title: Restoration of ankle movements with the ActiGait implantable drop foot stimulator: a safe and reliable treatment option for permanent central leg palsy.
abstract: OBJECT The ActiGait drop foot stimulator is a promising technique for restoration of lost ankle function by an implantable hybrid stimulation system. It allows ankle dorsiflexion by active peroneal nerve stimulation during the swing phase of gait. In this paper the authors report the outcome of the first prospective study on a large number of patients with stroke-related drop foot. METHODS Twenty-seven patients who experienced a stroke and with persisting spastic leg paresis received an implantable ActiGait drop foot stimulator for restoration of ankle movement after successful surface test stimulation. After 3 to 5 weeks, the stimulator was activated, and gait speed, gait endurance, and activation time of the system were evaluated and compared with preoperative gait tests. In addition, patient satisfaction was assessed using a questionnaire. RESULTS Postoperative gait speed significantly improved from 33.9 seconds per 20 meters to 17.9 seconds per 20 meters (p < 0.0001), gait endurance from 196 meters in 6 minutes to 401 meters in 6 minutes (p < 0.0001), and activation time from 20.5 seconds to 10.6 seconds on average (p < 0.0001). In 2 patients with nerve injury, surgical repositioning of the electrode cuff became necessary. One patient showed a delayed wound healing, and in another patient the system had to be removed because of a wound infection. Marked improvement in mobility, social participation, and quality of life was confirmed by 89% to 96% of patients. CONCLUSIONS The ActiGait implantable drop foot stimulator improves gait speed, endurance, and quality of life in patients with stroke-related drop foot. Regarding gait speed, the ActiGait system appears to be advantageous compared with foot orthosis or surface stimulation devices. Randomized trials with more patients and longer observation periods are needed to prove the long-term benefit of this device.
authors.affiliation: Department of Neurological Surgery, Carl-Gustav-Carus University Hospital of the Technical University of Dresden; and.
authors.forename: Klaus Daniel
authors.initials: KD
authors.lastname: Martin
authors.affiliation: Department of Neurological Surgery, Carl-Gustav-Carus University Hospital of the Technical University of Dresden; and.
authors.forename: Witold Henryk
authors.initials: WH
authors.lastname: Polanski
authors.affiliation: Department of Neurological Surgery, Carl-Gustav-Carus University Hospital of the Technical University of Dresden; and.
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Schulz
authors.affiliation: Neurologic Rehabilitation Centre, Brandenburg Klinik, Bernau-Waldsiedlung, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Jöbges
authors.affiliation: Radiologische Praxis Dresden, and.
authors.forename: Hansjoerg
authors.initials: H
authors.lastname: Hoff
authors.affiliation: Department of Neurological Surgery, Carl-Gustav-Carus University Hospital of the Technical University of Dresden; and.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schackert
authors.affiliation: Department of Neurological Surgery, Carl-Gustav-Carus University Hospital of the Technical University of Dresden; and.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pinzer
authors.affiliation: Department of Neurological Surgery, Carl-Gustav-Carus University Hospital of the Technical University of Dresden; and.
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Sobottka
mesh_terms: D000328:Adult; D000368:Aged; D000842:Ankle; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005528:Foot; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D019635:Neurosurgical Procedures / Q000379:methods*; D010243:Paralysis / Q000628:therapy*; D017060:Patient Satisfaction; D010807:Physical Endurance; D011446:Prospective Studies; D011788:Quality of Life; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D055815:Young Adult
keywords: ActiGait; drop foot; functional neurosurgery; implantable stimulator; stroke