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Surface peroneal nerve stimulation in lower limb hemiparesis: effect on quantitative gait parameters |
Sheffler LR, Taylor PN, Bailey SN, Gunzler DD, Buurke JH, Ijzerman MJ, Chae J |
American Journal of Physical Medicine & Rehabilitation 2015 May;94(5):341-357 |
clinical trial |
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
OBJECTIVE: The objective of this study was to evaluate possible mechanisms for functional improvement and compare ambulation training with surface peroneal nerve stimulation versus usual care via quantitative gait analysis. DESIGN: This study is a randomized controlled clinical trial. SETTING: The setting of this study is a teaching hospital of an academic medical center. PARTICIPANTS: One hundred ten chronic stroke survivors (> 12 wks poststroke) with unilateral hemiparesis participated in this study. INTERVENTIONS: The subjects were randomized to a surface peroneal nerve stimulation device or usual care intervention. The subjects were treated for 12 wks and followed up for 6-mo posttreatment. MAIN OUTCOME MEASURES: Spatiotemporal, kinematic, and kinetic parameters of gait were the main outcome measures. RESULTS: Cadence (F[3,153] = 5.81, p = 0.012), stride length (F[3,179] = 20.01, p < 0.001), walking speed (F[3,167] = 18.2, p < 0.001), anterior-posterior ground reaction force (F[3,164] = 6.61, p = 0.004), peak hip power in preswing (F[3,156] = 8.76, p < 0.001), and peak ankle power at push-off (F[3,149] = 6.38, p = 0.005) all improved with respect to time. However, peak ankle ankle dorsiflexion in swing (F[3,184] = 4.99, p = 0.031) worsened. In general, the greatest change for all parameters occurred during the treatment period. There were no significant treatment group x time interaction effects for any of the spatiotemporal, kinematic, or kinetic parameters. CONCLUSIONS: Gait training with peroneal nerve stimulation and usual care was associated with improvements in peak hip power in preswing and peak ankle power at push-off, which may have resulted in improved cadence, stride length, and walking speed; however, there were no differences between treatment groups. Both treatment groups also experienced a decrease in peak ankle ankle dorsiflexion in swing, although the clinical implications of this finding are unclear.
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