Effect of a Foot-Drop Stimulator and Ankle–Foot Orthosis on Walking Performance After Stroke

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.

[1]  K. Furie,et al.  Functional recovery following rehabilitation after hemorrhagic and ischemic stroke. , 2003, Archives of physical medicine and rehabilitation.

[2]  J MacGregor.  The evaluation of patient performance using long-term ambulatory monitoring technique in the domiciliary environment. , 1981, Physiotherapy.

[3]  J. Norton,et al.  Clinical use of the Odstock dropped foot stimulator: its effect on the speed and effort of walking. , 1999, Archives of physical medicine and rehabilitation.

[4]  L. Sheffler,et al.  Peroneal Nerve Stimulation versus an Ankle Foot Orthosis for Correction of Footdrop in Stroke: Impact on Functional Ambulation , 2006, Neurorehabilitation and neural repair.

[5]  Richard B. Stein,et al.  Does Functional Electrical Stimulation for Foot Drop Strengthen Corticospinal Connections? , 2010, Neurorehabilitation and neural repair.

[6]  Maarten J. IJzerman,et al.  A randomized controlled trial of an implantable 2-channel peroneal nerve stimulator on walking speed and activity in poststroke hemiplegia. , 2007, Archives of physical medicine and rehabilitation.

[7]  R. Stein,et al.  Long-Term Therapeutic and Orthotic Effects of a Foot Drop Stimulator on Walking Performance in Progressive and Nonprogressive Neurological Disorders , 2010, Neurorehabilitation and neural repair.

[8]  J H Burridge,et al.  Relation between abnormal patterns of muscle activation and response to common peroneal nerve stimulation in hemiplegia , 2000, Journal of neurology, neurosurgery, and psychiatry.

[9]  Jeffrey M. Hausdorff,et al.  Neuroprosthesis for footdrop compared with an ankle-foot orthosis: effects on postural control during walking. , 2009, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[10]  Jeffrey M. Hausdorff,et al.  Effects of a New Radio Frequency–Controlled Neuroprosthesis on Gait Symmetry and Rhythmicity in Patients with Chronic Hemiparesis , 2008, American journal of physical medicine & rehabilitation.

[11]  J. Stewart,et al.  Foot drop: where, why and what to do? , 2008, Practical Neurology.

[12]  Vivian Weerdesteyn,et al.  Is transcutaneous peroneal stimulation beneficial to patients with chronic stroke using an ankle-foot orthosis? A within-subjects study of patients' satisfaction, walking speed and physical activity level. , 2010, Journal of rehabilitation medicine.

[13]  Richard W. Bohannon,et al.  Rivermead Mobility Index: a brief review of research to date , 1999, Clinical rehabilitation.

[14]  Maarten J. IJzerman,et al.  The orthotic effect of functional electrical stimulation on the improvement of walking in stroke patients with a dropped foot: a systematic review. , 2004, Artificial organs.

[15]  Y. Nandabir,et al.  Acceptability of Conventional Lower limb Orthoses in the Rural Areas , 2001 .

[16]  T. Sinkjaer,et al.  Phase II trial to evaluate the ActiGait implanted drop-foot stimulator in established hemiplegia. , 2007, Journal of rehabilitation medicine.

[17]  Shawn M Robbins,et al.  The therapeutic effect of functional and transcutaneous electric stimulation on improving gait speed in stroke patients: a meta-analysis. , 2006, Archives of physical medicine and rehabilitation.

[18]  Maarten J. IJzerman,et al.  The effect of an ankle-foot orthosis on walking ability in chronic stroke patients: a randomized controlled trial , 2004, Clinical rehabilitation.

[19]  Catherine Bulley,et al.  User experiences, preferences and choices relating to functional electrical stimulation and ankle foot orthoses for foot-drop after stroke. , 2011, Physiotherapy.

[20]  Janice J Eng,et al.  Effects of a simple functional electric system and/or a hinged ankle-foot orthosis on walking in persons with incomplete spinal cord injury. , 2004, Archives of physical medicine and rehabilitation.

[21]  P. Taylor,et al.  Functional electrical stimulation: a review of the literature published on common peroneal nerve stimulation for the correction of dropped foot , 1998 .

[22]  C. Granger,et al.  The functional independence measure: a new tool for rehabilitation. , 1987, Advances in clinical rehabilitation.

[23]  D. Wade,et al.  The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. , 1991, International disability studies.