Matt Orchard Mitch Dreska What is foot drop Gait abnormality in which the patient experiences difficulty in dorsiflexion of the ankle relating to the anterior muscles of the lower leg especially the anterior tibialis ID: 774947
Download Presentation The PPT/PDF document " Functional Electrical Stimulation (FES)..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Functional Electrical Stimulation (FES) of the Ankle
Matt Orchard
Mitch Dreska
Slide2What is foot drop?
Gait abnormality in which the patient experiences difficulty in dorsiflexion of the ankle, relating to the anterior muscles of the lower leg, especially the anterior tibialisIt can be caused by underlying neurological or muscular issues. The most common being neurological due to damage of the common peroneal nerve.Foot drop leads to gait deviations including toe dragging, hip hiking, vaulting, and decreased heel strike.This causes an increase in energy consumption and fall risks
Slide3What causes foot drop?
Muscular- traumaNerve damage from surgery common in hip and knee replacement/repairNeurologicalPeripheral nerve damage, cauda equina, spinal cord, and brain injury (stroke, TBI)Disorders including MS, ALS, Charcot-Marie-Tooth, Parkinson’s, and Diabetes
Slide4Foot drop treatment
Physical TherapySurgeryBraces or Splints- AFOElectrical Stimulation- FES
Slide5Ankle Foot Orthotic (AFO)
A brace made to fit the lower leg to help support the foot and ankle in proper position for gait and balance. Fights foot drop by holding the foot in a more neutral or dorsiflexed positionDifferent versions allow for more or less movement depending upon the level of function of the patient
Slide6What is an ankle FES?
Used primarily to treat foot dropSecondary to many things such as stroke and MSUses electrical stimulation of the peroneal (fibular) nerve to activate dorsiflexors during the toe off to initial contact period (swing phase)Has several proposed benefits compared to that of a traditional ankle-foot orthosis (AFO)
Slide7Comparison of benefits
AFOReduces foot dropImproves gait mechanicsPrevents loss of PROM
FES
Reduces foot drop
Improves gait mechanics
Prevents loss of PROM
Prevents loss of AROM
Employs active muscle contraction
Slows muscle atrophy
Promotes motor learning
Promotes neuroplastic changes
Slide8Wired Systems
Wireless Systems
Implanted Systems
Slide9Where to buy?
WalkAide
Uses tilt sensor to analyze movement of the leg
$4,500
XFT-2001 Foot Drop System
Uses a heel sensor to determine when to stimulate the nerve
$1,500
Bioness L300
Uses a heel sensor to determine when to stimulate the nerve
$6,000
ActiGait and STIMuSTEP
Implantable systems
Still must use heel sensor to determine when to stimulate the nerve
$20,000-25,000?
Slide10Peroneal stimulation for foot drop after stroke: A systematic review
Clinically significant improvements in gait speed for FDS and control groups
Over 6-30 weeks FDS and AFO are effective and roughly equal in improving gait speed for those with drop foot following stroke
Clinically significant improvements in TUG, 6MWT, mEFAP, and QoL for those using a single-channel surface electrode FDS system
User satisfaction was significantly higher in the FDS group than the AFO group
Not enough evidence to see which patients would most benefit from which device
Slide11Effect of Peroneal Electrical Stimulation Versus an Ankle-Foot Orthosis on Obstacle Avoidance Ability in People With Stroke-Related Foot Drop: Within-Subject Comparison
Subjects who regularly use AFO were fitted with FES and tested on obstacle avoidance ability
Measured by markers on their shoes and their kinematic data in relation to the objects
Success rates were higher with FES than with AFO, especially those with decreased leg muscle strength, although results were small
Level of function and strength is important to consider
Slide12References
Dunning K, O'dell MW, Kluding P, Mcbride K. Peroneal Stimulation for Foot Drop After Stroke: A Systematic Review. Am J Phys Med Rehabil. 2015;94(8):649-64.
Farley, Jeremy. Controlling drop foot: Beyond standard AFOs. Lower Extremity Review Magazine.
http://lermagazine.com/article/controlling-drop-foot-beyond-standard-afos
. Published October 2009. Accessed July 17, 2016.
Dapul G, Bethoux F. Functional Electrical Stimulation for Foot Drop in Multiple Sclerosis. US Neurology. 2015; 11(1): 10-8. doi:
http://doi.org/10.17925/USN.2015/11.01.10
.
Jauch, Michael. Latest implantable and external neurostimulation technology for drop foot correction and gait rehabilitation. Advances in Clinical Neuroscience and Rehabilitation.
http://www.acnr.co.uk/2013/09/latest-implantable-and-external-neurostimulation-technology-for-drop-foot-correction-and-gait-rehabilitation/
. Published Sept 24, 2013. Accessed July 17, 2016.
Yerworth R. Engineering Solutions to Foot Drop. University College London.
https://wiki.ucl.ac.uk/display/BECS/Engineering+solutions+to+foot+drop
. Published December 11, 2015. Accessed July 16, 2016.
Van Swigchem R, et al. Effect of Peroneal Electrical Stimulation Versus an Ankle-Foot Orthosis on Obstacle Avoidance Ability in People With Stroke-Related Foot Drop. Journal of the American Physical Therapy Association. 2012; 92(3): 398-406. doi: 10.2522/ptj.20100405.