FUNCTIONAL ELECTRICAL STIMULATION FOR FOOTDROP IN HEMIPARESIS

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。偏瘫是中风的一个主要后果，并且显著地导致中风幸存者的身体残疾。足下垂，或在步态摆动阶段不能背屈麻痹踝关节，以及在站立阶段踝关节不稳定，是重要的步态异常，有助于减少中风幸存者的流动性。 在美国，解决这些缺陷的护理标准是定制模制踝足矫形器（AFO）。然而，不断发展的数据现在表明，主动重复运动训练是促进中风后运动再学习的主要基础。运动再学习是指中枢神经系统损伤后运动能力的重新获得。因此，虽然AFO可以帮助中风幸存者在短期内走动，但它也可能抑制长期的恢复。先前的研究已经证明，神经肌肉电刺激（NMES）介导的主动重复运动练习有助于中风幸存者的运动再学习。特别是，研究报告称，一些接受腓神经刺激器治疗足下垂的慢性卒中幸存者恢复充分，他们不再需要腓神经刺激器或AFO进行社区截肢。然而，目前还没有严格评估腓神经刺激器的运动再学习效果的盲法随机临床试验。因此，本项目的主要目的是评估经皮腓神经刺激，奥德斯托克垂足刺激器（ODFS），对慢性中风幸存者下肢运动再学习的影响。次要目的是评估经皮腓神经刺激对下肢活动性（残疾）和整体生活质量的影响。 将进行一项单盲随机临床试验，以评估在慢性卒中幸存者中使用腓神经刺激器进行截肢训练与使用AFO进行截肢训练的效果。共入组170例单侧轻偏瘫卒中受试者，这些受试者具有足够的耐力和运动能力，在不使用AFO的情况下，在最小辅助或更少辅助下连续行走至少30英尺。受试者将被随机分配至ODFS或AFO组。所有受试者将在研究特定理疗师的指导下接受相同的功能训练程序。他们将每周接受两次1小时的培训，为期12周，共24次。受试者将再接受总计6个月的随访。 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活动能力和生活质量方面的有效性。这种方法有望改善患者的预后，并挑战目前为足下垂的卒中幸存者开具AFO的临床模式

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. 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 stimulation, Odstock Dropped-Foot Stimulator (ODFS), 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. A total of 170 stroke subjects with unilateral hemiparesis who have sufficient endurance and motor ability to ambulate at least 30 feet continuously with minimal assistance or less without the use of an AFO will be enrolled. Subjects will be randomized to the ODFS or AFO group. All subjects will undergo the same functional training procedures with a study specific physical therapist. They will receive two, 1 hour training sessions per week, over 12 weeks, for a total of 24 sessions. Subjects will be followed for a total of another 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