Stroke Lower Limb Paresis

Why FES?

As noted previously, AFOs and FES have similar short-term benefits, but FES has proven to be more effective in the long-term. FES is more effective long-term because its effect on gait (due to foot drop recovery) is shown to persist after discontinuation of treatment (Ethier et al., 2015). As discussed previously, hemiparesis results from the inability to volitionally activate motor units due to damaged upper motor neurons (Knutson et al., 2015). Because of the brain plasticity, there is potential for reorganization, which rewires functions from the damaged part of the brain over to new, undamaged parts of the brain (Knutson et al., 2015) (Figure 17). When a post-stroke patient performs a movement with their unaffected limb, the brain regions activated are similar to that of a healthy control subject. However, when a post-stroke patient performs a movements with the affected limb, the brain regions activated are different from that of a healthy control subject. In the case shown, there is damage to the left hemisphere and therefore, in order to carry out the movement, the right hemisphere has learned to compensate for it. It has been found that meaningful neural reorganization is found to occur when important tasks such as gait are practiced repeatedly (Yana et al., 2017). FES not only helps patients practice these tasks effectively, but the process of artificially activating the hemiparetic muscle has been shown to be highly effective in aiding the neural reorganization process, as it provides movement related afferent feedback (Ethier et al.,2015).  Thus, by continually practicing gait with FES, reorganized pathways are expected to strengthen, facilitating recovery of voluntary ankle dorsiflexion (Knutson et al., 2015). As the individual  ability to voluntarily dorsiflex their ankle increases, the intensity of FES will decrease, until it is no longer needed.

 

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