title: Effect of a foot-drop stimulator and ankle-foot orthosis on walking performance after stroke: a multicenter randomized controlled trial.
abstract: BACKGROUND
  Studies have demonstrated the efficacy of functional electrical stimulation in the management of foot drop after stroke.
  
  
  OBJECTIVE
  To compare changes in walking performance with the WalkAide (WA) foot-drop stimulator and a conventional ankle-foot orthosis (AFO).
  
  
  METHODS
  Individuals with stroke within the previous 12 months and residual foot drop were enrolled in a multicenter, randomized controlled, crossover trial. Subjects were assigned to 1 of 3 parallel arms for 12 weeks (6 weeks/device): arm 1 (WA-AFO), n = 38; arm 2 (AFO-WA), n = 31; arm 3 (AFO-AFO), n = 24. Primary outcomes were walking speed and Physiological Cost Index for the Figure-of-8 walking test. Secondary measures included 10-m walking speed and perceived safety during this test, general mobility, and device preference for arms 1 and 2 for continued use. Walking tests were performed with (On) and without a device (Off) at 0, 3, 6, 9, and 12 weeks.
  
  
  RESULTS
  Both WA and AFO had significant orthotic (On-Off difference), therapeutic (change over time when Off), and combined (change over time On vs baseline Off) effects on walking speed. An AFO also had a significant orthotic effect on Physiological Cost Index. The WA had a higher, but not significantly different therapeutic effect on speed than an AFO, whereas an AFO had a greater orthotic effect than the WA (significant at 12 weeks). Combined effects on speed after 6 weeks did not differ between devices. Users felt as safe with the WA as with an AFO, but significantly more users preferred the WA.
  
  
  CONCLUSIONS
  Both devices produce equivalent functional gains.
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Dirk G
authors.initials: DG
authors.lastname: Everaert
authors.forename: Richard B
authors.initials: RB
authors.lastname: Stein
authors.forename: Gary M
authors.initials: GM
authors.lastname: Abrams
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Dromerick
authors.forename: Gerard E
authors.initials: GE
authors.lastname: Francisco
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Hafner
authors.forename: Thy N
authors.initials: TN
authors.lastname: Huskey
authors.forename: Michael C
authors.initials: MC
authors.lastname: Munin
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Nolan
authors.forename: Conrad V
authors.initials: CV
authors.lastname: Kufta
mesh_terms: D000328:Adult; D000368:Aged; D000842:Ankle / Q000294:innervation*; D018592:Cross-Over Studies; D004599:Electric Stimulation Therapy; D005260:Female; D033023:Foot Joints / Q000294:innervation; D061826:Foot Orthoses; D020233:Gait Disorders, Neurologic / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D020521:Stroke / Q000150:complications* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: drop foot; functional electrical stimulation; mobility; physiological cost; stroke rehabilitation; walking speed