be taken as additional evidence that tonic spasticity is of greater physiological and clinical significance than phasic spasticity. It may be concluded that use of FES can decrease tonic spasticity and, if applied early after the injury, can prevent the appearance of tonic spasticity.

Abstract-A dual-channel electrical stimulation system with a stimulator and a programmer/stride analyzer was designed for clinical rehabilitation of gait and for subsequent daily use as an orthotic aid. The stimulator, with controls to adjust amplitude only (50 mA), adapts chosen stimulation sequences to the walking rate of a patient. Pulse duration (50-500 ps), frequency (5-120 Hz), shape (symmetrical biphasic, monophasic), stimulation sequences (16 stride segments) and their cycle (2-12 sec), and right/left foot-switch choices are selected for each patient and programmed into a separate unit. The programming unit also statistically processes the footswitch data collected by the stimulator. The device was evaluated with regard to the programmable parameters, effectiveness during gait, and feasibility in clinical use. It was applied to 11 stroke patients and 10 brain injury patients during gait, stimulating 22 combinations of peroneal nerve and hamstring, quadriceps, triceps brachii, and gluteus maximus muscles. Forces on both feet, equinovarus, knee extension and hyperextension, elbow flexion, and hip extension were corrected. Selection of the stimulation sequences, their adaptation, range of pulse duration, and valid statistics were verified. Improved forces and joint angles were recorded together with significant changes in the stride time, length, and velocity by the stimulation.

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We present details of the modelling, design, and experimental testing of an implantable system with a monopolar half-cuff electrode for selective stimulation of fibres within certain superficial regions of the human common peroneal nerve which is capable of making a selective activation of muscles, thus contributing to strong dorsal flexion and moderate eversion of the hemiplegic foot. The development of the cuff electrode was based partly on data obtained from histological examination of human common peroneal nerves, and from previously described models of excitation of myelinated nerve fibres. The modelling objectives were to determine the electric field that would be generated within the deep peroneal branch of the nerve by a monopolar half-cuff electrode installed on the nerve behind the lateral head of the fibula. The extent of initial excitation of the nerve fibres within the superficial region of the deep peroneal branch elicited by a monopolar half-cuff electrode was predicted. In the past 6 months two systems were implanted. In both patients significant improvements of gait dynamics were observed.

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