Abstract
To evaluate functional electrical stimulation (FES) neuroprothesis as a method to improve gait in hemiplegic patients, using three different gait scoring methods as measures. Five hemiplegic patients (four with cerebral palsy at GMFCS I, one with diffuse pontine glioma) with a mean age of 16.5years were given a FES neuroprosthesis (NESS(®) L300™) that was applied and calibrated individually. After an adaptation period during which the participants increased their daily use of the neuroprosthesis, gait was assessed with the stimulation off and with the FES on. Kinematic, kinetic, and temporal spatial data were determined using motion analysis and summarized by three scoring methods: Gait Profile Score (GPS), Gait Deviation Index (GDI), and Gillette Gait Index (GGI). Indices were calculated using the Gaitabase program available online. Patients were followed for a minimum of 1year. When comparing gait with and without stimulation, all scoring methods showed improvement. GPS and GDI of the affected leg were significantly improved: 12.23-10.23° (p=0.017) and 72.36-78.08 (p=0.002), respectively. By applying the movement analysis profile, the decomposed GPS score, we found that only the ankle dorsiflexion and the foot progression angle were significantly changed. GGI of the affected leg showed improvement, but without statistical significance: 168.88-131.64 (p=0.221). Total GPS of legs and the GPS, GDI, and GGI of the nonaffected leg showed improvement without statistical significance. At the 1-year follow-up, all patients expressed high satisfaction and continued to use the device. Dorsiflexion functional electrical stimulation improves gait in hemiplegic patients, as reflected by GPS, GDI, and GGI.
Highlights
By applying the movement analysis profile, the decomposed Gait Profile Score (GPS) score, we found that only the ankle
Dorsiflexion functional electrical stimulation improves gait in hemiplegic patients, as reflected by GPS, Gait Deviation Index (GDI), and Gillette Gait Index (GGI)
Foot drop in patients with cerebral palsy (CP) hemiplegia was defined by Rodda [1] as a type 1 hemiplegia gait pattern, characterized by ankle plantarflexion during the swing phase due to an inability to selectively control the ankle without calf contracture, so that ankle dorsiflexion is relatively normal during the stance phase
Summary
Foot drop in patients with cerebral palsy (CP) hemiplegia was defined by Rodda [1] as a type 1 hemiplegia gait pattern, characterized by ankle plantarflexion during the swing phase due to an inability to selectively control the ankle without calf contracture, so that ankle dorsiflexion is relatively normal during the stance phase. This displays the greatest improvements in gait and functional mobility when using an ankle foot orthosis (AFOs) [2, 3]. Patients with type 2 hemiplegia may benefit from other solutions, such as botulinum toxin type A injections, serial casting, or a combination of both, and may show significant improvement in parameters such as the range of passive dorsiflexion, selective motor control, and their observational gait score [1, 4].
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