Reade, Amsterdam, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.
Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.
Hum Mov Sci. 2022 Jun;83:102953. doi: 10.1016/j.humov.2022.102953. Epub 2022 May 2.
Benefits of peroneal functional electrical stimulation in people with post-stroke drop foot may particularly emerge in environments that require continual gait adaptation. Such adaption is known to increase the attentional demands of gait.
Is performance of a target stepping task more accurate and less attention demanding with electrical stimulation ON compared to OFF in people with post-stroke drop foot?
Thirteen people with an implanted electrical stimulation system participated in this observational study. Participants performed a walking task with irregularly spaced targets on a self-paced treadmill, both as a single task and combined with an auditory Stroop task. Participants performed each task with electrical stimulation ON and OFF. In the OFF condition participants were allowed to use their own ankle-foot orthosis. The effects of Device (ON, OFF) and interaction of Device*Task (single, dual) on stepping performance in mediolateral and anteroposterior direction were tested based on the total error of foot placement relative to the targets, using repeated measurements ANOVA. Differences between electrical stimulation ON and OFF on auditory Stroop task accuracy were assessed using a non-parametric Wilcoxon signed-rank test. Non-parametric correlations were calculated to associate changes in stepping performance with paretic leg motor function (Fugl-Meyer Assessment - leg score).
Data of 12 participants were used for analysis. Mediolateral total error was smaller with peroneal functional electrical stimulation ON compared to OFF (Δ = 1.0 cm, p = 0.011). In the anteroposterior direction, no significant effects of Device were found. There were no significant interaction effects of Device*Task in either direction. Changes in total error (ON vs OFF) were not significantly associated with leg motor function. Stroop task accuracy was not statistically different between ON and OFF.
Implanted electrical stimulation may have benefits with regard to mediolateral accuracy of a continual target stepping task, although the effect size is relatively small. This benefit seems to be independent of the performance of a concurrent attention-demanding task and may reflect better gait stability in the mediolateral direction, which is known to be a problem in people with stroke.
腓肠肌功能性电刺激对脑卒中后足下垂患者的益处可能特别体现在需要持续步态适应的环境中。众所周知，这种适应会增加步态的注意力需求。
与关闭刺激相比，在患有脑卒中后足下垂的人群中，进行目标跨步任务时，开启电刺激是否能使步伐更准确且注意力要求更低？
13 名植入电刺激系统的参与者参与了这项观察性研究。参与者在自我调节跑步机上进行了具有不规则间隔目标的行走任务，既作为单一任务，也与听觉斯特鲁普任务相结合。参与者在电刺激开启和关闭的情况下完成了每个任务。在关闭状态下，参与者可以使用自己的踝足矫形器。使用重复测量方差分析，根据脚相对于目标的放置总误差，测试设备（开启、关闭）和设备*任务（单一、双重）对侧向和前后方向跨步性能的影响。使用非参数 Wilcoxon 符号秩检验评估电刺激开启和关闭时听觉斯特鲁普任务准确性的差异。计算非参数相关性，以将跨步性能的变化与患侧腿部运动功能（Fugl-Meyer 评估-腿部评分）相关联。
对 12 名参与者的数据进行了分析。与关闭刺激相比，腓肠肌功能性电刺激开启时侧向总误差较小（Δ=1.0cm，p=0.011）。在前后方向，未发现设备的显著影响。在任何方向都没有发现设备*任务的显著交互作用。总误差的变化（开启与关闭）与腿部运动功能无显著相关性。在开启和关闭状态下，斯特鲁普任务的准确性没有统计学差异。
植入式电刺激可能在持续目标跨步任务的侧向准确性方面具有益处，尽管效果大小相对较小。这种益处似乎独立于注意力要求高的并发任务的执行，并且可能反映了在脑卒中患者中已知存在问题的侧向步态稳定性的提高。
