Orthotic Effect of Functional Electrical Stimulation on the Improvement of Walking in Stroke Patients with Foot Drop: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

XU Xudong ¹ ,  JIN Yi ² , ZHAO Yuan ¹ , WU Wenwen ¹ , WANG Xiudong ²

1. Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China;2. Huan Hu Hospital, Tianjin 300060, China;

Corresponding author：

JIN Yi, Email: jinyi6196@sohu.com

Keywords：

Functional electrical stimulation; Stroke; Foot drop; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130130

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically evaluate the orthotic effect of functional electrical stimulation (FES) on the improvement of walking in stroke patients with foot drop.
Methods 　The randomized controlled trials (RCTs) that investigated the orthotic effect of FES on walking in stroke patients with foot drop were electronically searched in the databases such as PubMed, Web of Science, The Cochrane Library (Issue 1, 2013), EMbase, CBM, CNKI, VIP and WanFang Data from January 2000 to January 2013, and the relevant references of included papers were also manually searched. Two reviewers independently screened the trials according to the inclusion and exclusion criteria, extracted the data, and assessed the methodology quality. The meta-analyses were performed using RevMan 5.1 software.
Results 　A total of 8 RCTs involving 255 patients were included. The results of meta-analyses on 4 RCTs showed that, compared with the conventional rehabilitation intervention, the functional electrical stimulation could significantly improve the walking speed, with significant difference (MD=0.09, 95%CI 0.00 to 0.18, P=0.04). The other indicators were only descriptively analyzed due to the incomplete data.
Conclusions 　Functional electrical stimulation is effective in improving walking speed, but it is uncertain of other therapeutic indicators. So it should be further proved by conducting more high quality, large sample and multi-center RCTs.

Citation： XU Xudong,JIN Yi,ZHAO Yuan,WU Wenwen,WANG Xiudong. Orthotic Effect of Functional Electrical Stimulation on the Improvement of Walking in Stroke Patients with Foot Drop: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(6): 735-740. doi: 10.7507/1672-2531.20130130 Copy

1.	Loyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 2009, 11(3): 480-486.
2.	Warlow C, Sudlow C, Dennis M. Stroke. Lancet, 2003, 362(9391): 1211-1224.
3.	Laufer Y, Hausdorff JM, Ring H. Effects of a foot drop neuroprosthesis on functional abilities,social participation and gait velocity. American Journal of Physical Medicine and Rehabilitation, 2009, 88(1): 14-20.
4.	Rushton D. Functional electrical stimulation. Physiological Measure, 1997, 18(4): 241-275.
5.	Asplund K, Tuomilehto J, Stegmayr B, et al. Diagnosticcriteriaand quality control of the registration of stroke events in the MONICA project. Acta Med Scand Suppl, 1988, 728: 26-39.
6.	Higgins PT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
7.	Salisbury L, Shiels J, Todd I, et al. A feasibility study to investigate the clinical application of functional electrical stimulation (FES), for dropped foot, during the sub-acute phase of stroke-A randomized controlled trial. Physiother Theory Pract, 2013, 29(1): 31-40.
8.	Kottink AI, Tenniglo MJ, de Vries WH, et al. Effects of an implantable two-channel peroneal nerve stimulator versus conventional walking device on spatiotemporal parameters and kinematics of hemiparetic gait. J Rehabil Med, 2012, 44(1): 51-57.
9.	Solopova IA, Tihonova DY, Grishin AA, et al. Assisted leg displacements and progressive loading by a tilt table combined with FES promote gait recovery in acute stroke. NeuroRehabilitation, 2011, 29(1): 67-77.
10.	Sabut SK, Sikdar C, Kumar R, et al. Functional electrical stimulation of dorsiflexor muscle: effects on dorsiflexor strength, plantarflexor spasticity, and motor recovery in stroke patients. NeuroRehabilitation, 2011, 29(4): 393-400.
11.	Daly JJ, Zimbelman J, Roenigk KL, et al. Recovery of coordinated gait: randomized controlled stroke trial of functional electrical stimulation (FES) versus no FES, with weight-supported treadmill and over-ground training. Neurorehabil and Neural Repair, 2011, 25(7): 588-596.
12.	Sabut SK, Sikdar C, Mondal R, et al. Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke. Disabil Rehabil, 2010, 32(19): 1594-1603.
13.	Kottink AI, Hermens HJ, Nene AV. Therapeutic effect of an implantable peroneal nerve stimulator in subjects with chronic stroke and footdrop: A randomized controlled trial. Phys Ther, 2008, 88(4): 437-448.
14.	Ng MF, Tong RK, Li LS. A pilot study of randomized clinical controlled trial of gait training in subacute stroke patients with partial body-weight support electromechanical gait trainer and functional electrical stimulation: six-month follow-up. Stroke, 2008, 39(1): 154-160.
15.	Kottink AI, Hermens HJ, Nene AV, et al. A randomized controlled trial of an implantable 2-channel peroneal nerve stimulator on walking speed and activity in poststroke hemiplegia. Arch Phys Med Rehabil, 2007, 88(8): 971-978.
16.	Fredrickson E, Ruff RL, Dally JJ. Physiological cost index as a proxy measure for the oxygen cost of gait in stroke patients. Neurorehabil Neural Repair, 2007, 21(5): 429-434.
17.	Grant M, Ryan C, Tigbe W, et al. Validation of the activPAL activity monitor in measuring free-living physical activity. Biomechanics of the lower limb in health, disease and rehabilitation. Presented to: Salford, 3rd Intetnational Conference; 2005, Sept5-7; Slaford(UK).p196-197.
18.	Peckham PH, Mortimer JT, Marsolais EB. Alteration in the force and fatigability of skelteal muscle in quadriplegic humans following exercise induced by chronic electrical stimulation. Clin Orthop Relat Res, 1976, 46(114): 326-333.
19.	Kimberley TJ, Lewis SM, Auerbach EJ, et al. Electrical stimulation driving functional inprovements and cortical changes in subjects with stroke. Exp Brain Res, 2004, 154(4): 450-460.
20.	Hara Y. Neurorehabilitation with new functional electrical stimulation for hemiparetic upper extremity in stroke patients. J Nippon Med Sch, 2008, 75(1): 4-14.
21.	Kottink AI, Oostendorp LJ, Buurke JH, et al. The orthotic effect of functional electrical stimulation on the improvement of walking in stroke patients with a dropped foot: A systematic review. Artif Organs, 2004, 28(6): 577-86.
22.	Matsunaga T, Shimada Y, Sato M, et al. The akita heel sensor system (AHSS) for the correction of dropped foot gait in hemiplegic patients. Proceedings of the 5th Annual Conference of IFESS, Aalborg, Denmark, 2000: 394-395.
23.	Moher D. The consort guidelines: Improving the quality of research consolidated standards of reporting trials interview by bonnie horrigan. Altern Ther Health Med, 2002, 8(3): 103-108.

1. Loyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 2009, 11(3): 480-486.
2. Warlow C, Sudlow C, Dennis M. Stroke. Lancet, 2003, 362(9391): 1211-1224.
3. Laufer Y, Hausdorff JM, Ring H. Effects of a foot drop neuroprosthesis on functional abilities,social participation and gait velocity. American Journal of Physical Medicine and Rehabilitation, 2009, 88(1): 14-20.
4. Rushton D. Functional electrical stimulation. Physiological Measure, 1997, 18(4): 241-275.
5. Asplund K, Tuomilehto J, Stegmayr B, et al. Diagnosticcriteriaand quality control of the registration of stroke events in the MONICA project. Acta Med Scand Suppl, 1988, 728: 26-39.
6. Higgins PT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
7. Salisbury L, Shiels J, Todd I, et al. A feasibility study to investigate the clinical application of functional electrical stimulation (FES), for dropped foot, during the sub-acute phase of stroke-A randomized controlled trial. Physiother Theory Pract, 2013, 29(1): 31-40.
8. Kottink AI, Tenniglo MJ, de Vries WH, et al. Effects of an implantable two-channel peroneal nerve stimulator versus conventional walking device on spatiotemporal parameters and kinematics of hemiparetic gait. J Rehabil Med, 2012, 44(1): 51-57.
9. Solopova IA, Tihonova DY, Grishin AA, et al. Assisted leg displacements and progressive loading by a tilt table combined with FES promote gait recovery in acute stroke. NeuroRehabilitation, 2011, 29(1): 67-77.
10. Sabut SK, Sikdar C, Kumar R, et al. Functional electrical stimulation of dorsiflexor muscle: effects on dorsiflexor strength, plantarflexor spasticity, and motor recovery in stroke patients. NeuroRehabilitation, 2011, 29(4): 393-400.
11. Daly JJ, Zimbelman J, Roenigk KL, et al. Recovery of coordinated gait: randomized controlled stroke trial of functional electrical stimulation (FES) versus no FES, with weight-supported treadmill and over-ground training. Neurorehabil and Neural Repair, 2011, 25(7): 588-596.
12. Sabut SK, Sikdar C, Mondal R, et al. Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke. Disabil Rehabil, 2010, 32(19): 1594-1603.
13. Kottink AI, Hermens HJ, Nene AV. Therapeutic effect of an implantable peroneal nerve stimulator in subjects with chronic stroke and footdrop: A randomized controlled trial. Phys Ther, 2008, 88(4): 437-448.
14. Ng MF, Tong RK, Li LS. A pilot study of randomized clinical controlled trial of gait training in subacute stroke patients with partial body-weight support electromechanical gait trainer and functional electrical stimulation: six-month follow-up. Stroke, 2008, 39(1): 154-160.
15. Kottink AI, Hermens HJ, Nene AV, et al. A randomized controlled trial of an implantable 2-channel peroneal nerve stimulator on walking speed and activity in poststroke hemiplegia. Arch Phys Med Rehabil, 2007, 88(8): 971-978.
16. Fredrickson E, Ruff RL, Dally JJ. Physiological cost index as a proxy measure for the oxygen cost of gait in stroke patients. Neurorehabil Neural Repair, 2007, 21(5): 429-434.
17. Grant M, Ryan C, Tigbe W, et al. Validation of the activPAL activity monitor in measuring free-living physical activity. Biomechanics of the lower limb in health, disease and rehabilitation. Presented to: Salford, 3rd Intetnational Conference; 2005, Sept5-7; Slaford(UK).p196-197.
18. Peckham PH, Mortimer JT, Marsolais EB. Alteration in the force and fatigability of skelteal muscle in quadriplegic humans following exercise induced by chronic electrical stimulation. Clin Orthop Relat Res, 1976, 46(114): 326-333.
19. Kimberley TJ, Lewis SM, Auerbach EJ, et al. Electrical stimulation driving functional inprovements and cortical changes in subjects with stroke. Exp Brain Res, 2004, 154(4): 450-460.
20. Hara Y. Neurorehabilitation with new functional electrical stimulation for hemiparetic upper extremity in stroke patients. J Nippon Med Sch, 2008, 75(1): 4-14.
21. Kottink AI, Oostendorp LJ, Buurke JH, et al. The orthotic effect of functional electrical stimulation on the improvement of walking in stroke patients with a dropped foot: A systematic review. Artif Organs, 2004, 28(6): 577-86.
22. Matsunaga T, Shimada Y, Sato M, et al. The akita heel sensor system (AHSS) for the correction of dropped foot gait in hemiplegic patients. Proceedings of the 5th Annual Conference of IFESS, Aalborg, Denmark, 2000: 394-395.
23. Moher D. The consort guidelines: Improving the quality of research consolidated standards of reporting trials interview by bonnie horrigan. Altern Ther Health Med, 2002, 8(3): 103-108.

Chinese Journal of Evidence-Based Medicine

Orthotic Effect of Functional Electrical Stimulation on the Improvement of Walking in Stroke Patients with Foot Drop: A Systematic Review

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