Spatiotemporal, kinematic and kinetic assessment of the effects of a foot drop stimulator for home-based rehabilitation of patients with chronic stroke: a randomized clinical trial

Abstract

Background Gait disability affects the daily lives of patients with stroke in both home and community settings. An abnormal foot–ankle position can cause instability on the supporting surface and negatively affect gait. Our research team explored the ability of a portable peroneal nerve-targeting electrical stimulator to improve gait ability by adjusting the foot–ankle position during walking in patients with chronic stroke undergoing home-based rehabilitation. Methods This was a double-blinded, parallel-group randomized controlled trial. Thirty-one patients with chronic stroke and ankle–foot motor impairment were randomized to receive 3 weeks of gait training, which involved using the transcutaneous peroneal nerve stimulator while walking (tPNS group; n = 16, mean age: 52.25 years), or conventional home and/or community gait training therapy (CT group; n = 15, mean age: 54.8 years). Functional assessments were performed before and after the 3-week intervention. The outcome measures included spatiotemporal gait parameters, three-dimensional kinematic and kinetic data on the ankle–foot joint, and a clinical motor and balance function assessment based on the Fugl–Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance scales (BBS). Additionally, 16 age-matched healthy adults served as a baseline control of three-dimensional gait data for both trial groups. Results The FMA-LE and BBS scores improved in both the tPNS groups (p = 0.004 and 0.001, respectively) and CT groups (p = 0.034 and 0.028, respectively) from before to after training. Participants in the tPNS group exhibited significant differences in spatiotemporal gait parameters, including double feet support, stride length, and walking speed of affected side, and the unaffected foot off within a gait cycle after training (p = 0.043, 0.017, 0.001 and 0.010, respectively). Additionally, the tPNS group exhibited significant differences in kinematic parameters, such as the ankle angle at the transverse plane (p = 0.021) and foot progression angle at the frontal plane (p = 0.009) upon initial contact, and the peak ankle joint angle at the transverse plane (p = 0.023) and foot progression angle (FPA) at the frontal and transverse planes (p = 0.032 and 0.046, respectively) during gait cycles after 3 weeks of training. Conclusions Use of a portable tPNS device during walking tasks appeared to improve spatiotemporal gait parameters and ankle and foot angles more effectively than conventional home rehabilitation in patients with chronic stroke. Although guidelines for home-based rehabilitation training services and an increasing variety of market devices are available, no evidence for improvement of motor function and balance was superior to conventional rehabilitation. Trial registration Chictr, ChiCTR2000040137. Registered 22 November 2020, https://www.chictr.org.cn/showproj.aspx?proj=64424

How might the consideration of cell polarity affect the daily therapeutic practise? A review study.

“…A few investigations revealed that the use of neuromuscular electric stimulation (NMES), electric stimulation (ES), or devices for electrical stimulation of the peroneal nerve were ineffective in suppressing muscular spasms (12,25,31); however, these papers were based on trial and error, and it is unclear if the use of such devices may alter the bioelectric. In other words, neither bioelectric nor cell polarities were measured, but we know that timing and amplitude vary between devices and changes in bioelectric are sensitive to timing and amplitude of the devices (24).…”

“…Following a database search, 1281 citations were retrieved, of which 27 addressed the topics of this study. Only three of these 27 studies did not show statistically signi cant differences between ES (electric stimulator) and conventional approaches (12,25,31). These studies focused on the decrease of muscular spasm following a stroke or multiple sclerosis.…”

Functional electrical stimulation for foot drop syndrome in patients with cerebral stroke

“…Наши данные вступают в противоречие с результатами исследования [32], где было получено заметное улучшение функции ходьбы, при этом все пациенты, как и в нашей группе, имели срок впервые возникшего полушарного ишемического инсульта до 6 месяцев . В то же время в исследовании [33] получены улучшения как общих параметров ходьбы, так и специфичной для отвисающей стопы функции голеностопного сустава на амбулаторном этапе реабилитации . При этом все пациенты находились в хронической фазе .…”

Ankle rehabilitation robot training for stroke patients with foot drop: Optimizing intensity and frequency

“…Patients with stroke are unable to dorsiflex or have inadequate dorsiflexion due to triceps spasm and ankle dorsiflexion muscle weakness, resulting in a “circling gait” when walking ( Fernandez-Gonzalez et al, 2016 ; Nikamp et al, 2018 ). The compensatory gait pattern affects balance and walking efficiency, and increases the risk of falls, thus restricting their participation in many activities of daily life and in the community ( de Haart et al, 2004 ; Mao et al, 2022 ). Therefore, it is crucial to discover effective treatments for foot drop that facilitate the recovery of lower limb functions in individuals with hemiplegia, thereby enhancing their quality of life and facilitating reintegration into family and society.…”