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

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. LAY ABSTRACT Drop foot is a common impairment following stroke or other causes of disease in the nervous system. This study of 21 patients with drop foot caused by various diseases in the central nervous system reports data on patient self-perceived performance, satisfaction with performance, walking ability, and adverse effects after surgical implantation of the ActiGait® peroneal nerve stimulator. The patients’ self-perceived performance and satisfaction with performance were evaluated using the Canadian Occupational Performance Measure. Walking ability was assessed using a 10-m walk test and a 6-min walk test before implantation and at follow-up. At follow-up, patient self-perceived performance, satisfaction with performance, walking velocity, and walking distance increased. No changes in nerve function were demonstrated. In conclusion, implantable peroneal nerve stimulation increases self-perceived performance, satisfaction with performance, and ambulation in patients with long-lasting drop foot caused by central nervous system lesion.

Keywords

• drop foot gait
• implantable neurostimulator
• neurological rehabilitation
• walking speed