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植入式腓肠神经刺激器治疗中枢神经系统病变所致足下垂:21 例患者 12 个月随访。

Implanted Peroneal Nerve Stimulator Treatment for Drop Foot Caused by Central Nervous System Lesion: A Twelve-Month Follow-up of 21 Patients.

机构信息

Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Denmark.

Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Denmark.

出版信息

J Rehabil Med. 2022 Jun 20;54:jrm00288. doi: 10.2340/jrm.v54.2164.

DOI:10.2340/jrm.v54.2164
PMID:35451494
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9252092/
Abstract

OBJECTIVE

Drop foot is a common impairment following stroke or other causes of central pathology. We report data on patient self-perceived performance, satisfaction with performance, walking ability, and adverse effects after surgical implantation of the ActiGait® drop foot stimulator.

DESIGN

Prospective case study with a 12-month follow-up.

SUBJECTS

Twenty-one participants with drop foot caused by central nervous system lesion.

METHODS

The patients' self-perceived performance and satisfaction with performance were evaluated using the Canadian Occupational Performance Measure (COPM). Walking ability was assessed using a 10-m walk test and a 6-min walk. Nerve conduction of the peroneal nerve was examined in 10 patients.

RESULTS

At follow-up, COPM self-percieved performance from 3.2 to 6.7 points, the median increase being 2.8 (interquartile range (IQR) 2.2-5.0), p < 0.001. Likewise, the COPM satisfaction with performance increased from 2.6 to 6.9 points, the median increase being 4.2 (IQR 2.8-5.8), p < 0.001. Walking velocity increased 0.1 m/s from a baseline measurement of 0.73 m/s (95% confidence interval (95% CI) 0.03-0.2), n = 21, p < 0.01, and walking distance increased by 33 m, from a baseline measurement of 236 m (95% CI 15-51), n = 21, p < 0.001.

CONCLUSION

Stimulation of the peroneal nerve by an implantable stimulator increases self-perceived performance, satisfaction with performance, and ambulation in patients with long-lasting drop foot caused by a central nervous system lesion.

摘要

目的

足下垂是中风或其他中枢病变的常见后遗症。我们报告了患者对自身表现的感知、对表现的满意度、步行能力以及植入 ActiGait®足下垂刺激器后的不良反应的数据。

设计

前瞻性病例研究,随访 12 个月。

受试者

21 名因中枢神经系统病变导致足下垂的患者。

方法

使用加拿大职业表现量表(COPM)评估患者的自我感知表现和对表现的满意度。使用 10 米步行测试和 6 分钟步行测试评估步行能力。在 10 名患者中检查腓总神经的神经传导。

结果

随访时,COPM 自我感知表现从 3.2 分提高到 6.7 分,中位数提高了 2.8 分(四分位距(IQR)2.2-5.0),p<0.001。同样,COPM 对表现的满意度从 2.6 分提高到 6.9 分,中位数提高了 4.2 分(IQR 2.8-5.8),p<0.001。步行速度从基线时的 0.73 米/秒提高了 0.1 米/秒(95%置信区间(95% CI)0.03-0.2),n=21,p<0.01,步行距离从基线时的 236 米增加了 33 米(95% CI 15-51),n=21,p<0.001。

结论

植入式刺激器刺激腓总神经可提高中枢神经系统病变导致的长期足下垂患者的自我感知表现、对表现的满意度和步行能力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a47e/9252092/2fa8a8b1593c/JRM-54-2164-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a47e/9252092/592813516e6f/JRM-54-2164-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a47e/9252092/2fa8a8b1593c/JRM-54-2164-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a47e/9252092/592813516e6f/JRM-54-2164-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a47e/9252092/2fa8a8b1593c/JRM-54-2164-g002.jpg

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本文引用的文献

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2
The long-term effects of an implantable drop foot stimulator on gait in hemiparetic patients.植入式足下垂刺激器对偏瘫患者步态的长期影响。
PLoS One. 2019 Apr 17;14(4):e0214991. doi: 10.1371/journal.pone.0214991. eCollection 2019.
3
Kinematic and kinetic benefits of implantable peroneal nerve stimulation in people with post-stroke drop foot using an ankle-foot orthosis.
使用踝足矫形器对中风后足下垂患者进行植入式腓总神经刺激的运动学和动力学益处。
Restor Neurol Neurosci. 2018;36(4):547-558. doi: 10.3233/RNN-180822.
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Functional electrical stimulation through direct 4-channel nerve stimulation to improve gait in multiple sclerosis: a feasibility study.通过直接四通道神经刺激进行功能性电刺激以改善多发性硬化症患者的步态:一项可行性研究。
J Neuroeng Rehabil. 2015 Nov 14;12:100. doi: 10.1186/s12984-015-0096-3.
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Effects of implantable peroneal nerve stimulation on gait quality, energy expenditure, participation and user satisfaction in patients with post-stroke drop foot using an ankle-foot orthosis.植入式腓总神经刺激对使用踝足矫形器的中风后足下垂患者步态质量、能量消耗、参与度及用户满意度的影响
Restor Neurol Neurosci. 2015;33(6):795-807. doi: 10.3233/RNN-150501.
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New Therapeutic Option for Drop Foot with the ActiGait Peroneal Nerve Stimulator--a Technical Note.ActiGait腓总神经刺激器为足下垂提供的新治疗选择——技术说明
World Neurosurg. 2015 Dec;84(6):2037-42. doi: 10.1016/j.wneu.2015.06.074. Epub 2015 Jul 9.
7
Towards physiological ankle movements with the ActiGait implantable drop foot stimulator in chronic stroke.使用 ActiGait 可植入式足下垂刺激器实现慢性中风患者的生理性踝关节运动。
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8
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Stroke. 2013 Jun;44(6):1660-9. doi: 10.1161/STROKEAHA.111.000334. Epub 2013 May 2.
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