Long-Term Therapeutic and Orthotic Effects of a Foot Drop Stimulator on Walking Performance in Progressive and Nonprogressive Neurological Disorders
Long-Term Therapeutic and Orthotic Effects of a Foot Drop Stimulator on Walking Performance in Progressive and Nonprogressive Neurological Disorders
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DOI：
10.1177/1545968309347681
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发表时间：
2010-02-01
影响因子：
4.2
通讯作者：
Kuether, Gerald
中科院分区：
文献类型：
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作者：
Stein, Richard B.;Everaert, Dirk G.;Kuether, Gerald
背景对腓总神经施加功能性电刺激（FES）的刺激器改善了在几种疾病中发生的足下垂行走。Objective.比较足下垂刺激器对慢性非进展性（如卒中）和进展性（如多发性硬化）疾病受试者步行能力的矫正和治疗效果。方法.患有非进展性（41例）和进展性（32例）疾病的受试者在社区行走时使用足下垂刺激器3至12个月。采用10米测试和4分钟数字8测试测量步行速度;还测量了生理成本指数（PCI）和设备使用情况。受试者在使用刺激器之前和之后（治疗效果）接受FES开和关（矫正效果）测试。结果使用FES 3个月后，非渐进组和渐进组在8字形步行速度方面具有相似的显著矫正效果（分别为5.0%和5.7%，P <0.003;平均值的百分比变化）和FES关闭时的治疗效果（分别为17.8%和9.1%，P <0.005）。总体而言，PCI呈下降趋势（P = 0.031）。两组之间8字形速度的治疗效果在11个月时分别为28.0%（P <0.001）和7.9%。在11个月时，治疗加矫正对8字形速度的影响分别为37.8%（P < .001）和13.1%（P = .012）; PCI分别降低18.2%（P = .038）和6.5%。结论.患有进行性和非进行性疾病的受试者从FES中获得了长达11个月的矫形益处。非进展性疾病的治疗效果增加了11个月，但进展性疾病仅增加了3个月。联合效应仍然显著且具有临床相关性。
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.