Dual-channel functional electrical stimulation improvements in speed-based gait classifications

Abstract

BackgroundFunctional electrical stimulation (FES) is becoming an accepted treatment method for enhancing gait performance in patients who present with gait difficulties resulting from hemiparesis. The purpose of this study was to test whether individuals with hemiparesis who have varied gait speeds, which place them in different functional categories, benefit to the same extent from the application of FES.MethodsThirty-six subjects with chronic hemiparesis demonstrating foot-drop and deficits in knee and/or hip control were fitted with a dual-channel FES system activating the dorsiflexors and hamstring muscles. Gait was assessed during a 2-minute walk test with and without stimulation. A second assessment was conducted after 6 weeks of daily use. Analysis was performed with the subjects stratified into three functional ambulation classes according to their initial gait categories.ResultsThe dual-channel FES improved the gait velocity of all three subgroups. No minimal gait velocity was required in order to gain benefits from FES. For example, subjects with limited household ambulation capabilities improved their gait speed by 63.3% (from 0.30 ± 0.09 m/sec to 0.49 ± 0.20 m/sec; P < 0.01), while subjects with functional community ambulation capabilities improved their gait speed by 25.5% (from 0.90 ± 0.11 m/sec to 1.13 ± 0.22 m/sec; P < 0.01).ConclusionDual-channel FES positively affects gait velocity in patients with chronic hemiparesis, regardless of their initial gait velocity. Furthermore, gait velocity gains may be large enough to change an individual’s ambulation status to a higher functional category.

Behandlungsoptionen beim neurogenen Lähmungsfuß – eine systematische Literaturrecherche

“…Die im Methodenteil beschriebene systematische Literaturrecherche ergab 68 Treffer in der PubMed-und 11 Treffer in der Cochrane-Datenbank. Nach Anwenden der Selektionskriterien wurden 20 Studien berücksichtigt [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38], davon 18 RCTs und 2 Kohortenstudien. Alle unterschieden sich stark, z.…”

“…In 2 Kohortenstudien wurden Gangparameter vor und nach Anwendung von FES untersucht. Beide Studien stellten eine signifikante Verbesserung durch die Anwendung von FES fest [30,35].…”

Improving Walking with an Implanted Neuroprosthesis for Hip, Knee, and Ankle Control After Stroke

“…Prior studies of implanted foot drop stimulators produced neuroprosthetic improvements of 0.08 and 0.03 m/s 31,32 while studies of surface peroneal nerve stimulation produced increases of 0.06m/s 10 and 0.08m/s 29 . Only the NESS L300Plus (Bioness Inc., Valencia, CA) incorporates surface stimulation of knee flexors or extensors, which is associated with improvement in gait speed over peroneal nerve stimulation of 0.04m/s 33 where 13% of participants used quadriceps stimulation and 87% used hamstrings stimulation. However, there are currently no commercially available systems to provide effective active hip flexion for home use; such an approach would require an IPG.…”

Functional Electrical Stimulation (FES) Reduces Intermittent Claudication (IC) and Improves Quality of Life (QOL) Measures: A Cohort Crossover

“…Several investigators tested the benefit of using wearable FES on improving the ability to walk following damage to the brain. Springer and colleagues [5] reported that after training for 6 weeks using a dual channel wireless FES, subjects with limited household ambulation capabilities improved their gait speed by 63.3%, while subjects with functional community ambulation capabilities improved their gait speed by 25.5%. Kluding et al examined the benefits of walking for 30 weeks with a wireless FES designed to control foot drop associated with damage to the brain, comparing it to articulated ankle-foot orthosis (AFO), and concluded that the FES yielded clinically and statistically significant improvements in gait speed and other functional outcomes including greater patient satisfaction with using the FES compared to using the AFO [6].…”