Neurológia pre prax 5/2020

Use of functional electrical stimulation in adult neurological patients: how it can be used to manage gait issues

Introduction: Functional electrical stimulation (FES) of the peroneal nerve is used to improve gait in a large group of patients with central motor neuron disease. The aim of the article is to describe, based on available literature, how FES can be utilized in patients after stroke, brain or spinal cord injuries, or in those with multiple sclerosis (MS). Method: For the purpose of writing this article, specialist literature was searched using the PubMed database. Review articles and metaanalyses as well as articles comparing various groups of neurological patients were selected. Results: According to available literature, FES has a positive effect on increasing gait speed and efficiency, on reducing energy demands, and on symmetry and stability, particularly in patients after stroke, with the effect even being persistent. A positive effect on gait speed and its energy demands has also been described in patients with MS; however, the degree of improvement is more limited, particularly in progressive forms of the disease. In patients with other causes of central motor neuron disease, the evidence of FES effect is not sufficient; however, patients with a nonprogressive neurological diagnosis are generally reported to benefit from FES more significantly. Conclusion: In adult neurological patients with foot drop, FES may be one of the options how to improve both qualitative and quantitative gait parameters. In clinical practice, however, the effect on gait must be assessed individually in every patient, particularly in comparison with the use of ankle-foot orthosis.

Keywords: functional electrical stimulation, gait, foot drop, stroke, multiple sclerosis, brain and spinal cord injuries, hemiparesis