FES for foot-drop in hemiparesis

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DESCRIPTION (provided by applicant): Stroke is the leading cause of disability among adults in the United States. Hemiplegia is a striking manifestation 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 is an important gait abnormality that contributes to decreased mobility among stroke survivors. In the United States, the standard of care in addressing this deficit 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 learning after stroke. We define motor relearning 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 aim of this project is to assess the motor relearning effects of a transcutaneous peroneal nerve stimulator as reflected my measures of lower limb motor impairment, lower limb related physical disability and overall quality of life of acute stroke survivors. A single-blinded randomized clinical trial will be carried out to assess the effects of ambulation training with a peroneal nerve stimulator among acute stroke survivors compared to ambulation training with an AFO. Subjects will be treated for 8 weeks and followed for a total of 6 months. Results of this study will direct future investigations with respect to dose effect, mechanism and optimal prescriptive parameters