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Surface Peroneal Nerve Stimulation in Lower Limb Hemiparesis: Effect on Quantitative Gait Parameters

Sheffler, Lynne R. MD; Taylor, Paul N. PhD; Bailey, Stephanie Nogan BS; Gunzler, Douglas D. PhD; Buurke, Jaap H. PhD; IJzerman, Maarten J. PhD; Chae, John MD

American Journal of Physical Medicine & Rehabilitation: May 2015 - Volume 94 - Issue 5 - p 341–357
doi: 10.1097/PHM.0000000000000269
Original Research Articles: CME Article . 2015 Series . Number 5
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Objective The objective of this study was to evaluate possible mechanisms for functional improvement and compare ambulation training with surface peroneal nerve stimulation vs. usual care via quantitative gait analysis.

Design This study is a randomized controlled clinical trial.

Setting The setting of this study is a teaching hospital of an academic medical center.

Participants One hundred ten chronic stroke survivors (>12 wks poststroke) with unilateral hemiparesis participated in this study.

Interventions The subjects were randomized to a surface peroneal nerve stimulation device or usual care intervention. The subjects were treated for 12 wks and followed up for 6-mo posttreatment.

Main Outcome Measures Spatiotemporal, kinematic, and kinetic parameters of gait were the main outcome measures.

Results Cadence (F3,153 = 5.81, P = 0.012), stride length (F3,179 = 20.01, P < 0.001), walking speed (F3,167 = 18.2, P < 0.001), anterior-posterior ground reaction force (F3,164 = 6.61, P = 0.004), peak hip power in preswing (F3,156 = 8.76, P < 0.001), and peak ankle power at push-off (F3,149 = 6.38, P = 0.005) all improved with respect to time. However, peak ankle ankle dorsiflexion in swing (F3,184 = 4.99, P = 0.031) worsened. In general, the greatest change for all parameters occurred during the treatment period. There were no significant treatment group × time interaction effects for any of the spatiotemporal, kinematic, or kinetic parameters.

Conclusions Gait training with peroneal nerve stimulation and usual care was associated with improvements in peak hip power in preswing and peak ankle power at push-off, which may have resulted in improved cadence, stride length, and walking speed; however, there were no differences between treatment groups. Both treatment groups also experienced a decrease in peak ankle ankle dorsiflexion in swing, although the clinical implications of this finding are unclear.

From the Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio (LRS, JC); Cleveland Veterans Affairs Functional Electrical Stimulation Center of Excellence, Cleveland, Ohio (LRS, JC); Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute of Ohio, MetroHealth Medical Center, Cleveland, Ohio (LRS, MJI, JC); The National Clinical FES Center, Salisbury District Hospital, Salisbury, United Kingdom (PNT); Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio (SNB); Center for Health Policy Research, MetroHealth Medical Center, Cleveland, Ohio (DDG); Roessingh Research and Development, Enschede, the Netherlands (JHB); Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands (MJI); and Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio (JC).

All correspondence and requests for reprints should be addressed to: Lynne R. Sheffler, MD, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, 4229 Pearl Rd, 5N-556, Cleveland, OH 44109.

Funded by the National Institute for Child Health and Human Development grants R01HD44816, K23HD060689, and K24HD054600, and the National Center for Research Resources Clinical and Translational Science Collaborative of Cleveland (grant UL1RR024989). Clinical Trial Registration Information: http://www.clinicaltrials.gov. Unique identifier: NCT00148343.

The authors certify that one author has an affiliation with or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants and patents received, or pending royalties) with an organization or entity with a financial interest in, or financial conflict with, the subject matter or materials discussed in the article; all such affiliations and involvements are disclosed as follows:

Author PNT is the coinventor of the peroneal nerve stimulation device evaluated in this study and holds the patent for the device.

There are no disclosures for authors LRS, SNB, DDG, JHB, MJI, and JC.

The authors certify that all financial and material support for this research (e.g., National Institutes of Health or National Health Service grants) and work are clearly identified above on the title page of the article.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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