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Long-Term Therapeutic and Orthotic Effects of a Foot Drop Stimulator on Walking Performance in Progressive and Nonprogressive Neurological Disorders

^* To whom correspondence should be addressed. E-mail: richard.stein{at}ualberta.ca.

	Abstract

Background. Stimulators applying functional electrical stimulation (FES) to the common peroneal nerve improve walking with a foot drop, which occurs in several disorders. Objective.To compare the orthotic and therapeutic effects of a foot drop stimulator on walking performance of subjects with chronic nonprogressive (eg, stroke) and progressive (eg, multiple sclerosis) disorders.Methods. Subjects with nonprogressive (41) and progressive (32) conditions used a foot drop stimulator for 3 to 12 months while walking in the community.Walking speed was measured with a 10-m test and a 4-minute figure-8 test; physiological cost index (PCI) and device usage were also measured.The subjects were tested with FES on and off (orthotic effect) before and after (therapeutic effect) stimulator use. Results. After 3 months of FES use, the nonprogressive and progressive groups had a similar, significant orthotic effect (5.0% and 5.7%, respectively, P < .003; percentage change in mean values) and therapeutic effect with FES off (17.8% and 9.1%, respectively, P < .005) on figure-8 walking speed. Overall, PCI showed a decreasing trend (P = .031).The therapeutic effect on figure-8 speed diverged later between both groups to 28.0% (P < .001) and 7.9% at 11 months.The combined therapeutic plus orthotic effect on figure-8 speed at 11 months was, respectively, 37.8% (P < .001) and 13.1% (P = .012); PCI decreased 18.2% (P = .038) and 6.5%, respectively. Conclusions. Subjects with progressive and nonprogressive disorders had an orthotic benefit from FES up to 11 months.The therapeutic effect increased for 11 months in nonprogressive disorders but only for 3 months in progressive disorders.The combined effect remained significant and clinically relevant.

First published on October 21, 2009
Neurorehabilitation and Neural Repair 2009, doi:10.1177/1545968309347681


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