FES for foot-drop in hemiparesis

FES 治疗偏瘫足下垂

• 批准号: 6999355
• 负责人: John Chae
• 金额: $ 66.33万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-01-01 至 2009-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6999355
• 关键词: ankle; bioengineering /biomedical engineering; biomechanics; clinical research; clinical trials; electromyography; electrostimulus; foot; functional ability; gait; hemiplegia; human subject; human therapy evaluation; limb movement; medical implant science; medical rehabilitation related tag; neuromuscular stimulator; orthotics; patient oriented research; physical therapy; quality of life; rehabilitation; stroke therapy

DESCRIPTION (provided by applicant): Hemiplegia is a major consequence of stroke and contributes significantly to the physical disability of stroke survivors. Foot-drop, or inability to dorsiflex the paretic ankle during the swing phase of gait and ankle instability during stance phase are important gait abnormalities that contribute to reduced mobility among stroke survivors. In the United States, the standard of care in addressing these deficits is the custom molded ankle-foot-orthosis (AFO). However, evolving data now demonstrate that active repetitive movement training is the principal substrate for facilitating motor relearning after stroke. Motor relearning is defined as the reacquisition of motor ability after central nervous system injury. Thus, while an AFO may assist stroke survivors to ambulate in the short-term, it is possible that it also inhibits recovery in the long-term. Previous studies have demonstrated that active repetitive movement exercises mediated by neuromuscular electrical stimulation (NMES) facilitate motor relearning among stroke survivors. In particular, studies have reported that some chronic stroke survivors treated with a peroneal nerve stimulator for foot-drop experience sufficient recovery that they no longer need the peroneal nerve stimulator or an AFO for community ambulation. However, there are no blinded randomized clinical trials that rigorously evaluate the motor relearning effects of ambulation training with peroneal nerve stimulators. Thus, the primary aim of this project is to assess the effects of transcutaneous peroneal nerve stimulator on lower limb motor relearning among chronic stroke survivors. The secondary aim is to assess the effects of transcutaneous peroneal nerve stimulation on lower limb mobility (disability) and overall quality of life. A single-blinded randomized clinical trial will be carried out to assess the effects of ambulation training with a peroneal nerve stimulator among chronic stroke survivors compared to ambulation training with an AFO. Subjects will be treated for 12 weeks and followed for a total of 6 months. This project will determine the effectiveness of peroneal nerve stimulation in facilitating motor relearning and improving the mobility and quality of life of stroke survivors. This proposed approach is expected to improve patient outcome and challenge the present clinical paradigm of prescribing AFOs for stroke survivors with foot-drop.

描述(由申请人提供)：偏瘫是中风的主要后果，对中风幸存者的身体残疾有很大贡献。脚部下垂，或在步态摇摆阶段不能使偏瘫的踝关节背伸，以及在站立阶段脚踝不稳定是导致中风幸存者活动能力降低的重要步态异常。在美国，解决这些缺陷的护理标准是定制的脚踝-足部矫形器(AFO)。然而，不断发展的数据现在表明，积极的重复运动训练是促进中风后运动再学习的主要底物。运动再学习被定义为中枢神经系统损伤后运动能力的重新获得。因此，虽然AFO可以在短期内帮助中风幸存者行走，但从长远来看，它也可能阻碍康复。先前的研究表明，由神经肌肉电刺激(NMES)介导的主动重复运动练习可以促进中风幸存者的运动再学习。特别是，研究报告说，一些慢性中风幸存者接受了腓神经刺激器的足下垂治疗，他们经历了足够的康复，以至于他们不再需要腓神经刺激器或AFO进行社区行走。然而，目前还没有严格评价腓神经刺激器步行训练的运动再学习效果的随机盲法临床试验。因此，本项目的主要目的是评估经皮腓神经刺激器对慢性卒中幸存者的下肢运动再学习的影响。第二个目的是评估经皮腓神经刺激对下肢活动(残疾)和总体生活质量的影响。将进行一项单盲随机临床试验，以评估在慢性中风幸存者中使用腓神经刺激器进行步行训练的效果，并与使用AFO进行步行训练进行比较。受试者将接受为期12周的治疗，并总共随访6个月。该项目将确定腓神经刺激在促进运动再学习和改善中风幸存者的机动性和生活质量方面的有效性。这一拟议的方法有望改善患者的预后，并挑战目前为足下垂的中风幸存者开AFO的临床范例。