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FES and peroneal nerve damage

Would FES be appropriate to try with a patient who has sustained permanent damage to the nerve supplying Tibialis anterior, in order to activate dorsiflexion during gait? I am a physio working in N Ireland Many thanks. Fiona

fiona wilson

3 months ago

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Prof Alison Hoens
Prof Alison Hoens

Hello Fiona I support the comments offered by my colleagues and offer one additional comment - clinically, the key is the extent of the nerve damage (neuropraxia, neurotomesis or axonotomesis). This will dictate the potential for recovery and whether electrical stimulation (with FES [for innervated or partially innervated muscle] or with a device with a much longer pulse duration [ for denervated muscle]). Consultation with our EMG colleagues would be helpful in determining the degree of nerve damage.

fionawilson74438
fionawilson74438

Many thanks to all replies. Really helpful. Best Wishes, Fiona

gvpetrov223
gvpetrov223

Hi Fiona, theoreticaly you can use estim to improve the muscle condition, but it is hard work and it takes time and you need a special stimulator, like this one http://schuhfriedmed.at/stimulette/ (it is in German, because it is Austrian company). You can read also this blog http://fes4dm.blogspot.com/2012/ - it contains a lot of information about FES. And while there are systems that are made for hemiplegic or MS patients with drop foot, I am not sure that there are such for peripheral nerve injury. Anyway, managing tibialis anterior palsy is relatively easy - if it is within one year post injury you can try some nerve transfer - just find some good microsurgeon. If it is not an option the tibialis posterior to tibialis anterior tendon transfer is very well studied procedure with nice results. I work in hand/plastic/microsurgery unit and have seen many drop foots and these two options give satisfayng results. I hope it helps.

gvpetrov223
gvpetrov223

Hi Fiona, theoreticaly you can use estim to improve the muscle condition, but it is hard work and it takes time and you need a special stimulator, like this one http://schuhfriedmed.at/stimulette/ (it is in German, because it is Austrian company). You can read also this blog http://fes4dm.blogspot.com/2012/ - it contains a lot of information about FES. And while there are systems that are made for hemiplegic or MS patients with drop foot, I am not sure that there are such for peripheral nerve injury. Anyway, managing tibialis anterior palsy is relatively easy - if it is within one year post injury you can try some nerve transfer - just find some good microsurgeon. If it is not an option the tibialis posterior to tibialis anterior tendon transfer is very well studied procedure with nice results. I work in hand/plastic/microsurgery unit and have seen many drop foots and these two options give satisfayng results. I hope it helps.

Dr Ethne Nussbaum
Dr Ethne Nussbaum

Hello Fiona. I understand that you have 2 options for electrically activating muscle 1. Conventional muscle stim (tetanizing current) via the motor nerve which you state is permanently damaged, therefore not an option; 2. Direct activation of the muscle fibres. The latter is available but I cannot see that it would be useful. It requires a pulse duration >300 ms & the best that can be produced is a sluggish contraction localised to the area directly under the electrode. This would clearly not be applicable to gait i.e. not FES. best wishes. Ethne

Dr Sandy Rennie
Dr Sandy Rennie

Hello Fiona. Normal FES as used for innervated musculature will unlikely assist muscle(s) that are completely denervated as the stimulation parameters and mechanisms of response are different. See Nussbaum et al: Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice. Physiotherapy Canada 2018; 69 Special Issue, p. 62. In addition, look at Gordon & English: Strategies to promote peripheral nerve regeneration: electrical stimulation and/or exercise. Eur J Neuroscience. 2016;43(3):336-350. Hope this helps. Regards, Sandy

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