FUNCTIONAL ELECTRICAL STIMULATION FOR FOOTDROP IN HEMIPARESIS

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。偏瘫是中风的主要后果，对中风幸存者的身体残疾起着重要作用。在步态的摇摆阶段，足下垂或无力背屈麻痹的踝关节，以及站立阶段的踝关节不稳定，是导致中风幸存者活动能力降低的重要步态异常。在美国，治疗这些缺陷的标准是定制模塑踝足矫形器（AFO）。然而，不断发展的数据表明，积极的重复性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再习得。因此，虽然AFO可以在短期内帮助中风幸存者行走，但从长期来看，它也可能抑制康复。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有助于中风幸存者的运动再学习。特别是，有研究报道，一些慢性中风幸存者使用腓神经刺激器进行足下垂治疗后，经历了充分的恢复，他们不再需要腓神经刺激器或AFO进行社区活动。然而，尚无随机盲法临床试验严格评估腓神经刺激器下行走训练对运动再学习的影响。因此，本项目的主要目的是评估经皮腓神经刺激，Odstock落脚刺激器（ODFS）对慢性中风幸存者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能力（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，以评估腓神经刺激器行走训练与AFO行走训练对慢性卒中幸存者的影响。共有170例卒中患者伴有单侧偏瘫，他们有足够的耐力和运动能力，在最少的辅助或更少的辅助下不使用AFO连续行走至少30英尺。受试者将被随机分为ODFS组或AFO组。所有受试者将在研究特定的物理治疗师的指导下接受相同的功能训练程序。他们每周将接受两次1小时的培训，持续12周，总共24次。受试者将被随访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活动能力和生活质量方面的有效性。该建议的方法有望改善患者的预后，并挑战目前为中风幸存者开具afo处方的临床范例

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