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Neuroprosthesis Peroneal Functional Electrical Stimulation in the Acute Inpatient Rehabilitation Setting: A Case Series

K Dunning, PT, PhD, is Assistant Professor, Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati Academic Medical Center, and Director of Clinical Research, Drake Center Rehabilitation, Cincinnati, Ohio. Mailing address: Department of Rehabilitation Sciences, University of Cincinnati, 3202 Eden Ave, Cincinnati, OH 45220-0394 (USA).
K Black, PT, is Physical Therapist, Drake Center Rehabilitation.
A Harrison, PT, was Team Leader for inpatient physical therapy, Drake Center Rehabilitation, at the time this case report was written.
K McBride, PT, is Physical Therapist and Director of Clinical Support and Education, Bioness Inc, Valencia, California, and Assistant Professor, Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland.
S Israel, PT, MSPT, is Physical Therapist and a doctoral student, Department of Neuroscience, University of Cincinnati School of Medicine, Cincinnati, Ohio.

Address all correspondence to Dr Dunning at: kari.dunning{at}uc.edu

Background and Purpose: Studies have suggested that peroneal nerve functional electrical stimulation (peroneal FES) during walking improves gait in patients with chronic stroke. The effect of peroneal FES during the acute stages of stroke recovery is not known. The purposes of this case report are: (1) to describe differences between walking with and without a neuroprosthesis during the first few weeks after stroke, (2) to offer a clinical perspective on decision making for the use of peroneal FES during acute rehabilitation, and (3) to determine the feasibility of rehabilitation with peroneal FES neuroprostheses during the acute phases of stroke recovery.

Case Description: This case report describes 2 patients with different clinical presentations but both receiving inpatient rehabilitation less than 2 weeks after stroke. Each patient received peroneal FES via a neuroprothesis as tolerated while gait training in therapy.

Outcomes: One patient immediately increased gait speed (128%) and decreased time to perform the Timed "Up & Go" Test (40%) using the neuroprothesis. Both patients immediately increased the 6-Minute Walk Test distance using the neuroprothesis (121% and 101%). The patient who underwent testing with the instrumented walking system also demonstrated improved gait symmetry. After 1 to 3 weeks of using the neuroprothesis, the difference between outcomes with and without the neuroprothesis decreased.

Discussion: It is possible that peroneal FES delivered through a neuroprosthesis during acute stroke recovery may improve gait outcomes. Research is needed to determine proper duration and timing.

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