Gait Characteristics Following Stroke: A Prospective Crossover Study to Compare Ankle-Foot Orthosis with Functional Electrical Stimulation

Background: Management of foot-drop following stroke can be addressed with ankle-foot orthosis (AFO) or functional electrical stimulation (FES) of the peroneal nerve. There is limited evidence regarding the efficacy of FES as a substitute for a conventional ankle-foot orthosis. Objective: The aim of this study was to compare efficacy of FES against AFO in management of foot-drop in patients following stroke. Materials and Methods: Twenty patients (ten per group) were enrolled in this prospective crossover trial. Group A patients received gait training with AFO during first week followed by training with FES during second week and vice-versa for group B. Outcome parameters following AFO/FES training included Ten-meter, Six-minute walk test and spatiotemporal gait parameters. Patient satisfaction level was assessed using feedback questionnaire. Friedman test and Wilcoxon signed-rank test were performed to compare outcomes between barefoot, AFO and FES. The P value < 0.05 was considered statistically significant. Results: Nineteen males and one female aged 45.5 +/- 9.45 years were recruited. Statistically significant improvement was observed in Ten-meter and Six-minute walk tests, gait speed, Timed up and go test (TUG), stance-swing ratio and single-limb support among users of FES as compared to AFO and barefoot. There was no statistical difference observed in other gait parameters. Physiological cost index (PCI) showed trend in improvement among FES users. Patient satisfaction scores were higher for FES users. Conclusions: Quantitative and qualitative results were in favour of FES as compared to AFO and barefoot suggesting that FES can be a potential orthotic intervention in hemiplegic patients.

Automated summary

This study compared the efficacy of FES and AFO in the management of foot-drop in stroke patients. The results showed that patients using FES had significant improvements in various gait parameters compared to those using AFO and walking barefoot. The physiological cost index also showed a trend of improvement among FES users. Patients expressed higher satisfaction with FES.