Surface peroneal nerve stimulation in lower limb hemiparesis: Effect on quantitative gait parameters

Objective: The objective of this study was to evaluate possible mechanisms for functional improvement and compare ambulation training with surface peroneal nerve stimulation vs. usual care via quantitative gait analysis. Design: This study is a randomized controlled clinical trial. Setting: The setting of this study is a teaching hospital of an academic medical center. Participants: One hundred ten chronic stroke survivors (912 wks poststroke) with unilateral hemiparesis participated in this study. Interventions: The subjects were randomized to a surface peroneal nerve stimulation device or usual care intervention. The subjects were treated for 12 wks and followed up for 6-mo posttreatment. Main Outcome Measures: Spatiotemporal, kinematic, and kinetic parameters of gait were the main outcome measures. Results: Cadence (F_3,153 = 5.81, P = 0.012), stride length (F_3,179 = 20.01, P G 0.001), walking speed (F_3,167 = 18.2, P G 0.001), anterior-posterior ground reaction force (F_3,164 = 6.61, P = 0.004), peak hip power in preswing (F_3,156 = 8.76, P G 0.001), and peak ankle power at push-off (F_3,149=6.38, P=0.005) all improved with respect to time. However, peak ankle ankle dorsiflexion in swing (F_3,184 = 4.99, P = 0.031) worsened. In general, the greatest change for all parameters occurred during the treatment period. There were no significant treatment group timeinteraction effects for any of the spatiotemporal, kinematic, or kinetic parameters. Conclusions: Gait training with peroneal nerve stimulation and usual care was associated with improvements in peak hip power in preswing and peak ankle power at push-off, which may have resulted in improved cadence, stride length, and walking speed; however, there were no differences between treatment groups. Both treatment groups also experienced a decrease in peak ankle ankle dorsiflexion in swing, although the clinical implications of this finding are unclear.