Long-term effects of an implantable peroneal nerve stimulator on kinematics and gait capacities in the drop-foot treatment of stroke survivors.
Dr Florent MOISSENETa, Dr Frédéric CHANTRAINEa, Mrs Céline SCHREIBERa, Dr Elisabeth KOLANOWSKIa
a Laboratoire d’Analyse du Mouvement et de la Posture, CNRFR – Rehazenter
Objective: The aim of this study was to show the long-term effects of an implantable peroneal nerve stimulator on articular kinematics and gait capacities in the drop-foot treatment of stroke survivors.
Material and method: 12 patients (4 women, 8 men, 45.45+/-12.88 yrs, 171.92+/-8.07 cm, 81.14+/-20.30 kg) were selected and implanted with a Actigait stimulator (Neurodan, Denmark, OttoBock Group) in the CHL hospital of Luxembourg. A 12-month follow-up was proposed in CNRFR - Rehazenter to these patients composed of 4 assessments (1 month before implantation and 3, 6 and 12 months after implantation). At each assessment, a 10-m walk test, a 6-min walk test, a four square step test and a clinical gait analysis were performed. A t-test was used to evaluate the improvement of each parameter with confidence level of 95%.
Results: Most of the followed parameters, such as gait symmetry, foot/ankle kinematics and balance, are significantly improved after implantation. However, the 10-m walk test does not show any significant gait velocity improvement. Similarly, no significant effect appears on the compensations developed during gait. Even if the stimulator mainly has an orthotic effect, a therapeutic effect is shown for this patient group on the foot prepositioning in dorsiflexion at foot strike.
Discussion: Unlike recent results reported in the literature , gait velocity does not seem to be impacted by the use of the stimulator during gait. However, the global quality of gait is improved, with a better gait symmetry, a reduced risk of falling and a better balance. The use of an implantable peroneal nerve stimulator in the drop-foot treatment of stroke survivors is encouraging. Since it does not produce pain and is easy to use, such a device is becoming more and more an essential tool in the treatment of gait disorders.
 A.I.R. Kottink et al., J Rehabil Med 2012; 44:51-57
Keywords : Functional electrical stimulation, drop foot, gait, stroke.