Drop Foot Stimulator Research Articles

CSP2023: 410 - Functional Electrical Stimulation for Foot Drop: A Service Evaluation in Neuro- Outpatient Physiotherapy

CSP2023: 410 - Functional Electrical Stimulation for Foot Drop: A Service Evaluation in Neuro- Outpatient Physiotherapy

Bicephalic Transcranial Direct-Current Stimulation Does Not Add Benefits to a Footdrop Stimulator for Improving Functional Mobility in People With Chronic Hemiparesis After Stroke: A Double-Blind, Randomized Controlled Trial.

The aim of this study was to assess the effects of applying transcranial direct-current stimulation (tDCS), a footdrop stimulator (FDS), and gait training simultaneously on functional mobility in people with chronic hemiparesis after stroke. In this double-blind controlled trial, 32 individuals with mild, moderate, and severe chronic hemiparesis after stroke were randomized to tDCS plus FDS or sham tDCS plus FDS groups. Both groups underwent 10 concurrent tDCS and FDS gait training sessions 5 times per week for 2weeks. Functional mobility was evaluated by the Timed "Up & Go" test (TUG). Secondary outcomes included spasticity of plantarflexors, knee extensors, and hip adductors; quality of life; and walking endurance (distance covered during each treadmill gait training session). Clinical assessments were performed before treatment, after treatment, and at a 1-month follow-up. A generalized estimating equation was used to compare the effects of time, group, and time × group interaction. No difference between groups was observed during performance of the TUG or other outcomes. TUG performance was improved in both the tDCS plus FDS group (before treatment = 24.29 [95% CI = 17.72-33.28]; after treatment = 21.75 [95% CI = 15.75-30.08]) and the sham tDCS plus FDS group (before treatment = 19.63 [95% CI = 16.06-23.0]; after treatment = 18.45 [95% CI = 15.26-22.3]). This improvement remained at the follow-up evaluation. Both groups also showed reduced spasticity of plantarflexors and knee extensors, increased quality of life, and increased total distance walked. This study provided no evidence that bicephalic tDCS improves functional mobility, spasticity, quality of life, or walking endurance in people with chronic hemiparesis after stroke. Bicephalic tDCS does not add relevant benefits to FDS and gait training in people who have chronic hemiparesis after stroke. Given that tDCS has few additional effects and given its costs for clinical practice, tDCS for rehabilitation in people with chronic hemiparesis after stroke is discouraged. FDS and gait training improve functional mobility, walking resistance, and quality of life in people with chronic hemiparesis after stroke.

Functional Electrical Stimulation for Foot Drop in Post-Stroke People: Quantitative Effects on Step-to-Step Symmetry of Gait Using a Wearable Inertial Sensor.

The main purpose of the present study was to assess the effects of foot drop stimulators (FDS) in individuals with stroke by means of spatio-temporal and step-to-step symmetry, harmonic ratio (HR), parameters obtained from trunk accelerations acquired using a wearable inertial sensor. Thirty-two patients (age: 56.84 ± 9.10 years; 68.8% male) underwent an instrumental gait analysis, performed using a wearable inertial sensor before and a day after the 10-session treatment (PRE and POST sessions). The treatment consisted of 10 sessions of 20 min of walking on a treadmill while using the FDS device. The spatio-temporal parameters and the HR in the anteroposterior (AP), vertical (V), and mediolateral (ML) directions were computed from trunk acceleration data. The results showed that time had a significant effect on the spatio-temporal parameters; in particular, a significant increase in gait speed was detected. Regarding the HRs, the HR in the ML direction was found to have significantly increased (+20%), while those in the AP and V directions decreased (approximately 13%). Even if further studies are necessary, from these results, the HR seems to provide additional information on gait patterns with respect to the traditional spatio-temporal parameters, advancing the assessment of the effects of FDS devices in stroke patients.

Immediate Effect of Foot Drop Stimulator in Outpatients with Chronic Stroke: A Mixed Method Study

Background: The foot drop stimulator is designed to improve the walking ability of foot drop in patients after stroke, however, studies on clinical effects are still lacking. Objective: To investigate the effect of a foot drop stimulator on the walking and balancing abilities of foot drop patients after a stroke. Design: One-Group (Pretest-Posttest) Design. Methods: All subjects walked in all three conditions: foot drop stimulator (FDS) ankle foot orthosis (AFO) and barefoot. Primary outcome measures were assessed for walking and balance using a 10-m walking test (10MWT) and a timed up and go test (TUG). Secondary outcome measures consisted of a brief user interview, and the patients recorded the advantages and disadvantages of each condition. Results: FDS, AFO, and barefoot conditions showed a statistically significant difference in 10MWT and TUG (P .05). Conclusion: In this study, the foot drop stimulator contributed to improving the balance ability, and the walking ability was similar to the effect of the anklefoot orthosis.

Kinematic and Functional Gait Changes After the Utilization of a Foot Drop Stimulator in Pediatrics.

Foot drop is one of the most common secondary conditions associated with hemiplegia post stroke and cerebral palsy (CP) in children, and is characterized by the inability to lift the foot (dorsiflexion) about the ankle. This investigation focuses on children and adolescents diagnosed with brain injury and aims to evaluate the orthotic and therapeutic effects due to continuous use of a foot drop stimulator (FDS). Seven children (10 ± 3.89 years) with foot drop and hemiplegia secondary to brain injury (stroke or CP) were evaluated at baseline and after 3 months of FDS usage during community ambulation. Primary outcome measures included using mechanistic (joint kinematics, toe displacement, temporal-spatial asymmetry), and functional gait parameters (speed, step length, time) to evaluate the orthotic and therapeutic effects. There was a significant correlation between spatial asymmetry and speed without FDS at 3 months (r = 0.76, p < 0.05, df = 5) and no correlation between temporal asymmetry and speed for all conditions. The results show orthotic effects including significant increase in toe displacement (p < 0.025 N = 7) during the swing phase of gait while using the FDS. A positive correlation exists between toe displacement and speed (with FDS at 3 months: r = 0.62, p > 0.05, without FDS at 3 months: r = 0.44, p > 0.05). The results indicate an orthotic effect of increased dorsiflexion and toe displacement during swing with the use of the FDS in children with hemiplegia. Further, the study suggests that there could be a potential long-term effect of increased dorsiflexion during swing with continuous use of FDS.

Immediate effect of a wearable foot drop stimulator to prevent foot drop on the gait ability of patients with hemiplegia after stroke

ABSTRACT The purpose of this study was to compare the effects of a foot drop stimulator (FDS) and ankle-foot orthosis (AFO) on the gait ability of patients with hemiplegia after stroke. This study recruited 10 patients with hemiplegia after stroke. All patients performed gait under two conditions (AFO and FDS gait). Gait parameters were measured with the GAITRite® system to analyze the spatial and temporal parameters of the patients’ gaits. No significant differences in cadence, velocity, swing time, stance time, or step length of the affected or less-affected limbs were found between the two conditions (all, p > .05). These findings demonstrate that AFO and FDS have a similar effect on the gait ability of patients with hemiplegia after stroke.

Editorial

Lately, I have been loosely following the Women's World Cup. The fact that the soccer (or football, for non-US readers) games take place in France and the decent performance of the French team certainly contribute to ignite my interest. But what is the relationship with MS? I was contacted by a person with MS from the United States, who wanted to attend some of the games in person and needed an accessible seat, as well as mobility equipment to navigate the stadiums. This prompted me to investigate what accommodations were offered to persons with disabilities. I was pleased to discover that “Special Access” tickets were sold, with three categories of seats depending on one's level of walking limitations. It is heartwarming to learn that our patients, even when severely affected by MS, may be able to enjoy special events like this if they wish to do so. Unfortunately, the person who contacted me was having difficulty getting a response to his e-mail inquiries from the organizers. In event organization as in health care, communication is key, and opportunities for improvement always exist.The article featured for educational credit in this issue will undoubtedly resonate with many MS health care providers. Benjaminy and colleagues investigated the perceptions of MS patients and clinicians about time frames for stem cell research. Stem cells are not a new topic; when I was a resident, there was great enthusiasm about treating Parkinson disease with stem cells. However, in this time of social media and growing medical tourism, it is more essential than ever to understand perceptions in order to find avenues for communication between patients and clinicians, so that “informed hope” may be fostered. “Time is brain,” states one of the clinicians interviewed in this study, echoing the message of the Letter to the Editor from our founding editor Dr. Herndon.The other articles contained in this issue can be divided into two categories: comorbidities and the use of technology. Restless legs syndrome (RLS) is a comorbidity often mentioned but seldom researched in MS. Carnero Contentti and colleagues found a higher frequency of RLS in 189 patients with MS compared with 238 controls and identified factors associated with the presence of RLS. Psychiatric comorbidities are known to be highly prevalent in MS, although more attention has been paid to depression than to anxiety. Vissicchio and colleagues found that anxiety has an indirect effect on verbal learning through processing speed, illustrating the existence of negative synergies between various symptoms and comorbidities often witnessed in clinical practice.Technology comes in many forms and has many applications in MS care, particularly in MS rehabilitation. Functional electrical stimulation for foot drop constitutes an example of commercially available technology that improves gait and walking in some people with MS. In their literature review, Renfrew and colleagues found evidence of a positive impact of functional electrical stimulation on various aspects of quality of life. Antigravity treadmills provide an opportunity for aerobic exercise and gait training even in the presence of significant gait impairment. Using this technology, Willingham and colleagues observed improvement in muscle oxidative capacity and endurance in six people with MS and moderate-to-severe levels of disability.“Virtual consultations” between MS experts and community health care providers are made possible by advancements in communication technology, as illustrated in Project ECHO, a program already described in the November–December 2017 issue of IJMSC. In a follow-up article herein, Alschuler and colleagues report that participating providers perceived a positive impact on the care of their patients with MS.The recently released 2018 CiteScore value for IJMSC (up 24% from the previous value) reflects the continued year-to-year increase in the journal's scholarly impact. We are particularly grateful to our authors and reviewers for their contribution to this success.

The clinical- and cost-effectiveness of functional electrical stimulation and ankle-foot orthoses for foot drop in Multiple Sclerosis: a multicentre randomized trial

Objective: To compare the clinical- and cost-effectiveness of ankle-foot orthoses (AFOs) and functional electrical stimulation (FES) over 12 months in people with Multiple Sclerosis with foot drop. Design: Multicentre, powered, non-blinded, randomized trial. Setting: Seven Multiple Sclerosis outpatient centres across Scotland. Subjects: Eighty-five treatment-naïve people with Multiple Sclerosis with persistent (>three months) foot drop. Interventions: Participants randomized to receive a custom-made, AFO (n = 43) or FES device (n = 42). Outcome measures: Assessed at 0, 3, 6 and 12 months; 5-minute self-selected walk test (primary), Timed 25 Foot Walk, oxygen cost of walking, Multiple Sclerosis Impact Scale-29, Multiple Sclerosis Walking Scale-12, Modified Fatigue Impact Scale, Euroqol five-dimension five-level questionnaire, Activities-specific Balance and Confidence Scale, Psychological Impact of Assistive Devices Score, and equipment and National Health Service staff time costs of interventions. Results: Groups were similar for age (AFO, 51.4 (11.2); FES, 50.4(10.4) years) and baseline walking speed (AFO, 0.62 (0.21); FES 0.73 (0.27) m/s). In all, 38% dropped out by 12 months (AFO, n = 21; FES, n = 11). Both groups walked faster at 12 months with device (P < 0.001; AFO, 0.73 (0.24); FES, 0.79 (0.24) m/s) but no difference between groups. Significantly higher Psychological Impact of Assistive Devices Scores were found for FES for Competence (P = 0.016; AFO, 0.85(1.05); FES, 1.53(1.05)), Adaptability (P = 0.001; AFO, 0.38(0.97); FES 1.53 (0.98)) and Self-Esteem (P = 0.006; AFO, 0.45 (0.67); FES 1 (0.68)). Effects were comparable for other measures. FES may offer value for money alternative to usual care. Conclusion: AFOs and FES have comparable effects on walking performance and patient-reported outcomes; however, high drop-outs introduces uncertainty.

Motor Neuroprostheses.

Neuroprostheses (NPs) are electrical stimulators that activate nerves, either to provide sensory input to the central nervous system (sensory NPs), or to activate muscles (motor NPs: MNPs). The first MNPs were belts with inbuilt batteries and electrodes developed in the 1850s to exercise the abdominal muscles. They became enormously popular among the general public, but as a result of exaggerated therapeutic claims they were soon discredited by the medical community. In the 1950s, MNPs reemerged for the serious purpose of activating paralyzed muscles. Neuromuscular electrical stimulation (NMES), when applied in a preset sequence, is called therapeutic electrical stimulation (TES). NMES timed so that it enhances muscle contraction in intended voluntary movements is called functional electrical stimulation (FES) or functional neuromuscular stimulation (FNS). It has been 50 years since the first FES device, a foot-drop stimulator, was described and 40 years since the first implantable version was tested in humans. A commercial foot-drop stimulator became available in the 1970s, but for various reasons, it failed to achieve widespread use. With advances in technology, such devices are now more convenient and reliable. Enhancing upper limb function is a more difficult task, but grasp-release stimulators have been shown to provide significant benefits. This chapter deals with the technical aspects of NMES, the therapeutic and functional benefits of TES and FES, delayed-onset and carryover effects attributable to "neuromodulation" and the barriers and opportunities in this rapidly developing field. © 2019 American Physiological Society. Compr Physiol 9:127-148, 2019.

An exploration of the experiences and utility of functional electrical stimulation for foot drop in people with multiple sclerosis

Purpose: Functional electrical stimulation (FES) is effective in improving walking in people with multiple sclerosis (MS) with foot drop. There is limited research exploring people’s experiences of using this device. This study aims to explore the utility, efficacy, acceptability, and impact on daily life of the device in people with MS.Methods: An interpretative phenomenological approach was employed. Ten participants who had used FES for 12 months were interviewed. Transcripts were analysed, and emergent themes identified.Results: Nine participants continued to use the device. Three relevant super-ordinate themes were identified; impact of functional electrical stimulation, sticking with functional electrical stimulation, and autonomy and control. Participants reported challenges using the device; however, all reported positive physical and psychological benefits. Intrinsic and external influences such as; access to professional help, the influence of others, an individual’s ability to adapt, and experiences using the device, influenced their decisions to continue with the device. A thematic model of these factors was developed.Conclusions: This study has contributed to our understanding of people with MS experiences of using the device and will help inform prescribing decisions and support the continued, appropriate use of FES over the longer term.Implications for RehabilitationPeople with multiple sclerosis using functional electrical stimulation report benefits in many aspects of walking, improved psychological well-being and increased engagement in valued activities.A number of challenges impact on functional electrical stimulation use. Factors such as; a positive experience using the device, access to professional help, the influence of others, a strong sense of personal autonomy and an individual’s ability to adapt, influence an individual’s decision to continue using functional electrical stimulation.Clinicians prescribing functional electrical stimulation should be aware of these factors so that the right support and guidance can be provided to people with multiple sclerosis, thus improving outcomes and compliance over the long term.

Cyclogram based Joint Symmetry Assessment after Utilization of a Foot Drop Stimulator during Post Stroke Hemiplegic Gait.

In the absence of standardized symmetry assessments, quantifying symmetry based on the kinematic evolution of lower extremity joints can elucidate gait irregularities. The objective was to develop a novel cyclogram based symmetry (CBS) method to quantify lower extremity joints' symmetry and assess the effect of 6-month utilization of foot drop stimulator (FDS) on CBS of the lower limbs during hemiplegic gait post stroke. Twenty-four participants (13 stroke and 11 healthy controls (HC)) performed 10 walking trials at a free cadence on level ground. Symmetry values were computed using geometric properties of bilateral cyclograms obtained from normalized sagittal ankle, knee and hip kinematics. CBS and traditional temporospatial symmetry values were compared between the two groups using independent sample t-test. Effect of FDS utilization on symmetry was assessed by paired sample t- test computed at baseline and 6-month follow up. The CBS method successfully showed that the HC group was significantly more symmetrical at the ankle (p=0.001), knee (p=0.001) and hip (p<0.005) compared with the stroke group. The stroke group showed significant increment in hip symmetry with FDS at baseline but did not show any significant CBS changes at follow up. Pearson correlations revealed that hip and knee CBS had a significant influence on overall walking speed. The CBS method presents a unique approach to calculate symmetry based on the kinematics of lower extremities during gait.

Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research.

To compare the randomized controlled trial evidence for therapeutic effects on walking of functional electrical stimulation and ankle foot orthoses for foot drop caused by central nervous system conditions. MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination, Scopus and clinicaltrials.gov. One reviewer screened titles/abstracts. Two independent reviewers then screened the full articles. One reviewer extracted data, another screened for accuracy. Risk of bias was assessed by 2 independent reviewers using the Cochrane Risk of Bias Tool. Eight papers were eligible; 7 involving participants with stroke and 1 involving participants with cerebral palsy. Two papes reporting different measures from the same trial were grouped, resulting in 7 synthesized randomized controlled trials (n= 464). Meta-analysis of walking speed at final assessment (p = 0.46), for stroke participants (p = 0.54) and after 4-6 weeks' use (p = 0.49) showed equal improvement for both devices. Functional electrical stimulation and ankle foot orthoses have an equally positive therapeutic effect on walking speed in non-progressive central nervous system diagnoses. The current randomized controlled trial evidence base does not show whether this improvement translates into the user's own environment or reveal the mechanisms that achieve that change. Future studies should focus on measuring activity, muscle activity and gait kinematics. They should also report specific device details, capture sustained therapeutic effects and involve a variety of central nervous system diagnoses.

Secondary Benefits of a Foot Drop Stimulator on Spasticity and Motor Control for Cerebral Palsy

To evaluate the secondary benefits of a foot drop stimulator (FDS) on spasticity and motor control at the knee joint for a child diagnosed with cerebral palsy (CP).

Alterations in Spectral Attributes of Surface Electromyograms after Utilization of a Foot Drop Stimulator during Post-Stroke Gait.

A foot drop stimulator (FDS) is a rehabilitation intervention that stimulates the common peroneal nerve to facilitate ankle dorsiflexion at the appropriate time during post-stroke hemiplegic gait. Time-frequency analysis (TFA) of non-stationary surface electromyograms (EMG) and spectral variables such as instantaneous mean frequency (IMNF) can provide valuable information on the long-term effects of FDS intervention in terms of changes in the motor unit (MU) recruitment during gait, secondary to improved dorsiflexion. The aim of this study was to apply a wavelet-based TFA approach to assess the changes in neuromuscular activation of the tibialis anterior (TA), soleus (SOL), and gastrocnemius (GA) muscles after utilization of an FDS during gait post-stroke. Surface EMG were collected bilaterally from the TA, SOL, and GA muscles from six participants (142.9 ± 103.3 months post-stroke) while walking without the FDS at baseline and 6 months post-FDS utilization. Continuous wavelet transform was performed to get the averaged time-frequency distribution of band pass filtered (20-300 Hz) EMGs during multiple walking trials. IMNFs were computed during normalized gait and were averaged during the stance and swing phases. Percent changes in the energies associated with each frequency band of 25 Hz between 25 and 300 Hz were computed and compared between visits. Averaged time-frequency representations of the affected TA, SOL, and GA EMG show altered spectral attributes post-FDS utilization during normalized gait. The mean IMNF values for the affected TA were significantly lower than the unaffected TA at baseline (p = 0.026) and follow-up (p = 0.038) during normalized stance. The mean IMNF values significantly increased (p = 0.017) for the affected GA at follow-up during normalized swing. The frequency band of 250-275 Hz significantly increased in the energies post-FDS utilization for all muscles. The application of wavelet-based TFA of EMG and outcome measures (IMNF, energy) extracted from the time-frequency distributions suggest alterations in MU recruitment strategies after the use of FDS in individuals with chronic stroke. This further establishes the efficacy of FDS as a rehabilitation intervention that may promote motor recovery in addition to treating the secondary complications of foot drop due to post-stroke hemiplegia.

Peroneal Stimulation for Foot Drop After Stroke

The purpose of this systematic review was to summarize the effect of daily use of single-channel foot drop stimulation among persons with stroke. Randomized controlled trials were searched using electronic databases through May 2014. Six randomized controlled trials were included, involving 820 participants. Gait speed was the most common outcome measured. Other common outcomes included Timed Up and Go, modified Emory Functional Ambulation Profile, Berg Balance Scale, Physiologic Cost Index, Six-Minute Walk Test, quality-of-life, and lower extremity Fugl-Meyer. In summary, foot drop stimulation and ankle foot orthoses seem effective and "equivalent" for increasing gait speed. Other outcomes that consistently improved in both groups were the Timed Up and Go and Six-Minute Walk Test. Foot drop stimulation was more effective compared with ankle foot orthosis for decreasing Physiologic Cost Index and seemed to be preferred by participants. Physical therapy may facilitate improvement in both foot drop stimulation and ankle foot orthosis groups.

The effects of foot drop stimulation on lower limb motor function after stroke

Objective To observe the effects of treatment with a foot drop stimulator on the lower limb motor function of patients with foot drop after stroke. Methods Thirty stroke survivors with lower limb motor function problems received stimulation of the peroneal nerve and the tibialis anterior muscle while walking. They also received conventional drugs and rehabilitation therapy. Lower limb motor function was assessed on the basis of walking velocity, stair climbing velocity, the gait asymmetry index (GAI), swing time variability (STV), a physiologic cost index (PCI) and ankle range of motion (ROM). Each was compared with the value when the same patient was not given foot drop stimulation. Results No significant difference was found in ankle eversion whether stimulation was given or not, but all the other measures were significantly improved after stimulation with 10 meters walking velocity at (17.15±3.03)m/s, 10 stairs climbing velocity at (5.90±0.55)m/s, GAI of (32.70±6.75), STV of (60.50±16.09) and PCI of [(0.34±2.32)t/m], as well as ankle dorsiflexion of (15.00±13.03)°, plantarflexion of (35.67±9.04)° and varus of (41.10±11.11)° respectively. Conclusions Foot drop stimulation can effectively improve ankle dorsiflexion and reduce the varus while walking for stroke patients. This gives better lower limb motor function for patients with foot drop. Key words: Foot drop stimulator; Foot drop; Functional electrical stimulation; Lower limb motor function problem

The impact of walking speed on the effects of functional electrical stimulation for foot drop in people with multiple sclerosis

Purpose: Functional electrical stimulation (FES) is effective in assisting people with multiple sclerosis (pwMS) with gait. Previous studies have investigated the effects of FES in pwMS with slow self-selected walking speeds (SSWS). This study reports on the effect of the Odstock Dropped Foot Stimulator (ODFS) on the speed and oxygen (O2) cost of gait in pwMS walking at a range of SSWS. Methods: Twenty pwMS (mean age 50.4 ± 7.3 years) currently using FES walked at their SSWS for 5 min with and without FES. O2 cost of gait was measured using a gas analysis system, and gait speed was calculated. Data were analysed for all participants, and comparisons were made between those with a SSWS < and >0.8 m/s (walking speed required for community ambulation). Results: Significant improvements in the speed and O2 cost of gait were seen using FES in the group with SSWS <0.8 m/s (n = 11, p = 0.005). When participants’ SSWS >0.8 m/s, no difference in gait speed was noted, and a significant increase in O2 cost of gait using FES (n = 9, p = 0.004) was noted. Conclusion: FES has a different effect on the speed and O2 cost of gait dependent on the SSWS of pwMS. This requires further investigation.Implications for RehabilitationFunctional electrical stimulation (FES) used for foot drop is effective in improving the speed and oxygen cost of walking in pwMS walking at SSWS <0.8 m/s.FES does not seem to have a beneficial effect on the speed and oxygen cost of walking in pwMS walking at SSWS >0.8 m/s.Further research is needed to understand the possible mechanisms involved so that FES for foot drop can be efficiently prescribed.

Functional Electrical Stimulation for Foot Drop in Multiple Sclerosis

Functional electrical stimulation is an effective treatment strategy for the management of foot drop in various neurologic conditions, as demonstrated in improvements in gait performance, mobility, physiologic cost, perceived walking ability, balance, fall frequency, and quality of life. In this article, we review the current literature on the effects of functional electrical stimulation for foot drop in persons with multiple sclerosis.

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 RehabilitationInterventions 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.

Response and Prediction of Improvement in Gait Speed From Functional Electrical Stimulation in Persons With Poststroke Drop Foot

To describe changes in and predictors of comfortable gait speed (GS-C) after using a foot-drop stimulator (FDS; Bioness L300; Bioness Inc, Valencia, CA) for 42 weeks in persons who had sustained a stroke. Secondary analysis of prospective assessments. Multicenter clinical trial. A total of 99 subjects who had sustained a stroke ≥ 3 months earlier and who had GS-C ≤ 0.8 m/s and drop foot with a mean age of 60.7 years and a poststroke time of 4.8 years. GS-C was assessed at baseline and at 30 weeks with and without use of an FDS (therapeutic effect) and at 6, 12, 30, 36, and 42 weeks with use of an FDS (total effect). After subjects participated in 8 physical therapy sessions, an FDS was used for ambulation over the course of 42 weeks. Changes in mean GS-C over time, FDS "responder" status defined as either ≥ 0.1 m/s gain in GS-C (the minimal clinically important difference [MCID]) or advancing by one Perry Ambulation Category (PAC), and the incidence and nature of adverse events (AEs). A total of 74 (75%) and 69 (70%) of 99 subjects completed assessments at 30 weeks and 42 weeks, respectively. Baseline GS-C was 0.42 m/s without use of an FDS and 0.49 m/s with use of an FDS. GS-C improved to 0.54 m/s at 30 weeks without use of an FDS (effect size = 0.75) and 0.54, 0.55, 0.58, 0.60, and 0.61 m/s at 6, 12, 30, 36, and 42 weeks with use of an FDS, respectively (effect size 0.84 at 42 weeks). Half of the subjects achieved a maximum GS-C by 12 weeks. Approximately 18% were PAC responders and 29% were MCID responders for 30-week therapeutic effect, and 55% were PAC responders and 67% were MCID responders for 42-week total effect. After logistic regression, the following factors emerged as the strongest predictors of FDS responders: younger age, faster baseline GS-C and Timed Up and Go, and balance. At 42 weeks, 60% reported a device-related AE; 92% were mild and 96% were anticipated. When an FDS was used, GS-C improved progressively over 42 weeks, with ≥ 50% of patients achieving a clinically meaningful 42-week total effect and 50% achieving a maximum GS-C by 12 weeks. Younger patients with greater mobility levels may benefit most from use of an FDS. AEs were frequent, mild, and reversible.