FES for foot-drop in hemiparesis

Summary

Principal Investigator: J Chae
Affiliation: Case Western Reserve University
Country: USA
Abstract: Stroke is the leading cause of disability among adults in the United States. Hemiplegia is a striking manifestation of stroke and contributes significantly to the physical disability of stroke survivors. Foot-drop, or inability to dorsiflex the paretic ankle during the swing phase of gait is an important gait abnormality that contributes to decreased mobility among stroke survivors. In the United States, the standard of care in addressing this deficit is the custom molded ankle-foot-orthosis (AFO). However, evolving data now demonstrate that active repetitive movement training is the principal substrate for facilitating motor learning after stroke. We define motor relearning as the reacquisition of motor ability after central nervous system injury. Thus, while an AFO may assist stroke survivors to ambulate in the short-term, it is possible that it also inhibits recovery in the long-term. Previous studies have demonstrated that active repetitive movement exercises mediated by neuromuscular electrical stimulation (NMES) facilitate motor relearning among stroke survivors. In particular, studies have reported that some chronic stroke survivors treated with a peroneal nerve stimulator for foot-drop experience sufficient recovery that they no longer need the peroneal nerve stimulator or an AFO for community ambulation. However, there are no blinded randomized clinical trials that rigorously evaluate the motor relearning effects of ambulation training with peroneal nerve stimulators. Thus, the aim of this project is to assess the motor relearning effects of a transcutaneous peroneal nerve stimulator as reflected my measures of lower limb motor impairment, lower limb related physical disability and overall quality of life of acute stroke survivors. A single-blinded randomized clinical trial will be carried out to assess the effects of ambulation training with a peroneal nerve stimulator among acute stroke survivors compared to ambulation training with an AFO. Subjects will be treated for 8 weeks and followed for a total of 6 months. Results of this study will direct future investigations with respect to dose effect, mechanism and optimal prescriptive parameters
Funding Period: 2005-08-01 - 2006-07-31
more information: NIH RePORT

Top Publications

  1. pmc Relationship between body mass index and rehabilitation outcomes in chronic stroke
    Lynne R Sheffler
    Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH 22109, USA
    Am J Phys Med Rehabil 91:951-6. 2012
  2. pmc Spatiotemporal, kinematic, and kinetic effects of a peroneal nerve stimulator versus an ankle foot orthosis in hemiparetic gait
    Lynne R Sheffler
    Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH 22109, USA
    Neurorehabil Neural Repair 27:403-10. 2013
  3. pmc Randomized controlled trial of surface peroneal nerve stimulation for motor relearning in lower limb hemiparesis
    Lynne R Sheffler
    Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH 44109, USA
    Arch Phys Med Rehabil 94:1007-14. 2013
  4. ncbi Neuromuscular electrical stimulation in neurorehabilitation
    Lynne R Sheffler
    Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA
    Muscle Nerve 35:562-90. 2007
  5. doi Neuromuscular electrical stimulation for motor restoration in hemiplegia
    John Chae
    Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
    Top Stroke Rehabil 15:412-26. 2008

Scientific Experts

Detail Information

Publications6

  1. pmc Relationship between body mass index and rehabilitation outcomes in chronic stroke
    Lynne R Sheffler
    Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH 22109, USA
    Am J Phys Med Rehabil 91:951-6. 2012
    ..The aim of this study was to evaluate the relationship between body mass index (BMI) and change in motor impairment and functional mobility after a gait rehabilitation intervention in chronic stroke subjects...
  2. pmc Spatiotemporal, kinematic, and kinetic effects of a peroneal nerve stimulator versus an ankle foot orthosis in hemiparetic gait
    Lynne R Sheffler
    Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH 22109, USA
    Neurorehabil Neural Repair 27:403-10. 2013
    ..The relative effect of a transcutaneous peroneal nerve stimulator (tPNS) and an ankle foot orthosis (AFO) on spatiotemporal, kinematic, and kinetic parameters of hemiparetic gait has not been well described...
  3. pmc Randomized controlled trial of surface peroneal nerve stimulation for motor relearning in lower limb hemiparesis
    Lynne R Sheffler
    Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH 44109, USA
    Arch Phys Med Rehabil 94:1007-14. 2013
    ..To compare the motor relearning effect of a surface peroneal nerve stimulator (PNS) versus usual care on lower limb motor impairment, activity limitation, and quality of life among chronic stroke survivors...
  4. ncbi Neuromuscular electrical stimulation in neurorehabilitation
    Lynne R Sheffler
    Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA
    Muscle Nerve 35:562-90. 2007
    ..Perspectives on future developments and clinical applications of NMES are presented...
  5. doi Neuromuscular electrical stimulation for motor restoration in hemiplegia
    John Chae
    Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
    Top Stroke Rehabil 15:412-26. 2008
    ..The development of hand neuroprostheses is in its infancy and must await additional fundamental and technical advances before reaching clinical viability. The limitations of available systems and future developments are discussed...