A survey on foot drop and functional electrical stimulation
A survey on foot drop and functional electrical stimulation
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DOI：
10.1007/s41315-019-00088-1
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发表时间：
2019-03-01
影响因子：
1.7
通讯作者：
Chakrabarty, Samit
中科院分区：
文献类型：
--
作者：
York, Gareth;Chakrabarty, Samit
由于神经损伤或肌肉无力导致的小腿肌肉无力可能导致足下垂，步态的变化表现为行走时无法抬起脚趾。足下垂导致生活质量下降，无辅助运动变得困难或不可能。福尔斯跌倒的风险增加尤其成问题，因为脚下垂经常影响老年人或体弱者，对他们来说，跌倒已经构成了很大的危险。目前的治疗方案包括固定式踝足矫形器（AFO），旨在为足部提供刚性支撑（如果损伤轻微）或手术干预和功能性电刺激（FES）设备（如果虚弱更严重）。即使是严重的足下垂病例，FES干预也可以有效地提供非侵入性治疗。目前的模型的局限性涉及非自然的重建步态在受影响的腿和它的不适合患者广泛的周围神经损伤。虽然有尝试，以提高感官信息的整合和模仿自然的刺激模式，恢复自然的反馈回路的重点仍然是错误的。没有这样的闭环反馈，自然步态模式的恢复不太可能发生。在这里，我们建议，从多个肌肉的电机输出的集成，从高阶控制器的输入信息，记录完整的腿与闭环系统，以提高FES的有效性。
The weakness of the lower leg muscles due to nerve damage or muscle weakness can result in foot drop, a change in gait that manifests as an inability to lift the toes of the foot when walking. Foot drop results in a decreased quality of life, with unassisted movement becoming difficult or impossible. The increased risk of falls is particularly problematic as foot drop often affects the elderly or infirm for whom falling already presents a great danger. Current treatment options include fixed ankle-foot orthosis (AFO) aiming to provide rigid support to the foot if the impairment is mild or surgical intervention and functional electrical stimulation (FES) devices if the weakness is more severe. FES intervention is effective for providing a non-invasive treatment in even severe cases of foot drop. Limitations of current models relate to the non-naturalistic recreation of gait in the affected leg and its unsuitability for patients with extensive peripheral nerve damage. Although there are attempts to enhance integration of sensory information and mimic natural stimulation patterns, the focus on restoring a natural feedback loop is still amiss. Without such a closed loop feedback, restoration of a natural gait pattern is unlikely to occur. We here recommend, integration of motor output from multiple muscles, information about the inputs from higher-order controllers, recorded from the intact leg with a closed loop system to improve the effectiveness of FES.