Effect of a Foot-Drop Stimulator and Ankle–Foot Orthosis on Walking Performance After Stroke: A Multicenter Randomized Controlled Trial

Read the last line. But your therapist probably already figured that out.
http://nnr.sagepub.com/content/27/7/579.abstract

1. Dirk G. Everaert, PhD1
2. Richard B. Stein, DPhil1
3. Gary M. Abrams, MD2
4. Alexander W. Dromerick, MD3
5. Gerard E. Francisco, MD4
6. Brian J. Hafner, PhD5
7. Thy N. Huskey, MD6
8. Michael C. Munin, MD7
9. Karen J. Nolan, PhD8,9
10. Conrad V. Kufta, MD10

1. ¹University of Alberta, Edmonton, Alberta, Canada
2. ²University of California, San Francisco, CA, USA
3. ³National Rehabilitation Hospital and Georgetown University, Washington, DC, USA
4. ⁴University of Texas Health Sciences Center and TIRR Memorial Hermann, Houston, TX, USA
5. ⁵University of Washington, Seattle, WA, USA
6. ⁶Washington University in St. Louis, St. Louis, MO, USA
7. ⁷University of Pittsburgh, Pittsburgh, PA, USA
8. ⁸Kessler Foundation Research Center, West Orange, NJ, USA
9. ⁹UMDNJ–New Jersey Medical School, Newark, NJ, USA
10. ¹⁰Innovative Neurotronics, Inc, Austin, TX, USA

1. Richard B. Stein, University of Alberta, 5005 Katz-Rexall Centre, Edmonton, Alberta, T6G 2E1, Canada. Email: richard.stein@ualberta.ca

Abstract

Background. Studies have demonstrated the efficacy of functional electrical stimulation in the management of foot drop after stroke. Objective. To compare changes in walking performance with the WalkAide (WA) foot-drop stimulator and a conventional ankle–foot orthosis (AFO). Methods. Individuals with stroke within the previous 12 months and residual foot drop were enrolled in a multicenter, randomized controlled, crossover trial. Subjects were assigned to 1 of 3 parallel arms for 12 weeks (6 weeks/device): arm 1 (WA–AFO), n = 38; arm 2 (AFO–WA), n = 31; arm 3 (AFO–AFO), n = 24. Primary outcomes were walking speed and Physiological Cost Index for the Figure-of-8 walking test. Secondary measures included 10-m walking speed and perceived safety during this test, general mobility, and device preference for arms 1 and 2 for continued use. Walking tests were performed with (On) and without a device (Off) at 0, 3, 6, 9, and 12 weeks. Results. Both WA and AFO had significant orthotic (On–Off difference), therapeutic (change over time when Off), and combined (change over time On vs baseline Off) effects on walking speed. An AFO also had a significant orthotic effect on Physiological Cost Index. The WA had a higher, but not significantly different therapeutic effect on speed than an AFO, whereas an AFO had a greater orthotic effect than the WA (significant at 12 weeks). Combined effects on speed after 6 weeks did not differ between devices. Users felt as safe with the WA as with an AFO, but significantly more users preferred the WA. Conclusions. Both devices produce equivalent functional gains.