Spatiotemporal and Kinematic Effect of Peroneal Nerve Stimulation Versus an Ankle-Foot Orthosis in Patients With Multiple Sclerosis: A Case Series
A portion of this material was presented in poster format at the Neural Interfaces Workshop, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, August 21 to 23, 2006.
Received 17 November 2008; accepted 8 April 2009.
Objective
To compare the effect of a surface peroneal nerve stimulator (PNS) versus an ankle-foot orthosis (AFO) on spatiotemporal and kinematic parameters of gait in patients with multiple sclerosis.
Design
This was a case series design.
Participants
Four subjects with multiple sclerosis and dorsiflexion weakness.
Intervention
Quantitative gait analysis with the use of (1) no device, (2) AFO, and (3) PNS as a single point-in-time assessment.
Outcome Measures
Included walking speed, stride length, cadence, and double support time; kinematic parameters included peak pelvic obliquity during swing, peak contralateral hip abduction during stance, peak knee flexion and hip flexion during swing, ankle dorsiflexion at initial contact, and peak ankle internal rotation during swing.
Results
One-way analysis of variance was used to compare intrasubject performance under the 3 device conditions. The PNS significantly increased ankle dorsiflexion angle at initial contact, as compared with both no device and the AFO, in 3 of the 4 subjects. However, other spatiotemporal and kinematic gait parameters were more variably affected by the device conditions.
Conclusions
With the exception of ankle dorsiflexion angle at initial contact, PNS and AFO have a variable effect on spatiotemporal and kinematic gait parameters in individual subjects with multiple sclerosis. Further studies are indicated to determine the clinical significance of intrasubject differences between device conditions.
aDepartments of Physical Medicine and Rehabilitation, Cleveland Functional Electrical Stimulation Center; and Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, 2500 MetroHealth Drive S1-107A, Cleveland, OH 44109†
bDepartments of Physical Medicine and Rehabilitation, Cleveland Functional Electrical Stimulation Center; and Department of Research, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH‡
cDepartments of Physical Medicine and Rehabilitation, Cleveland Functional Electrical Stimulation Center; Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center; and Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH§
Address correspondence to: L.R.S.
Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org
† Disclosure: 8A, supported by the Neurostimulation and Neuromodulation Partnership, Ohio Board of Regents, BRTT03-005.
ABSTRACT