Dataset Information

Feasibility of a promising pulsed electrostimulator for rapid motor recovery of foot drop.

ABSTRACT:

Purpose

Foot drop still occurs in clinical practice, including in our case. Treatments for foot drop vary based on its etiology and severity of symptoms. Hence, in intractable foot drop cases, an invasive surgical intervention is needed. Here, we introduce a special noninvasive technique to treat our patient's foot drop. In this approach, we applied STIMPOD NMS460 neuromuscular stimulator device (STIMPOD NMS460), which is a low-frequency (10 Hz or less) transcutaneous electrical nerve stimulation (TENS) device with a pulsed radiofrequency (PRF) component. We are eager to know how effective the device is in treating foot drop, and we compared it with two kinds of surgical interventions.

Materials and methods

The device settings are 5 Hz in frequency and 30mA in current amplitude. The device was applied on her left side at the L4 and L5 regions and at the fibular head. Each therapy session consists of individual 15-min treatments on these two body areas, and it only takes a total of 30 minutes. We recorded the change in ankle dorsiflexion degrees and muscle strength of our patient.

Results and conclusions

To our surprise, our patient's actual treatment status through STIMPOD NMS460 showed more effective recovery and no specific side effects than surgical interventions in similar conditions. Besides, after a three-month intervention, her affected ankle dorsiflexion recovered to almost her usual status. The reason why this device has such an effect may be that it has the benefits of TENS and PRF. Besides, some studies have revealed the nerve-repair effect of TENS and PRF. In conclusion, we believe that this device is fairly promising and may be qualified to be used in other patients with foot drop.

SUBMITTER: Chang YC

PROVIDER: S-EPMC10847864 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

Feasibility of a promising pulsed electrostimulator for rapid motor recovery of foot drop.

Chang Yu-Cheng YC Chao Yuan-Ping YP Chang Shin-Tsu ST

Heliyon 20240201 3

<h4>Purpose</h4>Foot drop still occurs in clinical practice, including in our case. Treatments for foot drop vary based on its etiology and severity of symptoms. Hence, in intractable foot drop cases, an invasive surgical intervention is needed. Here, we introduce a special noninvasive technique to treat our patient's foot drop. In this approach, we applied STIMPOD NMS460 neuromuscular stimulator device (STIMPOD NMS460), which is a low-frequency (10 Hz or less) transcutaneous electrical nerve st ...[more]

PMID: 38327404

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Project description:Synergy analysis via dimensionality reduction is a standard approach in biomechanics to capture the dominant features of limb kinematics or muscle activation signals, which can be called "coarse synergies." Here we demonstrate that the less dominant features of these signals, which are often explicitly disregarded or considered noise, can nevertheless exhibit "fine synergies" that reveal subtle, yet functionally important, adaptations. To find the coarse synergies, we applied non-negative matrix factorization (NMF) to unilateral EMG data from eight muscles of the involved leg in ten people with drop-foot (DF), and of the right leg of 16 unimpaired (control) participants. We then extracted the fine synergies for each group by removing the coarse synergies (i.e., first two factors explaining ≥ 85% of variance) from the data and applying Principal Component Analysis (PCA) to those residuals. Surprisingly, the time histories and structure of the coarse EMG synergies showed few differences between DF and controls-even though the kinematics of drop-foot gait is evidently different from unimpaired gait. In contrast, the structure of the fine EMG synergies (as per their PCA loadings) showed significant differences between groups. In particular, loadings for Tibialis Anterior, Peroneus Longus, Gastrocnemius Lateralis, Biceps and Rectus Femoris, Vastus Medialis and Lateralis muscles differed between groups ( p<0.05 ). We conclude that the multiple differences found in the structure of the fine synergies extracted from EMG in people with drop-foot vs. unimpaired controls-not visible in the coarse synergies-likely reflect differences in their motor strategies. Coarse synergies, in contrast, seem to mostly reflect the gross features of EMG in bipedal gait that must be met by all participants-and thus show few differences between groups. However, drawing insights into the clinical origin of these differences requires well-controlled clinical trials. We propose that fine synergies should not be disregarded in biomechanical analysis, as they may be more informative of the disruption and adaptation of muscle coordination strategies in participants due to drop-foot, age and/or other gait impairments.

Project description:BackgroundMost peroneal nerve injuries resulting in foot drop are secondary to trauma or iatrogenic. Foot drop can occur due to potential complications from the hip, lumbosacral spine, and knee surgeries, which are critical to diagnose and manage.MethodsWe reviewed our foot drop patients' data to determine the incidence and iatrogenic causes of the injury and managed surgically by neurolysis of the peroneal nerve and transfer of functional fascicles of either the superficial peroneal or the tibial nerve to the deep peroneal nerve.ResultsWe found 28 iatrogenic foot drop patients who have had surgery and postoperative follow-up evaluations with us. Before the onset of foot drop, all except one (27 of 28) patient have had surgeries in other clinics before presenting to our institution. Foot drop in one patient was due to infection and hip wound after he was intubated and stayed in ICU for 4 weeks. Thirteen of the 28 patients have had lumbosacral (L3-4, L4-L5, and L5-S1) fusion or laminectomy, eight have had hip surgery, and five have had knee surgery. One patient had a fasciotomy due to compartment syndrome and another patient had two previous surgeries for posterior tibial entrapment and tarsal tunnel syndrome at other institutions. NCS and EMG reports showed that these patients had injuries to the peroneal or tibial nerve after their prior surgeries. One patient had a femoral nerve injury. Preoperatively, 10 patients had severe foot drop with muscle weakness and a functional grade of 0/5; 16 patients had grades ranging from 1 to 2/5; and two patients had 3/5. Overall, 23 of the 28 patients (83%) had improvement in their ankle dorsiflexion with anti-gravity and regained a healthier gait after the decompression, neurolysis, and nerve transfer at our clinic.ConclusionTwenty-three of the 28 (83%) iatrogenic foot drop patients in this report regained a healthier gait with improved ankle dorsiflexion and anti-gravity after the neurolysis, and nerve transfer of the peroneal or tibial nerve and transfer of functional fascicles of either the superficial peroneal or the tibial nerve to the deep peroneal nerve at our clinic.

Dataset Information

Feasibility of a promising pulsed electrostimulator for rapid motor recovery of foot drop.

Purpose

Materials and methods

Results and conclusions

Publications

Feasibility of a promising pulsed electrostimulator for rapid motor recovery of foot drop.

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