Foot drop stimulation versus ankle foot orthosis after stroke: 30-week outcomes.

BACKGROUND AND PURPOSE: Drop foot after stroke may be addressed using an ankle foot orthosis (AFO) or a foot drop stimulator (FDS). The Functional Ambulation: Standard Treatment versus Electric Stimulation Therapy (FASTEST) trial was a multicenter, randomized, single-blinded trial comparing FDS and AFO for drop foot among people ≥ 3 months after stroke with gait speed ≤ 0.8 m/s. METHODS: Participants (n=197; 79 females and 118 males; 61.14 ± 11.61 years of age; time after stroke 4.55 ± 4.72 years) were randomized to 30 weeks of either FDS or a standard AFO. Eight dose-matched physical therapy sessions were provided to both groups during the first 6 weeks of the trial. RESULTS: There was significant improvement within both groups from baseline to 30 weeks in comfortable gait speed (95% confidence interval for mean change, 0.11-0.17 m/s for FDS and 0.12-0.18 m/s for AFO) and fast gait speed. However, no significant differences in gait speed were found in the between-group comparisons. Secondary outcomes (standard measures of body structure and function, activity, and participation) improved significantly in both groups, whereas user satisfaction was significantly higher in the FDS group than in the control group. CONCLUSIONS: Using either an FDS or an AFO for 30 weeks yielded clinically and statistically significant improvements in gait speed and other functional outcomes. User satisfaction was higher in the FDS group. Although both groups did receive intervention, this large clinical trial provides evidence that FDS or AFO with initial physical therapy sessions can provide a significant and clinically meaningful benefit even years after stroke. Clinical Trial Registration Information- URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01138995.

Peroneal Stimulation for Foot Drop After Stroke: A Systematic Review.

The purpose of this systematic review was to summarize the effect of daily use of single-channel foot drop stimulation among persons with stroke. Randomized controlled trials were searched using electronic databases through May 2014. Six randomized controlled trials were included, involving 820 participants. Gait speed was the most common outcome measured. Other common outcomes included Timed Up and Go, modified Emory Functional Ambulation Profile, Berg Balance Scale, Physiologic Cost Index, Six-Minute Walk Test, quality-of-life, and lower extremity Fugl-Meyer. In summary, foot drop stimulation and ankle foot orthoses seem effective and "equivalent" for increasing gait speed. Other outcomes that consistently improved in both groups were the Timed Up and Go and Six-Minute Walk Test. Foot drop stimulation was more effective compared with ankle foot orthosis for decreasing Physiologic Cost Index and seemed to be preferred by participants. Physical therapy may facilitate improvement in both foot drop stimulation and ankle foot orthosis groups.

Improving selected hand functions using a noninvasive neuroprosthesis in persons with chronic stroke.

BACKGROUND AND PURPOSE: Loss of upper extremity function following stroke remains a major rehabilitation challenge. The purpose of this investigation was to determine whether the Handmaster system (NESS Ltd., Ra'anana, Israel) could improve selected hand functions in persons with chronic upper extremity paresis following stroke. METHODS: Twenty-nine poststroke subjects consented to participate in a home-based, 3-week, nonrandomized case series trial. Main outcome measures included 3 activities of daily living (ADL) tasks: (1) lifting a 2-handled pot, (2) holding a bag while standing with a cane, and (3) a subject-selected-ADL. Secondary outcomes included lifting a 600-g weight, grip strength, electrically induced finger motion, Fugl-Meyer spherical grasp, and perceived pain scale. RESULTS: Comparing baseline to study end point with the neuroprosthesis, the percent of successful trials with lifting the pot, weight, and bag (0% v 93%, 14% v 100%, and 17% v 93%, respectively) increased significantly. All subjects performed successfully their selected ADL and improved their Fugl-Meyer scores using the neuroprosthesis. Grip strength (6.4 +/- 7.3N v 17.7 +/- 6.2N) and active finger motion (0.5 +/- 1.2 cm v 8.4 +/- 2.6 cm) also improved with the neuroprosthesis. Pain scores significantly decreased in subjects reporting pain at baseline. Responses to questionnaire were favorable regarding the utility and therapeutic benefits of the device. CONCLUSIONS: We conclude that the Handmaster is a safe and effective noninvasive neuroprosthesis for improving the studied hand functions and impairments in selected persons with chronic hemiplegia secondary to stroke.

Response and prediction of improvement in gait speed from functional electrical stimulation in persons with poststroke drop foot.

OBJECTIVE: To describe changes in and predictors of comfortable gait speed (GS-C) after using a foot-drop stimulator (FDS; Bioness L300; Bioness Inc, Valencia, CA) for 42 weeks in persons who had sustained a stroke. DESIGN: Secondary analysis of prospective assessments. SETTING: Multicenter clinical trial. PARTICIPANTS: A total of 99 subjects who had sustained a stroke ≥ 3 months earlier and who had GS-C ≤ 0.8 m/s and drop foot with a mean age of 60.7 years and a poststroke time of 4.8 years. METHODS: GS-C was assessed at baseline and at 30 weeks with and without use of an FDS (therapeutic effect) and at 6, 12, 30, 36, and 42 weeks with use of an FDS (total effect). After subjects participated in 8 physical therapy sessions, an FDS was used for ambulation over the course of 42 weeks. MAIN OUTCOME MEASUREMENTS: Changes in mean GS-C over time, FDS "responder" status defined as either ≥ 0.1 m/s gain in GS-C (the minimal clinically important difference [MCID]) or advancing by one Perry Ambulation Category (PAC), and the incidence and nature of adverse events (AEs). RESULTS: A total of 74 (75%) and 69 (70%) of 99 subjects completed assessments at 30 weeks and 42 weeks, respectively. Baseline GS-C was 0.42 m/s without use of an FDS and 0.49 m/s with use of an FDS. GS-C improved to 0.54 m/s at 30 weeks without use of an FDS (effect size = 0.75) and 0.54, 0.55, 0.58, 0.60, and 0.61 m/s at 6, 12, 30, 36, and 42 weeks with use of an FDS, respectively (effect size 0.84 at 42 weeks). Half of the subjects achieved a maximum GS-C by 12 weeks. Approximately 18% were PAC responders and 29% were MCID responders for 30-week therapeutic effect, and 55% were PAC responders and 67% were MCID responders for 42-week total effect. After logistic regression, the following factors emerged as the strongest predictors of FDS responders: younger age, faster baseline GS-C and Timed Up and Go, and balance. At 42 weeks, 60% reported a device-related AE; 92% were mild and 96% were anticipated. CONCLUSIONS: When an FDS was used, GS-C improved progressively over 42 weeks, with ≥ 50% of patients achieving a clinically meaningful 42-week total effect and 50% achieving a maximum GS-C by 12 weeks. Younger patients with greater mobility levels may benefit most from use of an FDS. AEs were frequent, mild, and reversible.

Suppressed carrier scattering in CdS-encapsulated PbS nanocrystal films.

One of the key challenges facing the realization of functional nanocrystal devices concerns the development of techniques for depositing colloidal nanocrystals into electrically coupled nanoparticle solids. This work compares several alternative strategies for the assembly of such films using an all-optical approach to the characterization of electron transport phenomena. By measuring excited carrier lifetimes in either ligand-linked or matrix-encapsulated PbS nanocrystal films containing a tunable fraction of insulating ZnS domains, we uniquely distinguish the dynamics of charge scattering on defects from other processes of exciton dissociation. The measured times are subsequently used to estimate the diffusion length and the carrier mobility for each film type within the hopping transport regime. It is demonstrated that nanocrystal films encapsulated into semiconductor matrices exhibit a lower probability of charge scattering than that of nanocrystal solids cross-linked with either 3-mercaptopropionic acid or 1,2-ethanedithiol molecular linkers. The suppression of carrier scattering in matrix-encapsulated nanocrystal films is attributed to a relatively low density of surface defects at nanocrystal/matrix interfaces.

Neuroprosthesis peroneal functional electrical stimulation in the acute inpatient rehabilitation setting: a case series.

BACKGROUND AND PURPOSE: Studies have suggested that peroneal nerve functional electrical stimulation (peroneal FES) during walking improves gait in patients with chronic stroke. The effect of peroneal FES during the acute stages of stroke recovery is not known. The purposes of this case report are: (1) to describe differences between walking with and without a neuroprosthesis during the first few weeks after stroke, (2) to offer a clinical perspective on decision making for the use of peroneal FES during acute rehabilitation, and (3) to determine the feasibility of rehabilitation with peroneal FES neuroprostheses during the acute phases of stroke recovery. CASE DESCRIPTION: This case report describes 2 patients with different clinical presentations but both receiving inpatient rehabilitation less than 2 weeks after stroke. Each patient received peroneal FES via a neuroprothesis as tolerated while gait training in therapy. OUTCOMES: One patient immediately increased gait speed (128%) and decreased time to perform the Timed "Up & Go" Test (40%) using the neuroprothesis. Both patients immediately increased the 6-Minute Walk Test distance using the neuroprothesis (121% and 101%). The patient who underwent testing with the instrumented walking system also demonstrated improved gait symmetry. After 1 to 3 weeks of using the neuroprothesis, the difference between outcomes with and without the neuroprothesis decreased. DISCUSSION: It is possible that peroneal FES delivered through a neuroprosthesis during acute stroke recovery may improve gait outcomes. Research is needed to determine proper duration and timing.

Persons with C5 or C6 tetraplegia achieve selected functional gains using a neuroprosthesis.

OBJECTIVE: To test the efficacy and safety of the NESS Handmaster neuroprosthesis with subjects with C5 or C6 tetraplegia. DESIGN: Interventional, nonrandomized case series. SETTING: Subjects' residence and university research laboratory. PARTICIPANTS: Men, 3 to 17 years after C5 (n=5) and C6 (n=2) spinal cord injury (SCI). INTERVENTION: Subjects practiced with the neuroprosthesis daily to regain grasp, hold, and release ability and to restore selected functions of 1 of the 2 paralyzed hands. Subjects were observed 2 to 3 times weekly for 3 weeks. MAIN OUTCOME MEASURES: Three activities of daily living (ADL) tasks: (1) pick up a telephone, (2) eat food with a fork, and (3) perform 1 individually selected ADL task and 2 grasp, hold, and release tasks (lift a videocassette, lift a 150-g weight). Secondary outcomes were grip strength, electrically induced finger motion, and Fugl-Meyer spherical grasp. Nonparametric data were analyzed with the Wilcoxon signed-rank test, and parametric data (grip strength and finger motion) were analyzed by analysis of variance. All tests were considered significant at P equal to.01. RESULTS: At study completion, all 7 subjects were 100% successful at using the Handmaster in the studied ADL and grasp, hold, and release tasks. Significant improvements occurred in grip strength (from.57+/-.98N at baseline to 16.5+/-4.4N), finger linear motion (from 0.0cm at baseline to 8.4+/-3.2cm), and Fugl-Meyer scores. No safety issues were encountered. Six of 7 subjects rated their overall performance as "excellent." CONCLUSIONS: The Handmaster is a safe, noninvasive neuroprosthesis that improves hand function of selected subjects with C5 or C6 SCI.