G. Bultstra

The Sensitivity and Selectivity of an Implantable Two-Channel Peroneal Nerve Stimulator System for Restoration of Dropped Foot

The objective of this study was to evaluate the stimulation responses on each channel of an implantable two‐channel stimulator that stimulates the peroneal nerve branches innervating the muscles for dorsiflexion and eversion movements. Currently five Dutch patients and five English patients have been implanted with this system. Isometric ankle torque measurements were carried out in the patient with the longest follow‐up period (1 y). A force sensor measured the three components of moment generated at the ankle joint. Stimulation intensity can be adjusted with great accuracy. Dorsiflexion moments are almost entirely determined by the setting of channel 1. Eversion moments are determined mainly by channel 2 and to a lesser extent by channel 1. Both channels determined abduction/adduction moments. We conclude that stimulation responses in both dorsiflexion and eversion direction can be set individually and with great accuracy and are reproducible over a prolonged period.

Application of a dual channel peroneal nerve stimulator in a patient with a "central" drop foot

Dropped foot is a common mobility problem amongst patients after a cerebro vascular accident. The condition arises from paresis of the muscles that control the foot movement during the swing phase of gait. If the abnormal movement is not compensated for, it results in a significant decrease in the mobility and hence quality of life. Compensation for the drop foot can be achieved through the application of functional electrical stimulation. To date, in the clinical environment, the stimulation has been applied through electrodes placed on the skin over the common peroneal nerve, and using a single channel implant device. It is well known that with these techniques it is difficult to establish a balanced response of the foot. An implantable dual channel system for stimulation of the deep and superficial peroneal nerve has now been developed for patients with a drop foot following a stroke. By stimulation of the two branches of the common peroneal nerve separately it is possible to achieve a precisely balanced dorsal flexion and eversion of the foot. Stimulation occurs via small bipolar electrodes which are placed subepineural. After successful tests on animals we have now started the two channel peroneal nerve stimulator implantation in patients. The preliminary results of the first implants are presented.

Recent Developments in Implantable and Surface Based Dropped Foot Functional Electrical Stimulators

One approach to improving the gait of patients with foot drop is the use of functional electrical stimulation (FES) as a neural prosthesis. However, there remain limitations with the current clinically used technology and the paper describes some recent developments addressing some of these problems. The paper describes initial work on an alternative surface-based solution and recent developments of an implantable two channel stimulator.