, Volume 100, Issue 3, pp 223–229 | Cite as

Restoring mobility after stroke: first kinematic results from a pilot study with a hybrid drop foot stimulator

  • D. YaoEmail author
  • E. Jakubowitz
  • K. Tecante
  • M. Lahner
  • S. Ettinger
  • L. Claassen
  • C. Plaass
  • C. Stukenborg-Colsman
  • K. Daniilidis
Original Article



The objective was to obtain first insights into the kinematic and kinetic walking patterns resulting from an implanted functional electrical stimulation system in subjects with a drop foot caused by stroke.


Four subjects who experienced a stroke were chosen due to a comparatively long/short time after surgery and young/old at the stroke event were examined retrospectively with gait analysis. Kinematics and kinetics of normal walking were assessed in comparison with and without activated drop foot stimulation.


In general, an improvement regarding spatiotemporal parameters as a result of the stimulation could be observed. Walking speed was increased by 45 % and stride length by 22 % after a mean usage of 7 (2–14) months, whereas both younger subjects improved significantly more. Dorsiflexion increased in all subjects on average from 1.3° to 11.6° during initial contact as well as from 11.3° to 17.0° during mid-swing and therefore implies an advantage of around 5.5 inch foot clearance. Pathologic elements like knee hyperextension during loading response and mid-stance, leg circumduction during swing or the increased hip flexion of the contralateral leg during mid-stance could be in general adjusted with stimulation.


An implantable functional electrical stimulation system seems to be a promising treatment of drop feet following strokes. Further clinical investigations are necessary to confirm these first insights.


Drop foot Stroke Functional electrical stimulation Implantable functional electrical Stimulation system 



We like to thank Christopher Müller for drawings.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest related to the publication of this article.


  1. 1.
    Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V et al (2010) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study. Lancet 380:2095–2128CrossRefGoogle Scholar
  2. 2.
    Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet 380:2197–2223CrossRefPubMedGoogle Scholar
  3. 3.
    Cheng PT, Chen CL, Wang CM, Hong WH (2004) Leg muscle activation patterns of sit-to-stand movement in stroke patients. Am J Phys Med Rehabil 83:10–16CrossRefPubMedGoogle Scholar
  4. 4.
    Fatone S, Gard SA, Malas BS (2009) Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia. Arch Phys Med Rehabil 90:810–818CrossRefPubMedGoogle Scholar
  5. 5.
    Franceschini M, Massucci M, Ferrari L, Agosti M, Paroli C (2003) Effects of an ankle-foot orthosis on spatiotemporal parameters and energy cost of hemiparetic gait. Clin Rehabil 17:368–372CrossRefPubMedGoogle Scholar
  6. 6.
    Mulroy SJ, Eberly VJ, Gronely JK, Weiss W, Newsam CJ (2010) Effect of AFO design on walking after stroke: impact of ankle plantar flexion contracture. Prosthet Orthot Int 34:277–292CrossRefPubMedGoogle Scholar
  7. 7.
    Given JD, Dewald JP, Rymer WZ (1995) Joint dependent passive stiffness in paretic and contralateral limbs of spastic patients with hemiparetic stroke. J Neurol Neurosurg Psychiatry 59:271–279CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Janssen WG, Bussmann HB, Stam HJ (2002) Determinants of the sit-to-stand movement: a review. Phys Ther 82:866–879PubMedGoogle Scholar
  9. 9.
    Doğan A, Mengüllüoğlu M, Özgirgin N (2011) Evaluation of the effect of ankle-foot orthosis use on balance and mobility in hemiparetic stroke patients. Disabil Rehabil 33:1433–1439CrossRefPubMedGoogle Scholar
  10. 10.
    The management of stroke rehabilitation working group. VA/DoD clinical practice guideline for the management of stroke rehabilitation. Version 2.0; 2010:150.4Google Scholar
  11. 11.
    Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P et al (2010) Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke 41:2402–2448CrossRefPubMedGoogle Scholar
  12. 12.
    Truelsen T, Piechowski-Jozwiak B, Bonita R, Mathers C, Bogousslavsky J, Boysen G (2006) Stroke incidence and revalence in Europe: a review of available data. Eur J Neurol 13:581–598CrossRefPubMedGoogle Scholar
  13. 13.
    Sheffler LR, Hennessey MT, Naples GG, Chae J (2006) Peroneal nerve stimulation versus an ankle foot orthosis for correction of footdrop in stroke: impact on functional ambulation. Neurorehabil Neural Repair 20:355–360CrossRefPubMedGoogle Scholar
  14. 14.
    van Swigchem R, Vloothuis J, den Boer J, Weerdesteyn V, Geurts AC (2010) Is transcutaneous peroneal stimulation beneficial to patients with chronic stroke using an ankle-foot orthosis? A within-subjects study of patient’s satisfaction, walking speed and physical activity level. J Rehabil Med 42:117–121CrossRefPubMedGoogle Scholar
  15. 15.
    Ring H, Treger I, Gruendlinger L, Hausdorff JM (2009) Neuroprosthesis for footdrop compared with an ankle-foot orthosis: effects on postural control during walking. J Stroke Cerebrovasc Dis 18:41–47CrossRefPubMedGoogle Scholar
  16. 16.
    Kadaba MP, Ramakrishnan HK, Wootten ME, Gainey J, Gorton C, Cochran GV et al (1989) Repeatability of kinematic, kinetic, and electromyographic data in normal adult gait. J Orthop Res 7:849–860CrossRefPubMedGoogle Scholar
  17. 17.
    Kunst AE, Amiri M, Janssen F (2011) The decline in stroke mortality. Exploration of future trends in 7 western European countries. Stroke 42:2126–2130CrossRefPubMedGoogle Scholar
  18. 18.
    Foerch C, Misselwitz B, Sitzer M, Steinmetz H, Neumann-Haefelin T (2008) Die Schlaganfallzahlen bis zum Jahr 2050. Dtsch Ärzteblatt 26:467–473 (in German) Google Scholar
  19. 19.
    Busch M, Heuschmann P, Wiedmann S (2007) Recent changes in stroke mortality trends in Germany. Eur J Epidemiol 27(Suppl 1):S69–S70Google Scholar
  20. 20.
    Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) (2012) Schlaganfall DEGAM-Leitlinie Nr. 8. [Stroke DEGAM-Guidline No.8.] 1st ed. Balve: Zimmermann p 27 (in German)Google Scholar
  21. 21.
    Davis RB III, Ounpuu S, Tyburski D, Gage JR et al (1991) A gait analysis data collection and reduction technique. Hum Movement Sci 10:575–587CrossRefGoogle Scholar
  22. 22.
    Martin KD, Polanski WH, Schulz AK, Jöbges M, Hoff H, Schackert G, Pinzer T, Sobottka SB (2016) Restoration of ankle movements with the ActiGait implantable drop foot stimulator: a safe and reliable treatment option for permanent central leg palsy. J Neurosurg 124:70–76CrossRefPubMedGoogle Scholar
  23. 23.
    Duffell LD, Hope N, McGregor AH (2014) Comparison of kinematic and kinetic parameters calculated using a cluster-based model and vicon’s plug-in gait. Proc Inst Mech Eng H 228:206–210CrossRefPubMedGoogle Scholar
  24. 24.
    Hausdorff JM, Ring H (2008) Effects of a new radio frequency-controlled neuroprosthesis on gait symmetry and rhythmicity in patients with chronic hemiparesis. Am J Phys Med Rehabil 87:4–13CrossRefPubMedGoogle Scholar
  25. 25.
    Bethoux F, Rogers HL, Nolan KJ, Abrams GM, Annaswamy TM, Brandstater M et al (2014) The effects of peroneal nerve functional electrical stimulation versus ankle-foot orthosis in patients with chronic stroke: a randomized controlled trial. Neurorehabil Neural Repair 28:688–689CrossRefPubMedGoogle Scholar
  26. 26.
    Stein RB, Everaert DG, Thompson AK et al (2010) Long-term therapeutic and orthotic effects of a foot drop stimulator on walking performance in progressive and nonprogressive neurological disorders. Neurorehabil Neural Repair 24:152–167CrossRefPubMedGoogle Scholar
  27. 27.
    Sheffler LR, Bailey SN, Wilson RD, Chae J (2012) Spatiotemporal, kinematic, and kinetic effects of a peroneal nerve stimulator versus an ankle foot orthosis in hemiparetic gait. Neurorehabil Neural Repair 27:403–410CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Esquenazi A, Ofluoglu D, Hirai B, Kim S (2009) The effect of an ankle-foot orthosis on temporal spatial parameters and asymmetry of gait in hemiparetic patients. PM R 1:1014–1018CrossRefPubMedGoogle Scholar
  29. 29.
    O’Dell MW, Dunning K, Kluding P, Wu SS, Feld J, Ginosian J, McBride K (2014) Response and prediction of improvement in gait speed from functional electrical stimulation in persons with poststroke drop foot. PM R 6:587–601CrossRefPubMedGoogle Scholar

Copyright information

© Istituto Ortopedico Rizzoli 2016

Authors and Affiliations

  • D. Yao
    • 1
    Email author
  • E. Jakubowitz
    • 2
  • K. Tecante
    • 2
  • M. Lahner
    • 3
  • S. Ettinger
    • 1
  • L. Claassen
    • 1
  • C. Plaass
    • 1
  • C. Stukenborg-Colsman
    • 1
  • K. Daniilidis
    • 1
  1. 1.Department of Orthopaedic SurgeryHannover Medical SchoolHannoverGermany
  2. 2.Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic SurgeryHannover Medical SchoolHannoverGermany
  3. 3.Department of Orthopaedic Surgery and TraumatologyUniversity Hospital BochumBochumGermany

Personalised recommendations