Long-term use of implanted peroneal functional electrical stimulation for stroke-affected gait: the effects on muscle and motor nerve.
Frank Berenpas, Vivian Weerdesteyn, Alexander C Geurts and 1 others
PMID 31292003WHAT IT FOUND
One year of implanted peroneal FES made the stroke-affected ankle-lifting muscle thicker and less abnormal on ultrasound.
It did not improve walking, daily steps, or nerve and brain measures.
Key findings
01After one year, the paretic ankle-lifting muscle looked less abnormal and larger: its ultrasound brightness decreased by 1.03 SD and its thickness increased by 0.80 SD.
02Daily steps and comfortable walking speed were not significantly different after one year: steps 6248 ± 3019 (p = 0.59), speed 1.02 ± 0.2 m/s (p = 0.09).
03Nerve and brain-to-muscle measures did not improve: paretic CMAP area decreased from 58.7 to 46.0 mVms, and paretic MEP area decreased from 47.9 to 33.1 mVms.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 12 participants were analysed, and there was no control group, so the study cannot show what would have happened without the implant or stimulation. Participants had to walk at least 10 m without an aid, were not morbidly obese, and averaged about 5800 steps per day, so results may not apply to more impaired or less active stroke survivors. One participant died before follow-up and one system failed after 26 weeks; some non-paretic tibialis anterior values at 52 weeks were imputed. The clinical meaning of the ultrasound changes is uncertain; the authors say relevant cut-offs are not known. The nerve and brain measures decreased after implantation, and the study cannot separate surgical effects from stimulation effects. Hydration status and diuretics may affect muscle ultrasound.
Declared interests
No author conflicts or funding statement are included in the supplied text. The article is indexed as having non-U.S. government research support.
The easy way to misread this
Do not conclude that implanted peroneal FES improves walking or reverses stroke-related nerve damage. The ankle-lifting muscle looked better on ultrasound, but daily steps and walking speed did not change, and nerve and brain-to-muscle measures decreased or did not improve.