FES in Stroke

A standard intervention for addressing foot drop (the inability to lift the foot during walking) has been the use of an ankle foot orthosis (AFO). An AFO  holds the ankle in a fixed position to help clear the foot over ground, preventing it from dropping and catching on the ground during walking.

While it can be a useful intervention to assist walking after stroke there are some drawbacks associated with use of an AFO– the need for a larger shoe size to accommodate the AFO, the limitation of movement at the ankle (where it is an intervention to restrict ankle movement) and the continuing need in many situations to swing (circumduct) the affected limb outwards to take a step.

In contrast to an AFO a dropped foot stimulator directly stimulates leg muscles affected by the stroke enhancing rather than limiting ankle movement during walking and encouraging a more normal walking pattern where, not only ankle, but additionally, knee and hip excursion (movement) can be improved.

While correction of foot drop is the principal goal for fitting a dropped foot stimulator user audits report benefits related to improvement in walking that affect safety and quality of life. These   include: reduced incidence of falls; increased walking speed; improved walking confidence & independence; reduced anxiety and depression; reduced physiologic cost (effort) of walking as well as increased activity level and community participation.

The 6 most commonly cited reasons in a Canadian audit of 30 patients fitted with the Odstock Dropped Foot Stimulator (ODFS) include: ability to walk faster (70% of respondents); ability to walk further (60%); walking requires less effort: (66%); experience fewer falls: (66% ); ability to be more active: (57% ); feeling safer while walking: (57%) . These outcomes are similar to results of a British audit of users where greater confidence (79%); less effort (78%) and less prone to tripping (70%) were the three most common benefits cited with stimulator use. When evaluating individuals for a dropped foot stimulator it is important to consider the overall potential benefits to walking that can be achieved with simple restoration of ankle muscle activation.