Article
Change of temporospatial gait parameters after 4-channel functional electrical stimulation of the peroneal nerve in two patients with central drop foot
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Authors
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L. Buentjen
- Klinik für Stereotaktische Neurochirugie, Otto-von-Guericke-Universität Magdeburg
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J. Hausmann
- Klinik für Neurologie, Otto-von-Guericke-Universität Magdeburg
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U. Sobieray
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Standort Magdeburg
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I. Galazky
- Klinik für Neurologie, Otto-von-Guericke-Universität Magdeburg
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H. Feistner
- Klinik für Neurologie, Otto-von-Guericke-Universität Magdeburg
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J. Voges
- Klinik für Stereotaktische Neurochirugie, Otto-von-Guericke-Universität Magdeburg
| Published: | June 4, 2012 |
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Outline
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Objective: Evaluation of temporospatial gait parameters after implantation of a 4-channel functional electrical stimulation (FES) system of the peroneal nerve in two patients with central drop foot.
Methods: 2 patients (48-year-old male, 42-year-old female) received implantable FES of the peroneal nerve after suffering from central drop foot for several years. Both patients where able to ambulate with the aid of an ankle-foot-orthesis (AFO) at least 20 m and received botulinum toxin for treatment of spasticity. In both patients a 4 channel cuff electrode connected to a subcutaneous antenna (Actigait®) was implanted. Three weeks after implantation patients temporospatial gait analysis was carried out. A 10 m walking test was applied before and after surgery.
Results: In the 10 m walking test pt. 1 improved from 0.71 to 0.77 m/s while in pt.2 we recognised an improvement from 0,34 to 0,77 m/s. The limb index was improved by 21.5% in pt.1 and remained unchanged in pt.2. In pt. 1 single support changed from 0.70 s for the unaffected foot to 0.56 s and from 0.40 s to 0.38 s for the drop foot when FES was activated while in pt. 2 single support changed from 0.49 s to 0.56 s for the unaffected right foot and from 0.27 s to 0.34 s for the paretic left foot. Step length was not influenced in pt. 1 (unaffected 0.35 to 0.44 m, paretic 0.40 to 0.38 m) while it increased in pt. 2 (unaffected 0.16 m to 0.32 m, paretic 0.25 to 0.31 m). Stride length was increased on the paretic side in both pts (0.04 m in pt. 1 and 0.19 m in pt. 2) and even more in the unaffected side (0.1 m in pt. 1 and 0.24 in pt. 2).
Conclusions: FES of the peroneal nerve improved walking speed in these two pts. Walking speed more than doubled in one patient. FES considerably helped improving the limb index as a measure of gait symmetry by 21.5% in the other patient. Thus we are confronted with biomechanical benefits that exceed simple foot elevation. A normalised gait pattern will prevent unphysiological weight bearing and possibly secondary arthrosis in these comparatively young patients. While effects of external FES for central drop foot have been described in larger case series, only data from small cohorts are available for systems using implantable multichannel electrodes. Effects on gait parameters can vary considerably between individuals depending on preoperative screening criteria.
