van Swigchem Roos, Weerdesteyn Vivian, van Duijnhoven Hanneke J, den Boer Jasper, Beems Tjemme, Geurts Alexander C
Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Nijmegen, The Netherlands.
Arch Phys Med Rehabil. 2011 Feb;92(2):320-4. doi: 10.1016/j.apmr.2010.10.038.
In recent years, the use of functional electrical stimulation (FES) of the peroneal nerve has increased as an alternative for an ankle-foot orthosis (AFO) to treat stroke-related drop foot. We present a chronic stroke patient demonstrating an almost normal gait pattern with peroneal FES as a neuroprosthesis. A 60-year-old survivor of a right hemisphere infarction 21 months ago, who regularly used a polypropylene AFO, was provided with a surface-based peroneal FES device for severe drop foot. In a second instance, he received an implanted FES system because of skin problems with the surface stimulator. With both FES devices, the patient achieved an adequate foot elevation. Moreover, his hip and knee flexion angles during walking increased to normal values and his ankle push-off power increased. His gait pattern became almost symmetrical and less variable than with the AFO. Furthermore, his ability to avoid a sudden obstacle improved to normal values with FES. Our patient showed benefits from peroneal FES beyond what can be attributed to improved foot lift alone. With regard to the potential working mechanisms underlying this response to FES, biomechanical benefits related to improved ankle push-off are suggested as the main mechanism.
近年来，作为治疗中风相关足下垂的踝足矫形器（AFO）的一种替代方法，腓总神经功能性电刺激（FES）的应用有所增加。我们报告了一名慢性中风患者，其使用腓总神经FES作为神经假体表现出几乎正常的步态模式。一名21个月前右半球梗死的60岁幸存者，此前经常使用聚丙烯AFO，因严重足下垂而配备了基于表面的腓总神经FES装置。第二次，由于表面刺激器出现皮肤问题，他接受了植入式FES系统。使用这两种FES装置时，患者均实现了足够的足背屈。此外，他行走时的髋部和膝部屈曲角度增加到正常值，踝关节蹬离力量增强。与使用AFO相比，他的步态模式变得几乎对称且变异性更小。此外，使用FES时，他避开突然出现的障碍物的能力提高到了正常值。我们的患者从腓总神经FES中获得的益处不仅仅归因于单纯改善了足背屈。关于对FES产生这种反应的潜在作用机制，与改善踝关节蹬离相关的生物力学益处被认为是主要机制。
