Hemiplegia is a major consequence of stroke and contributes significantly to the physical disability of stroke survivors. Foot-drop, or inability to dorsiflex the paretic ankle during the swing phase of gait and ankle instability during stance phase are important gait abnormalities that contribute to reduced mobility among stroke survivors. In the United States, the standard of care in addressing these deficits is the custom molded ankle-foot-orthosis (AFO). However, evolving data now demonstrate that active repetitive movement training is the principal substrate for facilitating motor relearning after stroke. Motor relearning is defined as the reacquisition of motor ability after central nervous system injury. Thus, while an AFO may assist stroke survivors to ambulate in the short-term, it is possible that it also inhibits recovery in the long-term. Previous studies have demonstrated that active repetitive movement exercises mediated by neuromuscular electrical stimulation (NMES) facilitate motor relearning among stroke survivors. In particular, studies have reported that some chronic stroke survivors treated with a peroneal nerve stimulator for foot-drop experience sufficient recovery that they no longer need the peroneal nerve stimulator or an AFO for community ambulation. However, there are no blinded randomized clinical trials that rigorously evaluate the motor relearning effects of ambulation training with peroneal nerve stimulators. Thus, the primary aim of this project is to assess the effects of transcutaneous peroneal nerve stimulator on lower limb motor relearning among chronic stroke survivors. The secondary aim is to assess the effects of transcutaneous peroneal nerve stimulation on lower limb mobility (disability) and overall quality of life. A single-blinded randomized clinical trial will be carried out to assess the effects of ambulation training with a peroneal nerve stimulator among chronic stroke survivors compared to ambulation training with an AFO. Subjects will be treated for 12 weeks and followed for a total of 6 months. This project will determine the effectiveness of peroneal nerve stimulation in facilitating motor relearning and improving the mobility and quality of life of stroke survivors. This proposed approach is expected to improve patient outcome and challenge the present clinical paradigm of prescribing AFOs for stroke survivors with foot-drop.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Ansel, Beth
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Case Western Reserve University
Internal Medicine/Medicine
Schools of Medicine
United States
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Sheffler, Lynne R; Taylor, Paul N; Bailey, Stephanie Nogan et al. (2015) Surface peroneal nerve stimulation in lower limb hemiparesis: effect on quantitative gait parameters. Am J Phys Med Rehabil 94:341-57
Knutson, Jayme S; Fu, Michael J; Sheffler, Lynne R et al. (2015) Neuromuscular Electrical Stimulation for Motor Restoration in Hemiplegia. Phys Med Rehabil Clin N Am 26:729-45
Sheffler, Lynne R; Bailey, Stephanie Nogan; Gunzler, Douglas et al. (2014) Effect of body mass index on hemiparetic gait. PM R 6:908-13
Sheffler, Lynne R; Taylor, Paul N; Gunzler, Douglas D et al. (2013) Randomized controlled trial of surface peroneal nerve stimulation for motor relearning in lower limb hemiparesis. Arch Phys Med Rehabil 94:1007-14
Sheffler, Lynne R; Bailey, Stephanie Nogan; Wilson, Richard D et al. (2013) Spatiotemporal, kinematic, and kinetic effects of a peroneal nerve stimulator versus an ankle foot orthosis in hemiparetic gait. Neurorehabil Neural Repair 27:403-10
Sheffler, Lynne R; Knutson, Jayme S; Gunzler, Douglas et al. (2012) Relationship between body mass index and rehabilitation outcomes in chronic stroke. Am J Phys Med Rehabil 91:951-6
Chae, John; Sheffler, Lynne; Knutson, Jayme (2008) Neuromuscular electrical stimulation for motor restoration in hemiplegia. Top Stroke Rehabil 15:412-26
Sheffler, Lynne R; Chae, John (2007) Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve 35:562-90