Posts Tagged foot drop

[VIDEO] Using the SaeboStep and the SaeboStim Go – YouTube

Saebo, Inc. is a medical device company primarily engaged in the discovery, development and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 100,000 clients around the globe achieve a new level of independence.

In 2001, two occupational therapists had one simple, but powerful goal – to provide neurological clients access to transformative and life changing products.

At the time, treatment options for improving arm and hand function were limited. The technology that did exist was expensive and inaccessible for home use. With inadequate therapy options often leading to unfavorable outcomes, health professionals routinely told their clients that they have “reached a plateau” or “no further gains can be made”. The founders believed that it was not the clients who had plateaued, but rather their treatment options had plateaued.

Saebo’s commitment – “No Plateau in Sight” – was inspired by this mentality; and the accessible, revolutionary solutions began.

Saebo’s revolutionary product offering was based on the latest advances in rehabilitation research. From the SaeboFlex which allows clients to incorporate their hand functionally in therapy or at home, to the SaeboMAS, an unweighting device used to assist the arm during daily living tasks and exercise training, “innovation” and “affordability” can now be used in the same sentence.

Over the last ten years, Saebo has grown into a leading global provider of rehabilitative products created through the unrelenting leadership and the strong network of clinicians around the world. As we celebrate our history and helping more than 100,000 clients regain function, we are growing this commitment to affordability and accessibility even further by making our newest, most innovative products more accessible than ever.

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[WEB PAGE] A Guide to Individualized Management of Foot Drop

Most patients benefit from nonsurgical care of foot drop. Your task is to identify the optimal bracing options and work closely with the patient to understand their personal treatment expectations and goals.

By Jason Wright, DPM, PGY-2, And Marshall G. Solomon, DPM, FACPM, FACAS

Foot drop refers to loss of strength of the pedal dorsiflexors, leading to a decrease in ankle dorsiflexion during gait. Patients with foot drop are at an increased risk of falls because of their toes “catching” the ground while ambulating. Foot drop can be a challenging condition to manage: there are numerous causes, and each patient can have different needs and expectations about treatment. Understanding the possible causes of foot drop, recent advances in treatment, and specific patient goals allow healthcare professionals to provide the best possible care.

Several Causes

The etiology of foot drop includes disorders of the peripheral nervous system and central nervous system.

Peripheral trauma and disorders. Injury to the common peroneal nerve (CPN) is a common cause. Ankle dorsiflexors, including the anterior tibialis, are innervated by the deep peroneal nerve, which branches from the CPN. As this nerve passes into the leg, it wraps around the fibular head. At that location, the nerve is vulnerable to injury because soft-tissue coverage is sparse; patients who sustain a knee injury, high fibular fracture, laceration, or other trauma can experience injury to the CPN.

Prolonged increased pressure on the lateral leg can also lead to nerve damage. Examples include prolonged lateral sleeping position, driving while resting the left leg against the car door, and prolonged working while kneeling.1,2

Nerve injury can also be iatrogenic: The CPN can be injured during arthroscopic knee surgery, and the sciatic nerve can be injured during hip or knee arthroplasty. Also, poor patient positioning on the operating table can lead to increased pressure on the CPN. Last, a below-knee cast that extends too far proximally can lead to nerve damage.1,2

Other causes of foot drop do not involve direct nerve injury. Soft-tissue masses, including lipomas and ganglion cysts, can put pressure on the nerve, leading to a mass effect that contributes to foot drop. In such cases, surgical removal of the mass is usually indicated.2

Proximal disorders. It is also important to consider proximal causes when evaluating foot drop. Radiculopathy at L4 and L5 is a common cause.1,2 Last, many patients experience loss of muscle strength following a cerebrovascular accident or other cerebral injury.1,2,3

Take These Steps to the Diagnosis

Diagnosis of foot drop starts by obtaining a thorough history and physical examination. Patients often complain of falls caused by the toes dragging on the ground while walking. Physical examination reveals loss of muscle strength of the pedal dorsiflexors and, sometimes, loss of sensation to the dorsal foot. Shoewear examination is also highly important. Wear patterns on the outsoles can provide clues to biomechanical imbalances resulting from foot drop or worsening its effect. Electromyography and nerve-conduction velocity studies can be used to confirm the diagnosis. These studies can also determine the location and severity of the nerve lesion.1

Treatment With Ankle Foot Orthoses

The mainstay of nonsurgical treatment of foot drop is an ankle–foot orthosis (AFO), which functions by decreasing ankle–joint plantarflexion during gait. These orthoses are constructed of various designs and materials; it is important to consider patient factors when prescribing and fitting an AFO. Lifestyle, comorbidities, and goals of treatment determine which AFO is best suited to the individual patient.

Double-upright AFO. An earlier AFO design was the double-upright AFO, comprising a pair of metal bars rigidly attached to the shoe and a leather band wrapped around the calf. Bulkiness and inability to transfer between different shoes are major drawbacks of this AFO. A key benefit, however, is that the double-upright AFO can accommodate changes in the size of the leg. This is especially helpful in patients with lymphedema and venous insufficiency.4

Solid AFOs are typically made from a plastic polymer, such as polypropylene. Their design includes a foot plate and a posterior shell, with a strap at the level of the calf. Patients are able to move these AFOs between shoes. Because solid AFOs tend to be less bulky than metal AFOs, they increase patient satisfaction and adherence. Solid AFOs can be modified to meet the needs of an individual patient and can be either purchased prefabricated or custom-molded to the patient’s foot, using plaster casting.4,5

The mechanical properties of solid AFOs can be changed by adjusting the width of the posterior shell along trim lines. Lehmann et al6 showed that solid plastic AFOs with a wider and stronger posterior shell have increased stiffness leading to more plantarflexion resistance, thus reducing the possibility of toe drag during swing phase. Stiffer AFOs are also recommended in patients with ankle instability.7 Narrower posterior shells are more flexible and allow for some plantarflexion during gait. Many experts have proposed that some AFO flexibility creates a spring-like function that allows for a more natural gait.4,8,9 It is important to find the ideal balance of strength and flexibility for each patient.

In 2019, Totah and co-workers7 performed a literature review to identify the effect of ankle stiffness in AFOs on gait and patient satisfaction. The researchers compiled the results of 25 articles and reached the following conclusions:

  • Increased AFO stiffness led, as expected, to a decrease in peak ankle plantarflexion, peak ankle dorsiflexion, and ankle–joint range of motion (ROM).
  • Increased AFO stiffness also led to an increase in knee flexion during the early stance phase of gait.
  • There is no statistical correlation between AFO ankle stiffness and hip-joint biomechanics, energy use, or gait speed.

The review by Totah was unable to ascertain an association between patient satisfaction and stiffness of the AFO.7 This further emphasizes the need to understand the individual patient’s conditions and goals of treatment.

Kobayashi and colleagues10 found that, in an AFO with high-ankle stiffness at initial contact, the tibia will be abruptly rotated forward, leading to knee flexion and instability. However, an AFO with too little stiffness will lead to increased knee flexion, similar to the genu recurvatum often seen in patients with foot drop.

Dynamic AFOs are designed from flexible material to allow spring-like function. This design absorbs energy during initial contact and then releases it during toe-off. Dynamic AFOs can be made from plastic or carbon fiber9,11; the latter material has the added benefit of being both lightweight and strong.9

One type of dynamic AFO, the posterior leaf spring AFO (PLS-AFO), is constructed similar to a solid AFO. However, the posterior shell portion is shaped in a way that allows it to function like a spring. Other dynamic AFO designs include flexible struts along the sides, which also act like springs. Bregman et al11 showed that use of PLS-AFOs can reduce the energy cost of walking by 9.8% and reduce net ankle work by almost 30%, compared to walking without an AFO.

Zollo et al9 compared dynamic AFOs and solid AFOs in patients with stroke-induced foot drop. They showed that both PLS-AFOs and dynamic AFOs improved cadence and decreased ankle ROM; in fact, there was no statistical difference between the 2 designs in regard to cadence and ankle movement. The researchers recorded subjects’ muscle activity in the calf and anterior ankle muscles while wearing the 2 types of AFO: While using the dynamic AFO, patients had less co-contraction of these muscles. Zollo concluded that use of the dynamic AFO will provide patients with a gait that is more similar to unimpaired gait.

Choi et al12 compared the effect of the stiffness of dynamic AFOs at different walking speeds. By analyzing gastrocnemius muscle and anterior tibialis muscle length during the gait cycle, they determined that, at slower walking speeds, patients received less energy return, compared with faster walking speeds. The researchers recommended taking the patient’s lifestyle demands into consideration when considering a dynamic AFO.

Articulating AFOs are constructed in 2 pieces, with a joint at the ankle. Hinges with adjustable resistance are used to control the patient’s plantarflexion and dorsiflexion. Stops can also be incorporated into the AFO to place an absolute limit on the plantarflexion and dorsiflexion ROM. Kobayashi13 confirmed that incremental increases in hinge resistance lead to decreased ankle ROM during stance and swing phases.

3-dimensional (3D) printed AFOS. Recent advancements in 3D printing technology have led to greater interest in developing a technique to manufacture custom AFOs using this technology.

Cha et al14 developed and tested a 3D printing technique in which the patient’s foot is scanned using a 3D scanner; the image is then adjusted using computer software and then “printed” using thermoplastic polyurethane. The 3D printed AFO was compared to a custom AFO manufactured using the traditional casting technique. Patients alternated use of the 2 AFOs for 2 months and reported that they were happier with the ease of use and comfort of the 3D printed AFO.

Wojciechowski et al5 performed a literature review (N = < 50 patients) of 3D-printed AFOs, which revealed little difference in biomechanical properties, including ankle movement and speed of gait, between 3D-printed and plaster-cast AFOs. The review did demonstrate increased patient comfort and satisfaction with 3D-printed AFOs. The authors concluded that 3D printing is a feasible option for future AFO manufacture that could lead to improved customization and patient satisfaction.

General problem of patient acceptance. Nonadherence has a significant effect on the success of treatment with an AFO. Holtkamp et al15 surveyed more than 200 patients for whom an AFO was prescribed and found that 1 of every 15 patients never used it. They also found that nearly 25% of AFO users were dissatisfied with their orthosis. Common causes of dissatisfaction included skin reaction, poor fit, and difficulty of use. Survey respondents also commented on lack of follow-up and attention to their needs in the design of the AFO. Other studies have shown that AFO complications include contracture at the ankle joint, trouble standing from a sitting position, and undesirable appearance.16

Treatment With Foot Drop Stimulators

Another treatment option for foot drop is a foot drop stimulator (FDS), wearable devices that electronically stimulate the common peroneal nerve to activate the pedal dorsiflexors. Stimulators are useful for treating foot drop resulting from central nervous system pathology. They require an intact common peroneal nerve to stimulate the dorsiflexors of the foot, which means that they are not indicated for treatment of common peroneal nerve injury. Other contraindications include ankle and knee instability.4,16

In a randomized controlled trial of 179 patients by Kluding et al16 that compared AFOs and FDSs, both treatment groups were found to have significant improvement in  comfortable walking gait speed and fast walking gait speed. There was no statistical difference in improvement across several biomechanical markers. Participants in the FDS treatment group were more satisfied with treatment, however.

Reported adverse events with FDSs included skin irritation and falls. The rate of falls was equal in both treatment groups.

Summing Up

Foot drop encompasses a range of conditions of various causes; the common factor is loss of muscle strength of the pedal dorsiflexors. Most patients benefit from nonsurgical care of foot drop, regardless of the cause.

Because the cause of foot drop varies from patient to patient, and because individual patients therefore have different needs and expectations from treatment, it is the task of providers to identify the best bracing options for the individual by working closely with the patient to obtain and understand their goals for treatment of this condition.

Jason Wright, DPM, is a PGY-2 resident physician and Marshall G. Solomon, DPM, FACPM, FACFAS, is Residency Director, both at Beaumont Hospital, Farmington Hills, in Farmington Hills, MI.

LER is proud to partner with the American College of Foot & Ankle Orthopedics & Medicine to present clinically relevant peer-reviewed content, curated by Jarrod Shapiro, DPM, FACFAOM, FACFAS.

 

via A Guide to Individualized Management of Foot Drop | Lower Extremity Review Magazine

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[Abstract] Immediate effects of ankle eversion taping on gait ability of chronic stroke patients.

 

Abstract

OBJECTIVES:

The purpose of this study is to assess the immediate effects of applying ankle eversion taping using kinesiology tape in patients with foot drop after stroke.

DESIGN:

Randomized cross-over trial.

METHOD:

In this study, fifteen subjects with stroke underwent three interventions in a random order. Subjects were randomly initially assigned to an ankle balance taping, placebo taping, and no taping each group. The ankle eversion taping was used for mechanical correction. Ankle eversion taping is involved in ankle dorsiflexion and eversion. The placebo taping began from both malleolus and was applied up to the middle point of the lower limb. Gait ability was assessed by the GAITRite System. The measured gait variables are gait velocity, step length, stride length, H-H base support, and cadence. All of the measurements were performed immediately after intervention.

RESULTS:

Our results showed gait function in chronic stroke patients was improved after ankle eversion taping. Velocity, step length, stride length and cadence under the ankle eversion taping conditions significantly increased (p < 0.05) compared to the placebo and no taping conditions. Ankle eversion taping significantly reduced (p < 0.05) H-H base support compared to the no taping condition.

CONCLUSIONS:

We conclude that the application of ankle eversion taping that uses kinesiology tape instantly increased the gait ability of chronic stroke patients with foot drop. However, more research is necessary to identify the long-term effects of the ankle eversion taping.

via Immediate effects of ankle eversion taping on gait ability of chronic stroke patients. – PubMed – NCBI

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[Facebook POST] I just want to walk normal again.

 

I injured my brain on the right side nearly 2 years ago. I am having difficulty walking because my left side wants to do its own thing.
Is there anything that I can be doing to get this under control?
“I just want to walk “normally” again.”
—Elizabeth

 

Η εικόνα ίσως περιέχει: ένα ή περισσότερα άτομα, άτομα περπατούν και κείμενο

 

 

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[WEB PAGE] Treatments for foot drop compared

 

Continue —> Treatments for foot drop compared | MS Trust

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[WEB SITE] Achieve Dramatic Foot-Drop Relief with X-Strap Systems

X-Strap Systems offers unique proven products for foot drop relief. Products provide full-time comfort, normal ankle joint mobility, and normal gait. Products include the Dorsi-Strap, Dorsi-Strap PRO, and Dorsi-Lite Foot Splint.

Each foot drop product is easy on and off, ultra-low profile, lightweight, durable, washable, and latex free. No Rx needed. No fitting requirements. 30-day refund warranty. Shipped worldwide within 24 hours.

Dorsi-Lite can be used with or without shoes, during day or night, and in dry or wet conditions. No oversized shoes are needed. Treats plantar fasciitis, Achilles tendonitis, heel spurs and shin splints.

Dorsi-Strap is available in Standard and heavy-duty PRO models. Nothing is placed into the shoe or under the foot, so no oversize shoes are needed. The units offer quick adjustment and can be easily transferred or removed from the shoe. Available in White, Black, or Tan/Brown to match a wide array of shoe colors.

Guaranteed results!

via Achieve Dramatic Foot-Drop Relief with X-Strap Systems | Lower Extremity Review Magazine

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[ARTICLE] Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot – Full Text

Abstract

Background

Central drop foot is a common problem in patients with stroke or multiple sclerosis (MS). For decades, it has been treated with orthotic devices, keeping the ankle in a fixed position. It has been shown recently that semi-implantable functional electrical stimulation (siFES) of the peroneal nerve can lead to a greater gait velocity increase than orthotic devices immediately after being switched on. Little is known, however, about long-term outcomes over 12 months, and the relationship between quality of life (QoL) and gait speed using siFES has never been reported applying a validated tool. We provide here a report of short (3 months) and long-term (12 months) outcomes for gait speed and QoL.

Methods

Forty-five consecutive patients (91% chronic stroke, 9% MS) with central drop foot received siFES (Actigait®). A 10 m walking test was carried out on day 1 of stimulation (T1), in stimulation ON and OFF conditions, and repeated after 3 (T2) and 12 (T3) months. A 36-item Short Form questionnaire was applied at all three time points.

Results

We found a main effect of stimulation on both maximum (p < 0.001) and comfortable gait velocity (p < 0.001) and a main effect of time (p = 0.015) only on maximum gait velocity. There were no significant interactions. Mean maximum gait velocity across the three assessment time points was 0.13 m/s greater with stimulation ON than OFF, and mean comfortable gait velocity was 0.083 m/s faster with stimulation ON than OFF. The increase in maximum gait velocity over time was 0.096 m/s, with post hoc testing revealing a significant increase from T1 to T2 (p = 0.012), which was maintained but not significantly further increased at T3. QoL scores showed a main effect of time (p < 0.001), with post hoc testing revealing an increase from T1 to T2 (p < 0.001), which was maintained at T3 (p < 0.001). Finally, overall absolute QoL scores correlated with the absolute maximum and comfortable gait speeds at T2 and T3, and the increase in overall QoL scores correlated with the increase in comfortable gait velocity from T1 to T3. Pain was reduced at T2 (p < 0.001) and was independent of gait speed but correlated with overall QoL (p < 0.001).

Conclusions

Peroneal siFES increased maximal and comfortable gait velocity and QoL, with the greatest increase in both over the first three months, which was maintained at one year, suggesting that 3 months is an adequate follow-up time. Pain after 3 months correlated with QoL and was independent of gait velocity, suggesting pain as an independent outcome measure in siFES for drop foot.

 

Introduction

Drop foot is a common symptom in patients suffering from first motor neuron lesions, such as due to stroke and multiple sclerosis (MS). It is characterized by impaired lifting of the forefoot from the ground during the swing phase of walking and by a lack of stability during the early stance phase. Drop foot results in an altered gait pattern [3] and increased risk of falls [8]. Application of an ankle foot orthosis (AFO) is the traditional approach to improving gait pattern and reducing falls. However, it is not well-tolerated in all patients [10]. In recent years, gait improvement has been achieved using functional electrical stimulation (FES) [110162325], which combines the orthotic benefits of an AFO with a more physiological approach that involves muscle contraction and the related sensory feedback [1025]. Transcutaneous FES (tcFES) of the peroneal nerve has been associated with significantly reduced falls compared to intensive physiotherapy [7]. Indeed, 69% of the falls in this FES group occurred when the system was not used. Moreover, a systematic review of FES in MS patients indicates increased gait speed using FES [19]. Semi-implantable FES (siFES) of the peroneal nerve has been found to increase gait speed and improve gait patterns compared with a baseline without stimulation [61017], compared to orthotic devices [123], and also compared to tcFES [17]. The findings of a systematic review, including predominantly chronic stroke patients, however, did not suggest a difference between tcFES and siFES in terms of walking speed [13]. An implantable stimulator does, however, offer the advantage of avoiding the need for daily optimization of stimulator location [28] and potential skin lesions associated with surface stimulation electrodes. Moreover, the possibility of using a 4-channel implantable system, with independent control of each channel, means that the volume of tissue activated within the nerve can be individually selected, in order to optimize dorsiflexion of the foot while avoiding stimulation of the sensory fascicles of the common peroneal nerve [10]. Here we retrospectively hypothesised that increases in gait speed are associated with improvements in quality of life (QoL). Furthermore, we assumed pain scores had improved under therapy and expected them to be related to the overall QoL, and we hypothesised that increased gait velocity would have resulted in improvement of both physical and emotional subscores of the QoL. To address these hypotheses, we evaluated improvement in gait velocity in the largest cohort of patients to date, with stimulation ON and OFF, at three time points over 1 year, to assess the short- and long-term effects of siFES, examining correlation between gait speed and QoL, as well as between changes in these factors, over a year of continuous treatment.

Most studies of implantable systems for stroke to date cover observation periods of 3 to 6 months post-surgery and suggest siFES provides a promising approach to managing drop foot. An increase in gait velocity and endurance, as well as an improvement in QoL, was observed 3–6 weeks post-operatively in a cohort of 27 patients receiving siFES [17]. Trials applying tcFES, which has been available since the early seventies [27], have tended to employ standardized and stratified re-examination, with early and long-term follow-up periods, such as 6 and 12 weeks [16], 3 and 12 months [25], and 24 days and 3 years [28]. A recent long-term multi-centre study applying siFES reported an improved gait pattern in a cohort of 10 stroke patients 6 months following siFES activation and in a separate cohort of 12 stroke patients 1 year after activation [1]. Their findings suggested greater knee stability, ankle plantarflexion power, and propulsion than that provided by an AFO. Here, we examined both the short- and long-term effects of using multichannel peroneal siFES in the largest patient group thus far reported, including both stroke and MS patients. The independent association between slow gait velocity and an increased risk of falls [8] renders gait velocity a valid surrogate parameter for the orthotic functionality of devices aiming to improve the limitations of drop foot. We aimed to investigate whether gait velocity improvements translate into QoL changes. Long-term follow-up (one year or longer) has been reported for large cohorts (more than 20 patients) using tcFES [2528], and for a smaller cohort (N = 12) using siFES [1]. Long-term follow-up in a large cohort of patients receiving siFES and evaluating QoL has not yet been reported. The particular strengths of the current study are the large cohort, the inclusion of short- and long-term follow-up, and the evaluation of QoL and its correlation with gait speed.[…]

 

Continue —>  Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1Gait speed (m/s) in relation to duration of therapy with stimulation ON and OFF. a. Maximum gait velocity. Main effect of stimulation and time. Post hoc testing: significant difference from day 1 to month 3 (*). b. Comfortable gait velocity. Main effect of stimulation only. Error bars = standard error of the mean

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[VIDEO] FES (Functional Electrical Stimulation) System by FES Center India – YouTube

Functional Electrical Stimulation (FES): Best and latest treatment for Neurological rehabilitation/ Physiotherapy

FES is a technique that utilizes patterned electrical stimulation of neural tissue with the purpose of restoring or enhancing a lost or diminished function. It produces contractions in paralysed muscles by the application of small pulses of electrical stimulation to nerves that supply the paralysed muscle. The stimulation is controlled in such a way that the movement produced provides useful function.

FES is used as a tool to assist walking and also as a means of practicing various functional movements for therapeutic benefit. FES may be used to replace the natural electrical signals from the brain, helping the weak or paralyzed limbs move again. With continued stimulation over time, the brain may even be able to recapture and relearn this movement without the stimulation.

Use of “FES (Functional Electrical Stimulation) System India” for treatment of Foot Drop due to Hemiplegia. FES is a novel device for treatment/ rehabilitation of Neurological diseases. FES System India has many applications like

  1. Sit to stand training
  2. Pre Gait Training
  3. Correction of Foot Drop,
  4. Correction of Circumductory Gait

  5. for Paraplegia (Incomplete SCI) using FES unit on both sides

  6. Shoulder subluxation and shoulder rehabilitation

  7. Hand Function (Grasp and release)

This novel treatment is useful for all type of UMN disorders like hemiplegia (Cerebro Vascular Accident, Head Injury, Traumatic Brain injury, Brain tumor ), multiple scerosis, cerebral palsy, incomplete paraplegia etc.

contact “FES Center India” to buy FES System.

mail: fescenterindia@gmail.com

For more details visit: http://www.fescenterindia.com

via FES (Functional Electrical Stimulation) System by FES Center India – YouTube

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[VIDEO] Foot Drop and Functional Electrical Stimulation (FES) – YouTube

PhysioFunction are recognised as international experts in the use of Functional Electrical Stimulation (FES). We ensure our clients receive the most clinically correct rehabilitation technology suited to their needs. Jon Graham, Clinical Director at PhysioFunction talks about Foot Drop and Functional Electrical Stimulation.

via Foot Drop and Functional Electrical Stimulation (FES) – YouTube

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[VIDEO] Post Stroke Foot Dorsiflexion: Using Electrical Stimulation to Reduce Tone & Promote Plasticity – YouTube

Further reading on electrophysiology and muscle contractions: http://strokemed.com/motor-behaviour-…

via  Post Stroke Foot Dorsiflexion: Using Electrical Stimulation to Reduce Tone & Promote Plasticity – YouTube

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