Peroneal Nerve Stimulation versus an Ankle Foot Orthosis for Correction of Footdrop in Stroke: Impact on Functional Ambulation

Abstract

Objective. To compare the efficacy of the Odstock Dropped-Foot Stimulator (ODFS), a transcutaneous peroneal nerve stimulation device, versus an ankle foot orthosis (AFO) in improving functional ambulation of chronic stroke survivors. Intervention. Fourteen chronic stroke survivors with foot-drop participated in the study. Participants received ambulation training under 3 test conditions: 1) ODFS, 2) customized AFO, and 3) no device. Each participant was evaluated using the modified Emory Functional Ambulation Profile under the 3 test conditions. All participants were evaluated with a post-evaluation survey to solicit device feedback and preferences. Results. Functional ambulation with the AFO was significantly improved, relative to no device, on the floor (P = 0.000), carpet (P = 0.013), and “up and go” test (P = 0.042). There was a trend toward significance on the obstacle (P = 0.092) and stair (P = 0.067) trials. Functional ambulation with the ODFS was significantly improved, relative to no device, on the carpet(P = 0.004). A trend toward significance on floor (P = 0.081), obstaclxze (P = 0.092), and stair (P = 0.079) trials was observed. The difference in functional ambulation between the AFO and ODFS showed a trend toward statistical significance on floor (P = 0.065) and up and go (P = 0.082) trials only. Given a choice between the ODFS and AFO for long-term correction of footdrop, participants indicated a preference for the ODFS. Conclusion. The AFO and the ODFS may be comparable in their effect on improving functional ambulation as compared to no device. Specific characteristics of the ODFS may make it a preferred intervention by stroke survivors. More rigorously controlled trials are needed to confirm these findings.

Keywords

Electrical stimulation Peroneal nerve stimulation Ankle foot orthosis Hemiparesis Footdrop.

References

Dobkin BH. Neurologic rehabilitation team. In: Neurologic rehabilitation. Contemporary Neurology Series. Philadelphia: F. A. Davis; 1996:72-73.

Soffer R , Lipson Aisen M. Orthotics in neurologic disease. In: Lazar RB , ed. Principles of neurologic rehabilitation. New York: McGraw-Hill; 1998:454-454.

Teasell RW , Foley NC , Bhogal SK , Speechley MR. An evidence-based review of stroke rehabilitation. Top Stroke Rehabil 2003;10:29-58.

Lieberson W , Holmquist H , Scot D , Dow M. Functional electrotherapy: stimulation of the peroneal nerve synchronized with the swing phase of gait of hemiplegia patients. Arch Phys Med Rehabil 1961;42:101-105.

Burridge JH , Taylor PN , Hagan SA , Wood DE , Swain ID. The effects of common peroneal stimulation on the effort and speed of walking: a randomized controlled trial with chronic hemiplegic patients. Clin Rehabil 1997;11:201-210.

Taylor PN , Burridge JH , Dunkerley AI , et al. Clinical use of the Odstock dropped-foot stimulator: its effect on the speed and effort of walking. Arch Phys Med Rehabil 1999;80:1577-1583.

Burridge JH , McLellan DL. Relation between abnormal patterns of muscle activation and response to common peroneal nerve stimulation in hemiplegia. J Neurol Neurosurg Psychiatry 2000; 69:353-361.

Malone L , Ellis-Hill C , Swain I. Poster presentation. Thirteenth European Congress of Phys Med and Rehab Med; 2002.

Kim CM , Eng JJ , Whittaker MW. Effects of a simple functional electric system and/or a hinged ankle-foot orthosis on walking in persons with incomplete spinal cord injury. Arch Phys Med Rehabil 2004;85(10):1718-1723.

10.

Baer HR , Wolf SL. Modified Emory functional ambulation profile: an outcome measure for the rehabilitation of post stroke gait dysfunction. Stroke 2001;32:973-979.

11.

Berg K , Wood-Dauphinee S , Williams JI , Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can 1989;41:304-311.

12.

Berg K , Wood-Dauphinee S , Williams JI , Maki B. Measuring balance in the elderly: validation of an instrument. Can J Pub Health 1992;Jul/Aug(Suppl 2):S7-S11.

13.

Folstein MF , Folstein SE , McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.