Spatiotemporal, Kinematic, and Kinetic Effects of a Peroneal Nerve Stimulator Versus an Ankle Foot Orthosis in Hemiparetic Gait

Background. The relative effect of a transcutaneous peroneal nerve stimulator (tPNS) and an ankle foot orthosis (AFO) on spatiotemporal, kinematic, and kinetic parameters of hemiparetic gait has not been well described. Objective. To compare the relative neuroprosthetic effect of a tPNS with the orthotic effect of an AFO using quantitative gait analysis (QGA). Design. In all, 12 stroke survivors underwent QGA under 3 device conditions: (1) no device (ND), (2) AFO, and (3) tPNS. A series of repeated-measures analyses of variance (rmANOVAs) were performed with dorsiflexion status (presence or absence of volitional dorsiflexion) as a covariate to compare selected spatiotemporal, kinematic, and kinetic parameters for each device condition. Post hoc pairwise comparisons and/or subset analysis by dorsiflexion status were performed for significant effect. Results. Stride length was improved with both the AFO (P = .035) and the tPNS (P = .029) relative to ND. Those with absent dorsiflexion had longer stride length with the tPNS relative to ND (P = .034) and a higher walking velocity with a tPNS relative to the AFO (P = .015). There was no device effect on dorsiflexion angle at initial contact; however, a significant Device x Dorsiflexion status interaction effect favored the AFO relative to ND (P = .025) in those with dorsiflexion present. Conclusion. This study suggests that level of motor impairment may influence the relative effects of the tPNS and AFO devices in chronic hemiparetic gait; however, the small sample size limits generalizability. Future studies are necessary to determine if motor impairment level should be considered in the clinical prescription of these devices.