FES for foot-drop in hemiparesis

FES 治疗偏瘫足下垂

• 批准号: 6864159
• 负责人: John Chae
• 金额: $ 61.55万
• 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/6864159
• 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）：偏瘫是中风的一个主要后果，并大大有助于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和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器对慢性卒中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。受试者将接受12周的治疗，并接受总计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预后，并挑战目前为足下垂的卒中幸存者开具AFO处方的临床模式。