Comparison of Gait with Ankle Foot Orthosis (AFO) and Functional Electrical Stimulation (FES) in patients following Stroke

BACKGROUND: Evidence supports peroneal nerve functional electrical stimulation (FES) as an effective alternative to ankle-foot-orthosis (AFO) for treatment of foot-drop post-stroke, but no conclusive evidence to suggest that FES is superior to AFO for correction of foot drop (Hemiplegic foot). AIM OF THE STUDY: To determine whether FES has any added benefits as compared to ankle foot orthosis (AFO) in post stroke patients, by measuring gait parameters. OBJECTIVES: 1. To compare spatiotemporal parameters between AFO and FES. 2. To evaluate ankle-foot kinematics in patient with stroke. METHOD: The study was a non-randomized cross over trial. Twenty patients with history of cerebrovascular accidents, of at least 3 months duration, were enrolled. Patients were divided in two groups (group A and B) consisting of 10 patients in each group. Patients of group A were trained with Ankle-Foot-Orthosis (AFO) followed by Functional electrical stimulation (FES). Patients of group B were trained first with Functional electrical stimulation (FES) followed by Ankle-Foot-Orthosis (AFO). Primary outcomes - 10 meter walk test, 6 minute walk test, physiological cost index. Secondary outcomes - step length, stride length, stance-swing ratio, single limb support, timed up and go test, Ankle kinematics, feedback for satisfaction level. RESULTS: Peroneal nerve functional electrical stimulation (FES) improved the walking speed (p value-0.0001) and endurance (Six minute walk test, p value-0.004) in both the groups when compared to ankle-foot-orthosis (AFO). Physiological cost index (PCI) was reduced with both AFO and FES as compared to baseline, however there was no statistical difference between AFO and FES. (p value- 0.46). CONCLUSION: FES has positive orthotic effect on walking speed and endurance. FES was found to be effective to minimize ankle plantar-flexion during swing phase thus helps to restore normal ankle kinematics. Satisfaction level was higher with FES users

Effect of overground gait training with ‘Mobility Assisted Robotic System-MARS’ on gait parameters in patients with stroke: a pre-post study

Abstract Objective To observe the effect of overground gait training with ‘Mobility Assisted Robotic System-MARS’ on gait parameters in patients with stroke. Patients & methods This prospective pre-post study was conducted in a tertiary teaching research hospital with 29 adult stroke patients, with age up to 65 years. Patients fulfilling the inclusion criteria were divided in 2 groups based on the duration of stroke (≤ 6 months-sub-acute & > 6 months-chronic stroke) and provided overground gait training with MARS robot for 12 sessions (1 h/session) over a period of 2–3 weeks. Primary outcome measures were; 10-Meter walk test-10MWT, 6-min’ walk test-6MWT and Timed up & Go-TUG tests. Secondary outcome measures were Functional Ambulation Category-FAC, Modified Rankin Scale-MRS and Scandinavian Stroke Scale-SSS. Results No adverse events were reported. Twenty-five patients who were able to perform 10-MWT at the beginning of study were included in the final analysis with 12 in sub-acute and 13 in chronic stroke group. All primary and secondary outcome measures showed significant improvement in gait parameters at the end of the training (p < 0.05) barring 10-Meter walk test in sub-acute stroke group (p = 0.255). Chronic stroke group showed significant minimum clinically important difference-MCID difference in endurance (6MWT) at the end of the training and both groups showed better ‘minimal detectable change-MDC’ in balance (TUG) at the end of the training. Conclusions Patients in both the groups showed significant improvement in walking speed, endurance, balance and independence at the end of the training with overground gait training with MARS Robot. Clinical trial registry National Clinical Trial Registry of India (CTRI/2021/08/035695,16/08/2021)