Near-Normal Gait Pattern With Peroneal Electrical Stimulation as a Neuroprosthesis in the Chronic Phase of Stroke: A Case Report

NOT GOOD ENOUGH! WHOM is going to do the research to get to 'normal' gait? This fucking tyranny of low expectations needs to be killed off.

Near-Normal Gait Pattern With Peroneal Electrical Stimulation as a Neuroprosthesis in the Chronic Phase of Stroke: A Case Report

  Roos van Swigchem, PT, MSc, Vivian Weerdesteyn, PhD, Hanneke J. van Duijnhoven, MD, Jasper den Boer, PT, PhD, Tjemme Beems, MD†, Alexander C. Geurts, MD, PhD

ABSTRACT.  

In recent years, the use of functional electrical stimulation(FES) of the peroneal nerve has increased as an alternative for an ankle-foot orthosis (AFO) to treat stroke-related drop foot.We present a chronic stroke patient demonstrating an almost normal gait pattern with peroneal FES as a neuroprosthesis. A60-year-old survivor of a right hemisphere infarction 21months ago, who regularly used a polypropylene AFO, was provided with a surface-based peroneal FES device for severe drop foot. In a second instance, he received an implanted FES system because of skin problems with the surface stimulator.With both FES devices, the patient achieved an adequate foot elevation. Moreover, his hip and knee flexion angles during walking increased to normal values and his ankle push-off power increased. His gait pattern became almost symmetrical and less variable than with the AFO. Furthermore, his ability to avoid a sudden obstacle improved to normal values with FES.Our patient showed benefits from peroneal FES beyond what can be attributed to improved foot lift alone. With regard to the potential working mechanisms underlying this response to FES, biomechanical benefits related to improved ankle push-off are suggested as the main mechanism.

IN STROKE PATIENTS who suffer from a drop foot, anAFO is usually provided to lift the foot during the swing phase and early stance phase of gait in order to prevent the toes from touching the ground and to facilitate heel loading. As an alternative treatment, FES of the peroneal nerve as a form of neuroprosthesis is gradually becoming more feasible due to advanced and commercially available systems. Peroneal FES activates the muscles that dorsiflex and evert the ankle joint as well as the toe extensors and may lead to significant improvement in the gait pattern¹
and gait speed^2,3
compared to walking without aids. Although FES has several theoretical advantages over an AFO and patients’ preferences often support the use of FES, there is as yet no conclusive evidence for the superiority of peroneal FES over an AFO with respect to walking abilities.^4,5
The aim of the present report is to demonstrate the potential superiority of peroneal FES over an AFO. To this end,we present a stroke patient who was used to walking with a polypropylene AFO and who showed functional benefits from FES that went beyond what can be attributed to improved foot elevation alone (open access videos on http://www.neurorehab.nl/APMR_english.htm). Secondly, we aim to discuss the potential mechanisms underlying the observed functional improvements.