Behandlungsoptionen beim neurogenen Lähmungsfuß – eine systematische Literaturrecherche

Abstract

Neurogenic drop foot may be caused by central or peripheral lesions of the nervous system. Depending on whether the first or second motor neuron is damaged, a flaccid or spastic drop foot develops. Spastic drop foot persists as a residual long-term complication after stroke in about 14 % of patients. Various conservative and surgical treatment options are available. This article is based on a systematic literature review for medical evidence of functional electrical stimulation (FES) with the keywords "functional electrical stimulation AND drop foot" and "functional electrical stimulation AND gait AND stroke" in PubMed and Cochrane databases. Randomised controlled trials and cohort studies of the past 10 years were selected according to specific criteria. Additionally, four guidelines were included. Current guidelines provide little guidance for practical treatment and fail to give due consideration to new surgical procedures such as neural implants. In 18 randomised controlled trials on FES in stroke patients with drop foot, the FES-treated population showed either significant superiority or non-inferiority versus control. Two cohort studies confirmed significant improvements by FES. The analysis demonstrates the importance of considering causes and severity of drop foot as well as patients' pre- and post-operative conditions for choosing treatment options. For active, high-demand patients, neural implants are valuable treatment options.

Is functional electrical stimulation effective in improving walking in adults with lower limb impairment due to an upper motor neuron lesion? An umbrella review

“…Records excluded (n = 1255) characteristics of the included reviews, grouped by patient population. The majority of the reviews focused on stroke populations (n = 16), 29,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] followed by SCI (n = 5), 30,[46][47][48][49] MS (n = 2) 50,51 and one with mixed populations. 52 No reviews of PD, adult CP or TBI were found.…”

“…Five reviews did not report the age of the participants in the included studies. 37,46,47,49,52 Twenty reviews used the term FES and four used either Electrical Stimulation (ES) or NMES but we only extracted the information regarding interventions in which the nerves were stimulated during gait (i.e., functional). However, for two reviews it was not clear whether the interventions in the included studies investigated FES or NMES as defined in this umbrella review.…”

“…However, for two reviews it was not clear whether the interventions in the included studies investigated FES or NMES as defined in this umbrella review. 35,43 The majority (n = 15) of the reviews included studies reporting on both single and multi-channel stimulation, 29,30,[35][36][37][38][39][40][41][42][43]45,[50][51][52] with two reviews including only studies which investigated the effect of singlechannel stimulation. 32,33 The remaining reviews did not report this information.…”

Feasibility of a specific task-oriented training versus its combination with manual therapy on balance and mobility in people post stroke at the chronic stage: study protocol for a pilot randomised controlled trial

“…Functional walking limitation and motor control deficits in people post stroke are associated with the upper motor neuron syndrome [ 3 ]. Foot drop is often observed in stroke patients, induced by spasticity, weakness of the foot dorsiflexors, shortening of plantarflexors and ankle range of motion (ROM) limitation [ 4 , 5 ]. Such a complex movement disorder requires differentiated therapy strategies, to address both the structural and functional movement limitations.…”

Effects of a specific task-oriented training versus its combination with manual therapy on balance and mobility in people post stroke at the chronic stage: study protocol for a pilot randomised controlled trial

“…Functional walking limitation and motor control de cits in people post stroke are associated with the upper motor neuron syndrome (3). Foot drop is often observed in stroke patients, induced by spasticity, weakness of the foot dorsi exors, shortening of plantar exors and ankle range of motion (ROM) limitation (4,5). Such a complex movement disorder requires differentiated therapy strategies, to address both the structural and functional movement limitations.…”