Surface Peroneal Nerve Stimulation in Lower Limb Hemiparesis Effect on Quantitative Gait Parameters

Objective: The objective of this study was to evaluate possible mechanisms for functional improvement and compare ambulation training with surface peroneal nerve stimulation vs. 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,F-153 = 5.81, P = 0.012), stride length (F-3,F-179 = 20.01, P < 0.001), walking speed (F-3,F-167 = 18.2, P < 0.001), anterior-posterior ground reaction force (F-3,F-164 = 6.61, P = 0.004), peak hip power in preswing (F-3,F-156 = 8.76, P < 0.001), and peak ankle power at push-off (F-3,F-149 = 6.38, P = 0.005) all improved with respect to time. However, peak ankle ankle dorsiflexion in swing (F-3,F-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.