Hello, ekw70-ga!
Thank you for your patience and understanding in awaiting an answer
to your question. The foot drop statistics did, indeed, pose a problem
and prevented me from feeling confident about posting an answer. I am
sorry I could not come up with an acual number. I did manage to find
percentages for neurologic and mobility impairments but I realize that
is not as precise a figure as you are seeking.
As per you last clarification, I am happy to follow through with an
answer to the other components of your question!
==========
BACKGROUND
===========
What is Foot Drop?
"Foot drop can be defined as a significant weakness of ankle and toe
dorsiflexion. The foot and ankle dorsiflexors include the tibialis
anterior, extensor hallucis longus, and extensor digitorum longus.
These muscles help the body clear the foot during swing phase and
control plantar flexion of the foot on heel strike. Weakness in this
group of muscles results in an equinovarus deformity. This is
sometimes referred to as steppage gait, because the patient tends to
walk with an exaggerated flexion of the hip and knee to prevent the
toes from catching on the ground during swing phase. During gait, the
force of heel strike exceeds body weight, and the direction of the
ground reaction vector passes behind the ankle and knee center (see
Picture 1). This causes the foot to plantar flex, and if uncontrolled,
to slap the ground. Ordinarily, eccentric lengthening of the anterior
tibialis, which controls plantar flexion, absorbs the shock of heel
strike. Injury to the dorsiflexors, or to any point along the neural
pathways that supply them, can result in foot drop."
From "Foot Drop," by James W Pritchett, MD. Emedicine. (Last Updated:
June 27, 2002)
http://www.emedicine.com/orthoped/topic389.htm
======================================================================
US Statistics for Impaired Mobility, including foot drop - From Stroke
======================================================================
"Recent estimates suggest that nearly three quarters of a million
Americans annually suffer a stroke, an incidence rate nearly 50%
higher than previously calculated.1 Notwithstanding current
rehabilitative efforts, outcomes data consistently indicate that
** approximately two thirds of stroke survivors have chronic
neurological impairments that affect their activities of daily living
(ADL), especially their mobility.2
Principal among these long-term impairments is motor weakness.
Residual hemiparesis and spasticity enhance fall risk,3 increase
energy expenditure during gait,4 5 and ultimately foster activity
intolerance6 in these individuals. Collectively, the functional
consequences associated with long-term motor deficits predispose the
great majority of stroke survivors to a generally sedentary lifestyle
with concomitant deconditioning, disuse atrophy, and sarcopenia,
thereby contributing to further declines in ADL function and
disability status."
(See full article for footnoted references)
From "Task-Oriented" Exercise Improves Hamstring Strength and Spastic
Reflexes in Chronic Stroke Patients", by Gerald V. Smith, PhD, PT;
Kenneth H. C. Silver, MD; Andrew P. Goldberg, MD; Richard F. Macko,
MD. Stroke. 1999;30:2112-2118.)
http://stroke.ahajournals.org/cgi/content/full/30/10/2112
=========================
METHODS OF REHABILITATION
=========================
Overview:
=========
"CVA is a very common problem that can lead to lower extremity
complications. Impairment in gait pattern occurs often due to
spasticity and less frequently due to prolonged flaccidity. This
problem is manifested by equinus, varus, equinovarus, and toe flexion
deformities. Therefore, prevention or elimination of spasticity must
be achieved. Various modalities have been used, both conservative and
surgical. Nonsurgical interventions include range of motion and
strengthening exercises, pharmacologic agents, local anesthetic and
phenol motor point blocks, and the use of orthoses. Surgical
intervention should be considered after conservative treatment has
failed. The goal of treatment is to reduce the deforming force as a
result of spasticity and to allow for almost normal function to be
achieved. This includes tendon transfers, tendon lengthenings,
tenotomies, and arthrodeses of small toe joints. Preoperatively, the
extent and progression of spasticity must be determined because this
may affect the rate of recurrence of the deformity following surgical
correction. The combination of arthrodeses of the interphalangeal
joints and flexor tendon release is the best option in the presence of
a spastic deformity. Arthrodesis provides for stability at the joint,
whereas a flexor release eliminates the deforming force. Failure to
address the plantar-flexor force of the long flexors can lead to
instability at the fusion site. This may in turn lead to nonunion and
recurrence of flexion contracture as shown in the case report in this
article."
From "Stroke and its manifestations in the foot. A case report."
Harkless LB, Bembo GP.
Clin Podiatr Med Surg. 1994 Oct;11(4):635-45.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=95112226
====
"Independent ambulation is an important ultimate goal, often requiring
several stages of recovery. Initially, patients exhibit poor trunk
control, are unable to bear weight on the affected extremity, and are
unable to advance the leg during the swing phase. Initial therapy
should focus upon posture, trunk control, and weight transfer to the
hemiparetic leg. Many patients have weakness of ankle dorsiflexion and
require an ankle-foot orthosis (AFO) to prevent foot drop and maintain
knee extension during weight bearing."
"Methods to reeducate a hemiparetic limb include modalities such as
electromyography (EMG), biofeedback, and functional electrical
stimulation
From "Middle Cerebral Artery Stroke", by Daniel I Slater, MD.
Emedicine (updated 8/28/2003)
http://www.emedicine.com/pmr/topic77.htm
Physical Therapy:
=================
"Physical therapy (PT) helps restore physical functioning and skills
like walking and range of movement. Major impairments which PT works
on include partial or one-sided paralysis, faulty balance and foot
drop.
"Recovery and Rehabilitation." National Stroke Association.
http://209.107.44.93/NationalStroke/RecoveryAndRehabilitation/default.htm
Treadmill training:
==================
"Treadmill therapy with partial BWS is a promising new approach to
improve gait ability after stroke. This task-specific approach enables
nonambulatory patients the repetitive practice of complex gait cycles
instead of single-limb gait-preparatory maneuvers. Patients walk more
symmetrically with less spasticity and better cardiovascular
efficiency on the treadmill than with floor walking. Several
controlled, clinical studies have shown the potential of treadmill
training as a therapeutic intervention for nonambulatory patients with
chronic stroke-related hemiplegia. Furthermore, controlled trials in
acute stroke survivors have shown that treadmill training is as
effective as other physiotherapy approaches that stress the repetitive
practice of gait. Controlled multicenter trials comparing locomotor
training with conventional therapy will be forthcoming. An
electromechanical gait trainer that relieves the strenuous effort of
the therapists and provides control of the trunk in a phase-dependent
manner is a new technical alternative for gait training in severely
impaired stroke patients."
From "Treadmill training with partial body weight support after
stroke", by Hesse S, Werner C, von Frankenberg S, Bardeleben A. Phys
Med Rehabil Clin N Am. 2003 Feb;14(1 Suppl):S111-23.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12625641&dopt=Abstract
==
Virtual Reality on the Treadmill
"Soon, the same kind of technology that simulates flight for student
pilots will help people learn to walk again after a stroke. A research
team led by Dr. Carol Richards of Laval University and Dr. Joyce Fung
of McGill University is testing a unique rehabilitation program that
pushes traditional treadmill therapy to another dimension, by allowing
stroke patients to take their first trip to the mall without ever
leaving the security of a virtual reality world."
"Beginning this fall, a high-tech prototype for stroke therapy, funded
in part by the Canadian Stroke Network, will be used to develop stroke
patients? motor and cognitive abilities, enabling them to regain
skills lost after a stroke, or brain attack. Patients will wear a
safety harness and train on motorized treadmills and virtual reality
systems housed in two rehabilitation centres in Quebec City and
Montreal.
"The treadmills are mounted on platforms that rock and tilt in
synchrony with changing ?environmental animations? displayed on large
screens before their eyes. For example, as the stroke patient
approaches a ramp in the imaginary world on the screen, the treadmill
tilts to simulate the change in his path. The unique system is now
being developed and tested by a multi-disciplinary team of
rehabilitation specialists and engineers. More preliminary work
remains to be done before it can be used with patients. But, when the
system is ready, it will be tested on 10 patients over six weeks.
Another 10 patients will participate in a control group and receive
traditional treadmill therapy. Researchers will determine which system
works best by testing whether patients can transfer their functional
gains from therapy into actual situations. The goal of the virtual
reality system is to improve stroke recovery by making rehabilitation
motivating, interesting and fun."
(Read more......)
From "Making Stroke Recovery a Virual Reality" by Cathy Campbell.
Hospital News. (June 2003)
http://www.hospitalnews.com/content/pdfs/June2003/pdfs/01_15.pdf
Surgery
=======
"Surgical intervention should be considered after conservative
treatment has failed. The goal of treatment is to reduce the deforming
force as a result of spasticity and to allow for almost normal
function to be achieved. This includes tendon transfers, tendon
lengthenings, tenotomies, and arthrodeses of small toe joints."
From "Stroke and its manifestations in the foot. A case report."
Harkless LB, Bembo GP. Clin Podiatr Med Surg. 1994 Oct;11(4):635-45.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=95112226
Excerpts of Surgical Intervention studies:
-----------------------------------------
From "Tendon transfer for equinovarus deformed foot caused by
cerebrovascular disease", by Morita S, Muneta T, Yamamoto H, Shinomiya
K. Clin Orthop. 1998 May;(350):166-73.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=98265526
"Surgical correction was performed on 125 patients who had equinovarus
deformity caused by a cerebrovascular accident and who needed an ankle
foot orthosis for walking. The operative procedures involved anterior
transfer of the long toe flexors (flexor hallux longus and flexor
digitorum longus; long toe flexor group) or lateral transfer of the
anterior tibial tendon (anterior tibial tendon group), combined with
lengthening of the Achilles tendon.
* On evaluation more than 2 years after surgery, 83 of 110 patients of
the long toe flexor group and eight of 15 patients of the anterior
tibial tendon group were able to walk without a brace.
Five patients of the anterior tibial tendon group who had shown strong
contraction of the anterior tibial muscle during the swing phase
before surgery, needed a brace because of a drop foot after surgery.
Thus, lateral transfer of the anterior tibial tendon was abandoned in
1984. Recurrence of varus deformity was seen in approximately 15% of
the patients in both groups. Anterior transfer of the long toe
flexors, using them as dorsiflexor tendons or for tenodesis, seemed to
produce better results."
Ankle Foot Orthosis (AFO)
==========================
"If foot drop is not amenable to surgery, an ankle foot orthosis (AFO)
often is used. An AFO also is used during surgical or neurological
recovery. The specific purpose of an AFO is to provide toe
dorsiflexion during the swing phase, medial and/or lateral stability
at the ankle during stance, and if necessary, push-off stimulation
during the late stance phase. An AFO is helpful only if the foot can
achieve plantigrade position when standing. Any equinus contracture
prohibits its successful use."
"The most commonly used AFO in foot drop is constructed of
polypropylene and inserts into a shoe. If it is trimmed to fit
anterior to the malleoli, it provides rigid immobilization. This is
used when ankle instability or spasticity is problematic, such as in
patients with upper motor neuron diseases or stroke. If the AFO fits
posterior to the malleoli (posterior leaf spring type), plantar
flexion at heel strike is allowed, and push-off returns the foot to
neutral for the swing phase. This provides dorsiflexion assistance in
instances of flaccid or mild spastic equinovarus deformity. A
shoe-clasp orthosis that attaches directly to the heel counter of the
shoe also may be used."
From "Foot Drop," by James W Pritchett, MD. Emedicine. (Last Updated:
June 27, 2002)
http://www.emedicine.com/orthoped/topic389.htm
Electromyographic Signals and Electrical Stimulation
======================================================
What is EMG?
------------
"ElectroMyoGraphic signals are called EMG. They are electrical
activities originating in the brain and transported via nerve cells to
the muscles. These signals cause the muscles to contract. Often EMG
signals are disturbed after a brain attack leading to paralysis of
muscles."
What is NMES?
-------------
"NeuroMuscular Electrical nerve Stimulation (NMES) is the application
of an electrical stimulus for muscle rehabilitation. During NMES an
electrical impulse is passed from a device to electrodes placed on the
skin over a targeted muscle or muscle group. The stimulation causes
the muscle(s) to contract."
What is the difference between NMES, NMS, FES and ES?
-----------------------------------------------------
"It is all the same but with different names: NMES stands for
NeuroMuscular Electrical Stimulation. NMS stands for NeuroMuscular
Stimulation FES stands for Functional Electrical Stimulation. ES
stands for Electrical Stimulation."
What is EMG triggered NMES?
---------------------------
"The combination of both modalities offer superior possibilities for
re-learning of otherwise paralysed muscles. This combination method is
also called EMG controlled NMES."
Is EMG triggered NMES, EMS and ETEM similar?
--------------------------------------------
"All different names for exactly the same: EMS stands for
Electromyographic triggered electric Muscle Stimulation. ETEM stands
for Emg Triggered Electrical Myostimulation."
(The above excerpt is from the Curamove website:
http://www.curamove.com/faq1.html#3 )
===
Overview of Electrical Stimulation
----------------------------------
"In patients where foot drop is due to hemiplegia, peroneal nerve
stimulation can be considered. This type of stimulation was first
applied in 1961. Nerve stimulation has advantages to the AFO, as it
provides active gait correction and can be tailored to individual
patients. In this system, a short burst of electrical stimulation is
applied to the common peroneal nerve between the popliteal fossa and
fibular head. A switch in the heel of the affected limb controls this
burst. The stimulator is activated when the foot is lifted and then
stopped when the foot contacts the ground. This achieves dorsiflexion
and eversion during the swing phase of gait. The nerve stimulator can
be either external or implanted and radiofrequency activated. The use
of electrical stimulation in stroke patients with spastic hemiplegia
was reported to be useful in approximately 2% of the cases. This
method was found to do little to improve gait speed but did improve
inversion and heel strike during the stance phase, enhancing the
quality of gait."
From "Foot Drop," by James W Pritchett, MD. Emedicine. (Last Updated:
June 27, 2002)
http://www.emedicine.com/orthoped/topic389.htm
==
Excerpts of some studies involving electrical stimulation for foot
drop after stroke:
-------------------------------------------------------------------------------
From "Rehabilitation of walking with electromyographic biofeedback in
foot- drop after stroke", by D Intiso, V Santilli, MG Grasso, R Rossi
and I Caruso. Stroke, Vol 25, 1189-1192.
http://stroke.ahajournals.org/cgi/content/abstract/25/6/1189
"RESULTS: Electromyographic biofeedback patients showed significantly
increased scores on the Adams scale (P < .05) and Basmajian scale (P <
.01). Gait analysis in this group showed a recovery of foot-drop in
the swing phase (P < .02) after training. CONCLUSIONS: Our data
confirm that the electromyographic biofeedback technique increases
muscle strength and improves recovery of functional locomotion in
patients with hemiparesis and foot-drop after cerebral ischemia.
==
From "Peroneal stimulator; evaluation for the correction of spastic
drop foot in hemiplegia", by Granat MH, Maxwell DJ, Ferguson AC, Lees
KR, Barbenel JC. Arch Phys Med Rehabil. 1996 Jan;77(1):19-24.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=96143265
RESULTS: There was a significant orthotic improvement in inversion on
all surfaces and for symmetry on linoleum (AN-OVA, p = .05). There was
no significant improvement in patients' gait when not using the PS.
There was a significant improvement in the Barthel Index over the
treatment period (Wilcoxon, p = .05). CONCLUSION: Use of the PS an an
orthotic device late in the rehabilitation program would be
appropriate for a selected subpopulation of patients.
==
From "Treatment of drop foot using an implantable peroneal underknee
stimulator", by Strojnik P, Acimovic R, Vavken E, Simic V, Stanic U.
Scand J Rehabil Med. 1987;19(1):37-43.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=87206076
"An implantable peroneal stimulator has been developed to improve the
rehabilitation of the drop foot patients who cannot use or refuse the
use of conventionally applied peroneal braces. The small size promotes
convenient attachment on the stimulation site after a minor surgical
intervention. During the past two years twenty implants have been
applied. The influence of different stimulation parameters upon the
correction of anomalies during walking has been studied using clinical
and computer-supported assessment. Possible noxious effects on the
peroneal nerve have been studied by measuring nerve conduction
velocity. The stimulator is well accepted by patients. Clinical
observations show a significant correction of equinovarus and improved
gait."
========
PRODUCTS
========
(This is a small sample of some prominent manufacturers)
=============================================
Jockey Club Rehabilitation Engineering Clinic
=============================================
www.polyu.edu.hk/rec/reclinic
Jockey Club Rehabilitation Engineering Centre
The Hong Kong Polytechnic University
Phone: (852) 2766-7683
Fax: (852) 2362-4365
Email: rcdept@polyu.edu.hk
"Drop Foot Stimulator"
http://www.polyu.edu.hk/rec/fes/
=======================
Samsons Preston Roylan
=======================
http://www.sammonspreston.com/
Corporate Headquarters
Bolingbrook, IL 60440-5071
Phone: 630-226-1300
Fax: 630-226-1389
Email: spr@abilityone.com
Wisconsin Office
W68 N158 Evergreen Blvd.
Cedarburg, WI 53012
Phone: 1-800-228-3693
Fax: 1-262-387-8748
Rehab Catalog
http://www.sammonspreston.com/rehabCat.htm
See the Rolyan Wheelchair Foot Support (RehabMart catalog)
http://www.rehabmart.com/footdrop.asp
======================================================
Durrett's Orthotic, Prosthetic and Pedorthic Services
======================================================
http://www.durrettsoandp.com/index.shtml
20 Medical Village Drive, Suite 100
St. Elizabeth South Doctor's Building
Edgewood, Kentucky 41017
859-341-7688 Voice
859-341-4476 Fax
Products:
http://www.durrettsoandp.com/Business/productsbusiness/productsbusiness.htm
=======
AFO LAB
=======
http://www.afo-lab.com/
2295 McFaddin St.
Beaumont, TX 77701-1532
Voice: 800/200-5455
Fax: 409/832-4038
Orthotics Products
http://www.afo-lab.com/Catalog/CatalogPage.htm
================================
CURAMOVE 3000 by Curatronic Ltd.
================================
Contact Page: http://www.curamove.com/contact.html
"Stroke recovery and rehabilitation of paralyzed muscles after a
stroke is now possible with the advanced training device Curamove
3000. It is the only device on the market specially developed for use
at home by the stroke patient. The system is able to detect the
extremely small electrical EMG signals still measurable in paralyzed
muscles after a stroke. These tiny signals are used to initiate an
electrical stimulation impulse to the same muscles, resulting in
actual muscle movement! This stroke rehabilitation treatment method is
used to re-learn which part of the brain to activate and to re-develop
spontaneous muscle control. The technology is known as
ElectroMyoGraphic triggered NeuroMuscular Electrical Stimulation or
EMG triggered NMES."
http://www.curamove.com/index.html
"Founded in 1998 and delivering the first systems in March, 2000 the
company has already established itself as supplier of high quality and
very reliable devices. Tens of thousands of patients have already been
treated with Curatron systems. Curatronic supplies Pulsed
ElectroMagnetic Field (PEMF) systems worldwide via direct sales and
through a network of distributors."
http://www.curamove.com/about.html
===============================
MEDDASSIST GROUP - OrthoAbility
===============================
http://www.medassistgp.com/index.html#Orthability
13560 Wright Circle
Tampa, FL 33626
Customer Service: (800) 521-6664
OrthoAbility AFO Products:
http://www.medassistgp.com/medprod2.html
====
EMPI
====
http://www.empi.com/index.cfm
599 Cardigan Road
St. Paul, MN 55126-4099
1-800-328-2536
Electrical Stimulation for Gait Training
http://www.empi.com/products/nmes/gait.pdf
===========================
NeuroMotion Inc. - WalkAide
===========================
Neuromotion, Inc.
11044 82nd Ave., Suite 401
Edmonton, Alberta, CANADA T6G OT2
800/307-7564
FAX 403/433-2893
(No website)
WalkAide
-------
http://www.pde.com/portfoli/neuro/neuro.htm
The first user-friendly device to help restore a more normal gait
pattern for those with foot drop as a result of a neurological disease
or injury, WalkAideTM is a common peroneal nerve stimulator that
easily attaches to the leg with one hand. The unique wireless design
and lightweight construction allow WalkAideTM to be worn below the
knee and discreetly fit under most clothing."
==========
OrthoRehab
==========
http://www.orthorehab.com/index.asp
OrthoRehab
1415 W. 3rd Street, Suite 101
Tempe, Arizona 85281
Corporate Headquarters:
480-281-2200
or 800-711-2205
A3 Ankle
http://www.orthorehab.com/products/detail.asp?product=7
T1 Toe
http://www.orthorehab.com/products/detail.asp?product=9
===============================================
Restorative Care of America Incorporated - RCAI
===============================================
http://www.rcai.com/
12221 33rd Street North
St. Petersburg, Florida 33716
Phone: (800) 627-1595 or (727) 573-1595
Fax: (800) 545-7938 or (727) 573-1886
Email: info@rcai.com
Products for the foot:
http://www.rcai.com/cgi-bin/RCAIstore.storefront/3faa971300c34bfa273fac100331064a/Catalog/1014
=======
Deroyal
=======
http://www.deroyal.com/default.asp
DeRoyal Industries
200 DeBusk Lane
Powell, TN 37849
TEL: 888-938-7828
FAX: 865-362-1230
Other facilities:
http://www.deroyal.com/company/directions/default.asp
Orthopedic Products Catalog
http://www.deroyal.com/pccatalog/patientcare.asp
Medical Physics and Biomedical Engineering
==========================================
http://www.salisburyfes.com/index.htm
Salisbury District Hospital
Salisbury, Wiltshire, SP2 8BJ, UK
Tel (01722) 429065 FAX (01722) 425263
Odstock Dropped Foot Stimulators
http://www.salisburyfes.com/stimulat.htm
Electrologic of America
========================
http://www.electrologic.com/
2790 Indian Ripple Road
Beavercreek, Ohio 45440
(800) 758-3460
(937) 431-5488 fax
"StimMaster TM is a computer controlled rehabilitation bike using
electrical stimulation and your own muscles to combat the symptoms of
SCI. Neuropulse TM is the latest patented technology available. The
portable stimulator contains 28 predetermined settings. Recommended
users are SCI, Stroke, Head Injury, M.S., Chronic Pain , Muscle Injury
and Carpal Tunnel."
http://www.blvd.com/Wheelchairs_and_Accessories/Cycles/
================
I hope this information covers the basics! If you need further
clarification, please don't hesitate to ask.
And again, thank you for your patience!
umiat-ga
Google Search Strategy
"drop foot" statistics
"drop foot" stroke
"drop foot" hemiplegia
stroke statistics US
incidence of drop foot after stroke
stroke rehabilitation
stroke "foot-drop" rehabilitation
AFO manufacturers
ankle foot orthotics +foot drop
manufacturers of stroke rehabilitation devices |
,
0 Comments
)