Malešević Jovana, Dedijer Dujović Suzana, Savić Andrej M, Konstantinović Ljubica, Vidaković Aleksandra, Bijelić Goran, Malešević Nebojša, Keller Thierry
Tecnalia Serbia Ltd., Belgrade, Serbia.
University of Belgrade, Belgrade, Serbia.
J Neuroeng Rehabil. 2017 Jul 3;14(1):66. doi: 10.1186/s12984-017-0275-5.
Functional electrical stimulation (FES) can be applied as an assistive and therapeutic aid in the rehabilitation of foot drop. Transcutaneous multi-pad electrodes can increase the selectivity of stimulation; however, shaping the stimulation electrode becomes increasingly complex with an increasing number of possible stimulation sites. We described and tested a novel decision support system (DSS) to facilitate the process of multi-pad stimulation electrode shaping. The DSS is part of a system for drop foot treatment that comprises a custom-designed multi-pad electrode, an electrical stimulator, and an inertial measurement unit.
The system was tested in ten stroke survivors (3-96 months post stroke) with foot drop over 20 daily sessions. The DSS output suggested stimulation pads and parameters based on muscle twitch responses to short stimulus trains. The DSS ranked combinations of pads and current amplitudes based on a novel measurement of the quality of the induced movement and classified them based on the movement direction (dorsiflexion, plantar flexion, eversion and inversion) of the paretic foot. The efficacy of the DSS in providing satisfactory pad-current amplitude choices for shaping the stimulation electrode was evaluated by trained clinicians. The range of paretic foot motion was used as a quality indicator for the chosen patterns.
The results suggest that the DSS output was highly effective in creating optimized FES patterns. The position and number of pads included showed pronounced inter-patient and inter-session variability; however, zones for inducing dorsiflexion and plantar flexion within the multi-pad electrode were clearly separated. The range of motion achieved with FES was significantly greater than the corresponding active range of motion (p < 0.05) during the first three weeks of therapy.
The proposed DSS in combination with a custom multi-pad electrode design covering the branches of peroneal and tibial nerves proved to be an effective tool for producing both the dorsiflexion and plantar flexion of a paretic foot. The results support the use of multi-pad electrode technology in combination with automatic electrode shaping algorithms for the rehabilitation of foot drop.
This study was registered at the Current Controlled Trials website with ClinicalTrials.gov ID NCT02729636 on March 29, 2016.
功能性电刺激（FES）可作为足下垂康复中的一种辅助和治疗手段。经皮多电极片电极可提高刺激的选择性；然而，随着可能的刺激部位数量增加，刺激电极的塑形变得越来越复杂。我们描述并测试了一种新型决策支持系统（DSS），以促进多电极片刺激电极的塑形过程。该DSS是用于治疗足下垂的系统的一部分，该系统包括定制设计的多电极片电极、电刺激器和惯性测量单元。
该系统在10名足下垂的中风幸存者（中风后3 - 96个月）中进行了20次每日疗程的测试。DSS输出基于肌肉对短刺激序列的抽搐反应，建议刺激电极片和参数。DSS根据对诱发运动质量的一种新测量方法，对电极片和电流幅度的组合进行排序，并根据患侧足的运动方向（背屈、跖屈、外翻和内翻）对其进行分类。训练有素的临床医生评估了DSS在为刺激电极塑形提供令人满意的电极片 - 电流幅度选择方面的有效性。患侧足的运动范围被用作所选模式的质量指标。
结果表明，DSS输出在创建优化的FES模式方面非常有效。所包含的电极片的位置和数量在患者之间和疗程之间显示出明显的变异性；然而，多电极片电极内诱发背屈和跖屈的区域明显分开。在治疗的前三周，FES实现的运动范围显著大于相应的主动运动范围（p < 0.05）。
所提出的DSS与覆盖腓神经和胫神经分支的定制多电极片电极设计相结合，被证明是产生患侧足背屈和跖屈的有效工具。结果支持将多电极片电极技术与自动电极塑形算法相结合用于足下垂的康复。
本研究于2016年3月29日在Current Controlled Trials网站注册，ClinicalTrials.gov标识符为NCT02729636。
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