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FES or AFO to improve hemiplegic gait post stroke

March 11, 2019

 

A 2015 study  by Bethoux et al., investigating dropped foot stimulation (DFS) versus an ankle foot orthosis (AFO)  to assist gait post stroke, reported  DFS to be “not inferior “  to an AFO in improving gait components in stroke subjects. (Long-Term Follow-up to  a Randomized Controlled Trial comparing FES ro an AFO for Patients with Chronic Stroke: J of Neurorehabilitation and Neural Repair, February 2015). Other studies also report the benefit of  dropped foot stimulation to assist gait.

In light of published evidence for both DFS and AFO in improving stroke gait, the decision on which intervention is best for the patient can be difficult particularly if clinician experience with  FES  is limited. The conventional approach may be patient referral for an AFO but without knowledge of whether it is, in fact, the best long- term approach.

While an AFO can only be tried by the patient after fabrication is completed, DFS can be assessed at any time during rehabilitation using a muscle stimulator, available in most physiotherapy departments.

Single or repeated FES trials will assist the physiotherapist in determining the patient’s response to stimulation & the potential long term benefit of a DFS.

Ensuring adequate & sufficient assessment of available interventions (FES or AFO) for foot drop is key to optimizing gait outcomes in stroke care.

More on considerations & assessment for DFS in upcoming blog posts.

 

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