Clinical use of the Odstock dropped foot stimulator: its effect on the speed and effort of walking

OBJECTIVE: To assess the clinical effectiveness of the Odstock dropped foot stimulator by analysis of its effect on physiological cost index (PCI) and speed of walking. This functional electrical stimulation (FES) device stimulates the common peroneal nerve during the swing phase of gait. DESIGN: A retrospective study of patients who had used the device for 4 1/2 months. SUBJECTS: One hundred fifty-one patients with a dropped foot resulting from an upper motor neuron lesion. SETTING: A medical physics and biomedical engineering department of a district general hospital specializing in the clinical application of FES and a neurophysiotherapy department at a separate hospital. MAIN OUTCOME MEASURES: Changes in walking speed and effort of walking, as measured by PCI over a 10-meter course. RESULTS: There was a 92.7% compliance with treatment. Stroke patients showed a mean increase in walking speed of 27% (p<.01) and reduction in PCI of 31% (p<.01) with stimulation, and changes of 14% (p<.01) and 19% (p<.01), respectively, while not using the stimulator. Multiple sclerosis patients gained similar orthotic benefit but no "carry-over." CONCLUSIONS: The measured differences in walking with and without stimulation were statistically significant in the stroke and multiple sclerosis groups. In this study use of the stimulator improved walking. Those with stroke demonstrated a short-term "carry-over" effect.     

User experiences, preferences and choices relating to functional electrical stimulation and ankle foot orthoses for foot-drop after stroke

Objectives

To explore experiences, preferences and choices relating to the use of ankle foot orthoses (AFOs) and functional electrical stimulation (FES) for foot-drop by people who have suffered a stroke and their carers, with the aim of informing clinical decision-making.

Design

Semi-structured interviews explored individual experiences through a phenomenological approach. The Interpretative Phenomenological Analysis framework was used to enable organisation and interpretation of qualitative interview data.

Setting

Participants who had used both transcutaneous FES and one of several types of AFO were recruited from a single FES clinic.

Participants

Nine people who had suffered a stroke and four carers were recruited purposively, including people between 2 and 9 years post stroke, with different degrees of difficulty in walking.

Results

Participants described experiences, preferences and choices relating to AFO and FES use. All but one person expressed a preference for FES use and related this to being able to move the ankle more freely; walk more normally, safely and independently; and greater comfort. Several people also used AFOs when the FES equipment failed, when travelling and near water. One person rationed their use of FES on a daily basis due to allergic reactions.

Conclusions

The consensus in this sample demonstrated positive and negative experiences of both FES and AFO use. Participants weighed up the pros and cons, and despite predominant preferences for FES, many also used AFOs due to some drawbacks of FES. Further research and development are required to reduce drawbacks and further explore users’ experiences.     

Experiences of functional electrical stimulation (FES) and ankle foot orthoses (AFOs) for foot-drop in people with multiple sclerosis

Purpose: A constructivist phenomenological study explored impacts of ankle foot orthoses (AFOs) or functional electrical stimulation (FES) on people with foot-drop from multiple sclerosis (MS). Method: Focus groups following topic guides were analysed using interpretative phenomenological analysis, with researcher reflexivity, participant verification and peer checking of analysis. Participants with sustained use of the devices (under 2 y) were invited from two quantitative studies that (a) investigated immediate FES effects (n?=?12) and (b) compared habitual use of AFO (n?=?7) or FES (n?=?6). Two focus groups addressed AFO (n?=?4) and FES (n?=?6) experiences. Results: Similar numbers of positive and negative aspects were described for AFO and FES. Both reduced fatigue, improved gait, reduced trips and falls, increased participation, and increased confidence; greater balance/stability was reported for AFOs, and increased walking distance, fitness and physical activity for FES. Barriers to both included avoiding reliance on devices and implications for shoes and clothing; a non-normal gait pattern was reported for AFO, and difficulties of application and limitations in the design of FES. However, participants felt the positives outweighed the negatives. Conclusions: Participants felt benefits outweighed the drawbacks for AFO and FES; greater understanding of user preferences and satisfaction may increase likelihood of usage and efficacy.

• Implications for Rehabilitation

• Interventions to reduce the impacts of foot-drop in people with multiple sclerosis (MS) are important to optimise physical activity participation and participation in life; they include ankle foot orthoses (AFOs) and functional electrical stimulation (FES).

• Research is lacking regarding user satisfaction and perceived outcomes, therefore, two separate focus groups were conducted from a constructivist phenomenological perspective to explore the impacts of AFOs (n?=?4) and FES (n?=?6) on people with foot-drop from MS.

• Some similar positive aspects of AFO and FES use were described, including reduced fatigue, improved gait and fewer trips and falls, while common barriers included finding the device cumbersome, uncomfortable, and inconvenient, with some psychological barriers to their use.

• On balance, the impacts of the devices on improving activities and participation were more important for participants than practical barriers, highlighting the importance of combining understanding of individual experiences and preferences with clinical decision-making when prescribing a device to manage foot-drop.

     

Comparison of Gait Aspects According to FES Stimulation Position Applied to Stroke Patients

[Purpose] This study sought to identify the gait aspects according to the FES stimulation position in stroke patients during gait training. [Subjects and Methods] To perform gait analysis, ten stroke patients were grouped based on 4 types of gait conditions: gait without FES stimulation (non-FES), gait with FES stimulation on the tibialis anterior (Ta), gait with FES stimulation on the tibialis anterior and quadriceps (TaQ), and gait with FES stimulation on the tibialis anterior and gluteus medius (TaGm). [Results] Based on repeated measures analysis of variance of measurements of gait aspects comprised of gait speed, gait cycle, and step length according to the FES stimulation position, the FES stimulation significantly affected gait aspects. [Conclusion] In conclusion, stimulating the tibialis anterior and quadriceps and stimulating the tibialis anterior and gluteus medius are much more effective than stimulating only the tibialis anterior during gait training in stroke patients using FES.Key words: Stroke, FES, Gait     

步态触发功能性电刺激对偏瘫足下垂患者步行能力的影响

目的:比较步态诱发式功能性电刺激(FES)与神经肌肉电刺激(NMES)对脑卒中后足下垂患者下肢运动功能以及步行速度的影响。方法:将30例脑卒中偏瘫足下垂患者随机分为两组,试验组和对照组,均接受神经内科常规药物及康复功能训练,试验组采用步态诱发式FES,刺激患侧腓总神经和胫前肌,2次/天,每次20min,每周7天,共4周。对照组采用NMES。分别在治疗前、治疗后评定偏瘫侧主动踝背伸的角度、FMA下肢运动功能以及步行速度。结果:治疗4周后,两组患者偏瘫侧主动踝背伸的角度、FMA值以及10m最大步行速度较治疗前都有显著改善(P0.05)。主动踝背伸角度试验组增加了58.3%,对照组增加了29.6%;FMA值试验组增加了38%,对照组增加了19%;10米最大步行速度试验组增加了34%,对照组增加了11%;治疗后与治疗前的差值,两组比较有显著性差异(P0.05)。结论:常规康复训练结合NMES能够改善偏瘫侧下肢运动功能及步行速度,常规康复训练结合FES后效果更明显,因此步态诱发式FES可以作为一种常规的训练方法在临床上广泛使用。     

An exploration looking at the impact of domiciliary and day hospital delivery of stroke rehabilitation on informal carers

OBJECTIVES: To explore the impact of two methods of post-hospital stroke rehabilitation on both carers' perceptions of the health services offered and their quality of life. SETTING: East Dorset Health Authority. SUBJECTS: Forty-six informal carers were recruited from a sample of 106, initially identified from stroke patients participating in a larger randomized controlled trial. DESIGN: Qualitative methods. METHODS: Semi-structured interviews were used at baseline and six months to explore carers' perception of a good therapy, the advantages and disadvantages of the different services and their fulfilment with the services. In-depth thematic analysis was carried out to explore the impact of the two different methods of service delivery on carers' quality of life. RESULTS: Day hospitals provided carers with respite opportunities, whilst domiciliary stroke teams provided carers with better educational opportunities to be involved in therapy. No qualitative difference was found in the impact that the different services had on carers' quality of life, which were influenced by factors such as the degree of disruption that caring had on their lives, the loss of a shared life and the availability of social support. Ultimately, carers saw the services as providing benefit for survivors and not themselves. CONCLUSIONS: Domiciliary stroke teams provided informal stroke carers with skills that could help improve postdischarge stroke rehabilitation amongst stroke survivors. Informal carers also benefited from the respite elements of day hospital. A mixed model using both domiciliary care and day hospital care, could provide carers with the benefits of education, convenience and respite.     

Clinical application of acceleration sensor to detect the swing phase of stroke gait in functional electrical stimulation

Functional electrical stimulation (FES) can improve the gait of stroke patients by stimulating the peroneal nerve in the swing phase of the affected leg, causing dorsiflexion of the foot that allows the toes to clear the ground. A sensor can trigger the electrical stimulation automatically during the stroke gait. We previously used a heel sensor system, which detects the contact pressure of the heel, in FES to correct foot drop gait. However, the heel sensor has disadvantages in cosmetics and durability. Therefore, we have replaced the heel sensor with an acceleration sensor that can detect the swing phase based on the acceleration speed of the affected leg, using a machine learning technique (Neural Network). We have used a signal for heel contact in a gait using the heel sensor before training with the Neural Network. The accuracy of the Neural Network detector was compared with a swing phase detector based on the heel sensor. The Neural Network detector was able to detect similarly the swing phase in the heel sensor. The largest difference in timing of the swing phase was less than 60 milliseconds in normal subjects and 80 milliseconds in stroke patients. We were able to correct foot drop gait using FES with an acceleration sensor and Neural Network detector. The present results indicate that an acceleration sensor positioned on the thigh, which is cosmetically preferable to systems in which the sensor is farther from the entry point of the electrodes, is useful for correction of stroke gait using FES.     

Stroke: the increasing complexity of carer needs.

In Australia, more than 346,000 individuals who experience a stroke return to living in their homes with varying degrees of disability. They rely on emotional and physical support from informal carers, typically family members. Informal carers have an indispensable role in patient care poststroke, and the ability of carers to manage this role effectively is crucial for stroke survivors to be able to return home. The aim of this study was to examine the impact of the caring role on carers of stroke survivors, particularly the services provided and the levels of depression and well-being experienced. The study used a longitudinal design incorporating survey methods. Stroke survivors were assessed for functional ability, quality of life, and depression using three assessment tools: the Stroke Impact Scale, World Health Organization Quality of Life-BREF scale, and Zung Self-Rating Depression Scale. A total of 26 people were surveyed: 13 stroke survivors and their 13 carers. Carer knowledge of stroke support services was also explored. Information was collected by using survey methods and structured interviews at 3 weeks and at 3 months postdischarge. The main finding was that depression scores for carers and stroke survivors were below Australian norms at both assessment time points. The major concern identified by carers was poor follow-up procedures for initiating rehabilitation in the home. This study highlighted that a lack of appropriate discharge planning, in conjunction with early discharge of stroke survivors, can have an impact on the rehabilitation process and place increased and unrealistic demands on carers.     

乳腺外科护士对乳腺癌化疗相关性味觉改变患者实施一体化管理体验的质性研究

目的 深入了解乳腺外科护士(简称护士)对乳腺癌化疗相关性味觉改变患者实施一体化管理的体验,为采取针对性措施改善其相关性味觉改变症状提供参考.方法 2019年11月—12月,采用目的性抽样法,选取10名乳腺外科护理人员为研究对象,运用质性研究中的现象学研究方法对其进行访谈,采用Colaizzi资料分析原则进行资料整理分析...     

Chronic pain and occupation: an exploration of the lived experience.

OBJECTIVE: There is limited research on the relationship between chronic pain and occupation. This phenomenological research study explored the lived occupational experiences of people who have chronic pain. METHOD: Via demographic questionnaires, semistructured interviews, and field notes, data were collected on 13 participants with various types of pain. RESULTS: Thematic analysis yielded one main theme: "Chronic Pain Is Life Changing." The following subthemes also emerged: "Chronic Pain Triggers Emotional Distress"; "Chronic Pain Reveals the Strength of Relationships"; "Chronic Pain and Occupation Are Reciprocally Related Forces"; and "Chronic Pain Elicits Innovative Adaptive Responses." Study participants reported experiencing myriad troubling emotions; however, they resourcefully modified their routines and tasks and found enhanced meaning in favored occupations. CONCLUSIONS: This study illuminates the importance of therapeutic listening, the innovativeness of people who have chronic pain, and the possible therapeutic potential of occupation.     

功能性电刺激治疗脑卒中后肩关节半脱位疗效观察

目的　观察功能性电刺激 (FES)对脑卒中患者肩关节半脱位的短期和长期疗效。方法　将 36例脑卒中后肩关节半脱位患者随机分为FES组和肩托组。FES组应用FES刺激患侧肩袖和三角肌 ,每日 1次 ,每次 2 0min ;肩托组只采用肩托保护。治疗前、治疗 2 0d后、治疗 6 0d后 ,分别摄取双侧肩关节X线片及进行指诊。对评测结果进行比较分析。结果　治疗前 2组各项指标差异无显著性 (P >0 .0 5 )。治疗 2 0d后 ,FES组肩关节半脱位复位率 ( 5 2 .6 % )显著高于肩托组 ( 17.6 % ) (P <0 .0 0 1) ;而治疗 6 0d后 ,FES组复位率 ( 84.2 % )和肩托组 ( 76 .5 % )接近 (P >0 .0 5 )。结论　FES能够在短期内明显提高肩关节半脱位的复位率 ,但长期疗效和肩托治疗无显著性差异。     

Balance-related efficacy compared with balance function in patients with acute stroke

It is well known that patients who have suffered a stroke have problems with balance and have feelings of unsteadiness. The aim of this study was to analyse the correlation between how patients estimate their perceived confidence in task performance without falling and the objective assessment of balance made by a physiotherapist, and whether the Falls Efficacy Scale (FES(S)) is to be recommended for use in patients in the acute phase of stroke. Sixty patients divided into two groups assessed their belief to perform daily life activities without fear of falling using the FES(S) and were assessed by using the Berg Balance Scale (BBS) and Timed Up and Go (TUG) by a physiotherapist. Group 1 assessed themselves before, whereas Group 2 assessed themselves after the objective assessment. The correlation between the FES(S) and the TUG was moderate to good, but these two scales consider different aspects and dimensions of balance, ability, and belief and are therefore not interchangeable. The correlation between FES(S) and BBS was low to moderate. The conclusion of this study was that the FES(S) is not to be recommended as a single measurement in the acute phase of stroke because it does not measure actual balance function.     

功能电刺激治疗脑卒中足下垂合并内翻的疗效观察

目的:观察动作反馈的功能性电刺激(FES)对脑卒中足下垂合并足内翻患者下肢运动功能和步行能力的影响。方法:脑卒中足下垂合并足内翻患者34例,随机分为观察组和对照组各17例,2组均进行基础康复治疗,观察组另行功能电刺激下20min步行训练,对照组行相同时间的常规步行训练。在康复治疗前和治疗4周后采用Fug1-Meyer量表下肢部分(FMA-LE)、起立-行走计时测试(TUGT)、徒手肌力测试(MMT)和改良Ashworth量表(MAS)对两组患者进行功能评估;观察组另记录步态不对称指数(GAI)和非偏瘫侧摆动时间变异(STV)。结果:治疗4周后,观察组患者FMA-LE、TUGT、MMT、MAS、GAI和STV评分均较治疗前显著提高(P0.05),对照组TUGT及MMT评分较治疗前明显提高(P0.05),其余各评分治疗前后比较均差异无统计学意义;治疗后组间比较,观察组FMA-LE、TUGT和MAS评分均显著高于对照组(P0.05),但MMT评分组间比较差异无统计学意义。结论:动作反馈功能性电刺激能显著改善脑卒中足下垂合并足内翻患者的运动功能和步行能力,并能提高踝背屈肌力、缓解踝关节相关肌群痉挛。     

经颅直流电刺激结合功能性电刺激对脑卒中平台期患者上肢运动功能康复影响的研究

目的:将经颅直流电刺激(tDCS)和功能性电刺激(FES)结合,观察这种联合治疗干预方式对脑卒中平台期患者上肢功能的影响。方法:3例脑卒中后平台期偏瘫患者在4周基线期后接受4周的tDCS结合FES治疗干预。干预前后用Fugl-Meyer上肢运动功能评分(U-FMA)、表面肌电图(sEMG)、经颅磁刺激(TMS)进行评定。结果:干预后U-FMA分数较干预前提高。7个主动肌中有5个表面肌电激活性干预前后有明显变化。用TMS成对刺激方法评估受试者健侧大脑短潜伏期皮质内抑制与短潜伏期皮质内易化结果显示部分的干预前后变化。结论:tDCS结合FES治疗干预改善了受试者上肢的运动功能,该方案可能是针对脑卒中平台期患者的一种有前景的干预康复方案。     

Examination of Factors Related to the Effect of Improving Gait Speed With Functional Electrical Stimulation Intervention for Stroke Patients

Background

Functional electrical stimulation (FES) for patients with stroke and foot drop is an alternative to ankle foot orthoses. Characteristics of FES responders and nonresponders have not been clarified.

Intensive Training of Subjects with Chronic Hemiparesis on a Motorized Cycle Combined with Functional Electrical Stimulation (FES): A Feasibility and Safety Study

Background and Purpose. This study tested the safety and ability of subjects with chronic hemiplegia to tolerate intensive training using a motorized cycle combined with functional electrical stimulation (FES) system. Methods. A case series of 10 subjects with chronic stroke participated in 30‐minute three times per week cycling on a stationary motorized cycling system combined with FES (RT300^TM). The stimulation activated the dorsal and plantar flexors, the quadriceps and the hamstrings using four channels and a stimulation pattern that assisted cycling motion of the paretic lower limb. Patients were instructed to cycle as close as possible to 60 rpm and the resistance to cycling was gradually increased using a computer‐based algorism. The training lasted eight weeks. Results. All 10 participants completed the training without adverse reactions to the training or the FES. The kcal utilized during the training increased significantly (p = 0.0003) between session 1 (2.2 ± 0.47), session 12 (4.3 ± 1.2) and session 24 (7.5 ± 1.8). Peak pedaling power increased from 6.5 ± 0.5 W pre‐training to 18.0 ± 5.4 W post‐training. Locomotion variables that improved significantly were time to complete the get up and go test (45.4 ± 54.9 seconds vs. 34.0 ± 31.8 seconds) a 24.6% improvement (p = 0.03) and gait velocity, which increased 25.0% from 0.4 ± 0.3 m/sec to 0.5 ± 0.4 m/sec (p = 0.01). Conclusion. Using a motorized cycle combined with FES intensive training appears safe and can be tolerated by patients with chronic stroke of wide age range, diverse severity of cardio‐pulmonary deconditioning, motor loss and locomotor deficits. Copyright © 2010 John Wiley & Sons, Ltd.     

The impact of stroke in Italy: first step for a National Burden of Disease Study

PURPOSE: To calculate the impact of stroke in Italy in 1998, expressed in terms of disability adjusted life years (DALYs) according to the WHO Global Burden of Disease (GBD) Study. METHOD: The data on first-ever stroke incidence (FES), remission rate and case fatality derived from the health information system and a research on post-FES disability of the Friuli Venezia-Giulia (FVG) Region, were used to compute the years of life lived with disability (YLDs), which were added to the years of life lost due to premature mortality (YLLs), calculated from stroke mortality data, to obtain the DALYs. The results were extrapolated to the rest of Italy after examination of national stroke registries data. RESULTS: Standardized estimated incidence of FES in FVG in 1998 was lower (135 cases of FES per 100 000 inhabitants) than that reported in other published national and international studies. Estimated case fatality rate and distribution of post-FES disability did not differ from other similar studies. About 100 000 YLLs and 273 000 YLDs due to FES were estimated in 1998 for Italy. CONCLUSIONS: The estimated proportion of the YLDs on total DALYs (27%) is comparable with that obtained in the EURO-A group (the European area including Italy) of the GBD 2000 Study (31%), and the Australian BoD Study (35%).     

Near-normal gait pattern with peroneal electrical stimulation as a neuroprosthesis in the chronic phase of stroke: a case report

van Swigchem R, Weerdesteyn V, van Duijnhoven HJ, den Boer J, Beems T, Geurts AC. Near-normal gait pattern with peroneal electrical stimulation as a neuroprosthesis in the chronic phase of stroke: a case report.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. A 60-year-old survivor of a right hemisphere infarction 21 months 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.     

Effects of brain-computer interface-based functional electrical stimulation on balance and gait function in patients with stroke: preliminary results

[Purpose] The purpose of this study was to determine the effects of brain-computer interface (BCI)-based functional electrical stimulation (FES) on balance and gait function in patients with stroke. [Subjects] Subjects were randomly allocated to a BCI-FES group (n=5) and a FES group (n=5). [Methods] The BCI-FES group received ankle dorsiflexion training with FES according to a BCI-based program for 30 minutes per day for 5 days. The FES group received ankle dorsiflexion training with FES for the same duration. [Results] Following the intervention, the BCI-FES group showed significant differences in Timed Up and Go test value, cadence, and step length on the affected side. The FES group showed no significant differences after the intervention. However, there were no significant differences between the 2 groups after the intervention. [Conclusion] The results of this study suggest that BCI-based FES training is a more effective exercise for balance and gait function than FES training alone in patients with stroke.Key words: Brain-computer interface, Functional electrical stimulation, Gait