A review of portable FES-based neural orthoses for the correction of drop foot
Abstract
This paper reviews the technological developments in neural orthoses for the correction of upper motor neurone drop foot since 1961, when the technique was first proposed by Liberson and his co-workers. Drop foot stimulator (DFS) developments are reviewed starting with hard-wired single-channel and multichannel surface functional electrical stimulation (FES) systems, followed by implanted drop foot stimulators, and then continuing with microprocessor-based surface and implanted drop foot stimulators. The review examines the role of artificial and "natural" sensors as replacements for the foot-switch as the primary control sensor in drop foot stimulators. DFS systems incorporating real-time control of FES and completely implanted DFS systems finish the review.
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The peaks were not as well defined compared to the CVs of activated iridium oxide in et al [1].
“These peaks were not as well defined compared to the CVs of activated iridium oxide in et al [1].”
From Flexible Nerve Stimulation Electrode With Iridium Oxide Sputtered on Liquid Crystal Polymer (2009) · cites this paper as [1]
Similar multiple peaks had been reported by Cogan et al. [1] and Slavcheva et al. [2].
“Similar multiple peaks had been reported by Cogan et al. [1] and Slavcheva et al. [2].”
From Flexible Nerve Stimulation Electrode With Iridium Oxide Sputtered on Liquid Crystal Polymer (2009) · cites this paper as [1]
The peaks indicated an active Ir(IV) + e− ⇋ Ir(III) charge transfer mechanism.
“However, these peaks indicated an active Ir(IV) + e− ⇋ Ir(III) charge transfer mechanism.”
From Flexible Nerve Stimulation Electrode With Iridium Oxide Sputtered on Liquid Crystal Polymer (2009) · cites this paper as [1]
The charge storage capacity of the iridium oxide electrodes here was observed to be larger than the charge storage capacity obtained with activated iridium oxide films reported by Agnew et al [4] and sputtered iridium oxide films reported by Cogan et al. [1].
“The charge storage capacity of the iridium oxide electrodes here was observed to be larger than the charge storage capacity obtained with activated iridium oxide films reported by Agnew et al [4] and sputtered iridium oxide films reported by Cogan et al. [1]”
From Flexible Nerve Stimulation Electrode With Iridium Oxide Sputtered on Liquid Crystal Polymer (2009) · cites this paper as [1]
The morphology and structure of the iridium oxide on the LCP substrate electrodes were markedly different compared to the cauliflower morphology reported by Cogan et al [1] and Slavcheva et al [2].
“The morphology and structure of the iridium oxide on the LCP substrate electrodes were markedly different compared to the cauliflower morphology reported by Cogan et al [1]and Slavcheva et al [2].”
From Flexible Nerve Stimulation Electrode With Iridium Oxide Sputtered on Liquid Crystal Polymer (2009) · cites this paper as [1]
Impedance testing of the sputtered iridium oxide films also revealed Bode plots with slightly higher impedances compared the sputtered iridium oxide films reported by Cogan et al. [1] and Slavcheva et al [2], but lower compared to electrodeposited and activated iridium oxide films [3].
“Impedance testing of the sputtered iridium oxide films also revealed Bode plots with slightly higher impedances compared the sputtered iridium oxide films reported by Cogan et al. [1] and Slavcheva et al [2], but lower compared to electrodeposited and activated iridium oxide films [3].”
From Flexible Nerve Stimulation Electrode With Iridium Oxide Sputtered on Liquid Crystal Polymer (2009) · cites this paper as [1]
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“Although surface and percutaneous FES technologies have been developed and used by many laboratories worldwide for decades [11,14,21– 22,25], we present the deployment of implantable technology from our center that may surmount the challenges of ambulation after incomplete paralysis.”
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“Electronic technology has evolved a great deal since 1961, as have the methods used to combat drop foot (Lyons et al., 2002).”
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“However, this solution has certain disadvantages because it is not possible to detect the swing subphases and the accuracy and reliability depend on the location of the FSR sensors [2].”
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“Functional electrical stimulation (FES) has been successfully used at various sites including the peroneal nerve (treatment of foot drop) [ 3 ], phrenic nerve (restoration of breathing in tetraplegic patients) [4], and anterior sacral roots (treatment of bladder dysfunction in paraplegia) [5].”
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“Lyons et al. [21] correct foot drop problems of palsy patients by lifting up the foot with EMS signals while walking.”
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“The FES is used to correct drop foot by stimulating the peroneal nerve during the swing phase of gait cycle (Lyons et al., 2002).”
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“High thresholds nd the concurrent activation of cutaneous pain fibers bounded he primary application space of surface electrode systems [5,6].”
BackgroundClosed loop electrical control of urinary continence.
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“Dorsiflexion in the swing phase can be achieved by electrical stimulation of the peroneal nerve, however, a trigger for turning the stimulation on is needed and has been conventionally a heel-strike senor (Lyons et al., 2002).”
BackgroundKobravi, H.-R., & Erfanian, A. (2009) · Journal of Neural Engineering · doi:10.1088/1741-2560/6/4/046007 · Cited by 64 · see citing works
“This technology has been used to restore hand grasp and elbow extension in individuals with tetraplegia [1–3], to provide standing and locomotion for paraplegic subjects [4, 5] and to correct drop foot in subjects with an upper motor neuron lesion (due to stroke, incomplete spinal cord injury, multiple sclerosis, cere…”
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Flexible Nerve Stimulation Electrode With Iridium Oxide Sputtered on Liquid Crystal Polymer
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“In functional electrical stimulation, electrical stimulation has been used effectively in the treatment of foot drop [1], the restoration”
Functional electrical stimulation in rehabilitation engineering
Zhang, D., Guan, T. H., Widjaja, F., & Ang, W. T. (2007) · International Convention on Rehabilitation Engineering & Assistive Technology · doi:10.1145/1328491.1328546 · Cited by 56 · see citing works
“This technique is very mature now [58].”
Sensor-driven four-channel stimulation of paretic leg: Functional electrical walking therapy
Kojović, J., Djuric-Jovicic, M. D., Dosen, S. S., Popović, M. B., & Popović, D. B. (2009) · Journal of Neuroscience Methods · doi:10.1016/j.jneumeth.2009.04.005 · Cited by 56 · see citing works
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Trends and Technologies in Rehabilitation of Foot Drop: A Systematic Review
Alnajjar, F. S. K., Zaier, R., Khalid, S., & Gochoo, M. (2020) · Expert Review of Medical Devices · doi:10.1080/17434440.2021.1857729 · Cited by 50 · see citing works
“Studies have shown that DFS have improved walking speed, reduced spasticity and reduced physiological effort of walking in stroke survivors [33–42].”
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Automatic identification of gait events using an instrumented sock
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“These approaches can be considered as either passive devices, such as ankle foot orthoses, or active devices, such as functional electrical stimulation (FES) [ 7 ] or intelligent orthoses [8,9].”
BackgroundAssessment of a Smart Sensing Shoe for Gait Phase Detection in Level Walking
Carbonaro, N., Lorussi, F., & Tognetti, A. (2016) · Electronics · doi:10.3390/electronics5040078 · Cited by 46 · see citing works
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“4 million Americans who have sustained a stroke may be living with drop foot, and many have decreased gait speed as a result [5].”
BackgroundMicrochannel Electrodes for Recording and Stimulation: In Vitro Evaluation
FitzGerald, J. J., Lacour, S. P., McMahon, S. B., & Fawcett, J. W. (2009) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2009.2013960 · Cited by 45 · see citing works
“Nerve cuffs may be regarded as the most mature technology as they have reached clinical use in diverse applications including phrenic nerve stimulation for diaphragmatic pacing [3], peroneal nerve stimulation for foot drop [4], sacral root stimulation for bladder control in paraplegia [5], and vagus nerve stimulation…”
BackgroundThe functional reanimation of paralyzed limbs
Loeb, G. E., & Davoodi, R. (2005) · IEEE Engineering in Medicine and Biology Magazine · doi:10.1109/memb.2005.1511499 · Cited by 44 · see citing works
“A few centers have provided such prostheses to a few hundred patients in these two categories [6], [7], but commercial success and widespread availability remain elusive.”
BackgroundSong, W., Ramakrishnan, A., Udoekwere, U. I., & Giszter, S. F. (2009) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2009.2026284 · Cited by 40 · see citing works
“Such research is essential because neural circuits for control of forelimbs differ in various ways from those that control the trunk/hindlimb, and both neural recording types may figure in various therapies and restoration approaches [6], [7].”
Chen, M., Wu, B., Lou, X., Zhao, T., Li, J., Xu, Z., Hu, X., & Zheng, X. (2012) · Medical Engineering & Physics · doi:10.1016/j.medengphy.2012.04.016 · Cited by 39 · see citing works
Real-Time Gait Event Detection Based on Kinematic Data Coupled to a Biomechanical Model †
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“FSRs, however, have strong limitations regarding mechanical wear and reliability, and are therefore best avoided in practical applications [13,14].”
BackgroundNeural Prosthetics: A Review of Empirical vs. Systems Engineering Strategies
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“One successful application focuses on a very localized problem—foot drop in the weak leg of a stroke patient [72].”
BackgroundBroderick, B. J., Kennedy, C., Breen, P. P., Kearns, S. R., & OLaighin, G. M. (2010) · Medical Engineering & Physics · doi:10.1016/j.medengphy.2010.09.003 · Cited by 38 · see citing works
Neuromuscular structure of the tibialis anterior muscle for functional electrical stimulation
Yi, K., Cong, L., Bae, J., Park, E. S., Rha, D., & Kim, H. (2016) · Surgical and Radiologic Anatomy · doi:10.1007/s00276-016-1698-6 · Cited by 37 · see citing works
“ankle musculature, making it a major disability in rehabilitation [5, 30].”
BackgroundA Preliminary Study on Robot-Assisted Ankle Rehabilitation for the Treatment of Drop Foot
Zhang, M., Cao, J., Xie, S. Q., Zhu, G., Zeng, X., Huang, X., & Xu, Q. (2017) · Journal of Intelligent & Robotic Systems · doi:10.1007/s10846-017-0652-0 · Cited by 37 · see citing works
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Brain-controlled muscle stimulation for the restoration of motor function
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A Novel sEMG Triggered FES-Hybrid Robotic Lower Limb Rehabilitation System for Stroke Patients
Petersen, I. L., Nowakowska, W., Ulrich, C., & Struijk, L. N. S. A. (2020) · IEEE Transactions on Medical Robotics and Bionics · doi:10.1109/tmrb.2020.3019081 · Cited by 36 · see citing works
Ji, N., Zhou, H. D., Guo, K., Samuel, O. W., Huang, Z., Xu, L., & Li, G. (2019) · Sensors · doi:10.3390/s19163462 · Cited by 35 · see citing works
Electronic stimulators for surface neural prosthesis
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“[3] and the restoration of upper and lower limb functions in”
BackgroundBîrlea, S. I., Breen, P. P., Corley, G. J., Bîrlea, N. M., Quondamatteo, F., & OLaighin, G. M. (2014) · Physiological Measurement · doi:10.1088/0967-3334/35/2/231 · Cited by 34 · see citing works
“Some of the functional applications of NMES include electrical stimulation assisted standing or walking (Lyons et al 2002b, Mushahwar et al 2007, Popović et al 2008), upper-limb motor restoration following stroke (Mangold et al 2009, Chan et al 2009, Chan et al 2006) and control of respiratory…”
BackgroundFeedback control of foot eversion in the adaptive peroneal stimulator
Seel, T., Laidig, D., Valtin, M., Werner, C., Raisch, J., & Schauer, T. (2014) · Mediterranean Conference on Control and Automation (MED) · doi:10.1109/med.2014.6961585 · Cited by 34 · see citing works
Adaptive Inverse Optimal Neuromuscular Electrical Stimulation
Wang, Q., Sharma, N., Johnson, M., Gregory, C. M., & Dixon, W. E. (2013) · IEEE Transactions on Cybernetics · doi:10.1109/tsmcb.2012.2228259 · Cited by 33 · see citing works
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Adaptive multichannel FES neuroprosthesis with learning control and automatic gait assessment
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Hemodynamic effects of habituation to a week-long program of neuromuscular electrical stimulation
Corley, G. J., Breen, P. P., Bîrlea, S. I., Serrador, J. M., Grace, P. A., & OLaighin, G. M. (2011) · Medical Engineering & Physics · doi:10.1016/j.medengphy.2011.08.005 · Cited by 31 · see citing works
Continuous gait cycle index estimation for electrical stimulation assisted foot drop correction
Coste, C., Jović, J., Pissard-Gibollet, R., & Froger, J. (2014) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/1743-0003-11-118 · Cited by 30 · see citing works
“Abbreviations FES: Functional electrical stimulation; DFS: Droop foot stimulator; GCI: Gate cycle index; Std: Standard deviation.”
BackgroundInfluentialDujović, S. D., Malesevic, J. M., Malešević, N., Vidakovic, A. S., Bijelić, G., Keller, T., & Konstantinović, L. M. (2017) · Neurorehabilitation · doi:10.3233/nre-172153 · Cited by 30 · see citing works
“(Lyons, Sinkjær, Burridge, & Wilcox, 2002).”
A programmable and portable NMES device for drop foot correction and blood flow assist applications
Breen, P. P., Corley, G. J., O'Keeffe, D. T., Conway, R., & OLaighin, G. M. (2008) · Medical Engineering & Physics · doi:10.1016/j.medengphy.2008.05.003 · Cited by 30 · see citing works
“An extensive review of portable FES-based neural orthoses for the correction of drop foot up until 2002 was conducted by Lyons et al. [ 2 ].”
BackgroundMeng, L., Martínez-Hernández, U., Childs, C. R., Dehghani-Sanij, A. A., & Buis, A. W. P. (2019) · IEEE Sensors Journal · doi:10.1109/jsen.2019.2938764 · Cited by 29 · see citing works
“Most devices for drop foot correction depend on simple and fixed pattern control where gait events switch on/off the external assistance, making these robots susceptible to failure during the assistance to human [7].”
BackgroundState of the Art in Gait Analysis Using Wearable Sensors for Healthcare Applications
Zhang, B., Jiang, S., Wei, D., Marschollek, M., & Zhang, W. (2012) · IEEE/ACIS International Conference on Computer and Information Science (ICIS) · doi:10.1109/icis.2012.100 · Cited by 28 · see citing works
Zhang, Q., Iyer, A., Sun, Z., Kim, K., & Sharma, N. (2021) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2021.3106900 · Cited by 28 · see citing works
Nonlinear model predictive control of joint ankle by electrical stimulation for drop foot correction
Benoussaad, M., Mombaur, K., & Coste, C. (2013) · IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS) · doi:10.1109/iros.2013.6696470 · Cited by 28 · see citing works
The ICVSIE: A General Purpose Integral Equation Method for Bio-Electromagnetic Analysis
Gomez, L. J., Yücel, A. C., & Michielssen, E. (2017) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2017.2704540 · Cited by 27 · see citing works
“Finally, the ICVSIE and VIE are used to simulate NMES, a procedure widely used to induce artificial muscle contractions during physical therapy [43]–[45].”
MethodBala, S., Vishnu, V. Y., & Joshi, D. (2023) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2023.3290293 · Cited by 27 · see citing works
“acteristics under clinical settings [9], [10].”
Accelerometers and Force Sensing Resistors for Optimal Control of Walking of a Hemiplegic
Dosen, S. S., & Popović, D. B. (2008) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2008.919715 · Cited by 27 · see citing works
“The cost function Rn was nonlinear with respect to the controls and it had to be minimized subject to constraints involving both the state variables (e.g., physiological joint constraints) and control inputs (e.g., ui∈[0, 1 ]).”
BackgroundMethodInfluentialDoll, B. D., Kirsch, N. A., Bao, X., Dicianno, B. E., & Sharma, N. (2017) · Muscle & Nerve · doi:10.1002/mus.25777 · Cited by 26 · see citing works
“FES allows individuals with mobility impairments to perform functional tasks, such as standing and walking(2) or grasping,(3,4) and it is also used to correct physical impairments, such as loss of arm control(5) and drop foot.(6) FES recruits motor units in a nonselective, spatially fixed, and temporally synchronous p…”
BackgroundBreen, P. P., O'Keeffe, D. T., Conway, R., & Lyons, G. M. (2005) · Medical Engineering & Physics · doi:10.1016/j.medengphy.2005.04.008 · Cited by 26 · see citing works
“Electronics technology has evolved a great deal since 1961, as have the methods used to combat drop-foot [2].”
MethodSelf-citationBrunetti, F., Garay, A. Y. B., Moreno, J. C., & Pons, J. L. (2011) · International Conference on Rehabilitation Robotics · doi:10.1109/icorr.2011.5975370 · Cited by 26 · see citing works
“Unlike CVA, almost the 50% of SCI population is between the ages of 16 and 30, causing an even deeper impact in social structure and important economical burdens, [14].”
BackgroundInfluentialUltrasound Echogenicity as an Indicator of Muscle Fatigue during Functional Electrical Stimulation
Zhang, Q., Iyer, A., Lambeth, K., Kim, K., & Sharma, N. (2022) · Sensors · doi:10.3390/s22010335 · Cited by 25 · see citing works
Sheffler, L. R., Bailey, S. N., & Chae, J. (2009) · PM&R · doi:10.1016/j.pmrj.2009.04.002 · Cited by 25 · see citing works
“Functional electrical stimulation in the form of peroneal nerve stimulation (PNS) [7] may e a promising alternative to the use of an AFO in the MS patient population.”
BackgroundAutomatic Control of a Drop‐Foot Stimulator Based on Angle Measurement Using Bioimpedance
Nahrstaedt, H., Schauer, T., Shalaby, R., Hesse, S., & Raisch, J. (2008) · Artificial Organs · doi:10.1111/j.1525-1594.2008.00617.x · Cited by 25 · see citing works
Sheffler, L. R., Hennessey, M. T., Naples, G. G., & Chae, J. (2007) · Neurorehabilitation and neural repair · doi:10.1177/1545968306297869 · Cited by 25 · see citing works
A decision support system for electrode shaping in multi-pad FES foot drop correction
Malesevic, J. M., Dujović, S. D., Savić, A. M., Konstantinović, L. M., Vidakovic, A. S., Bijelić, G., Malešević, N., & Keller, T. (2017) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-017-0275-5 · Cited by 25 · see citing works
“, the dorsiflexion (DF) of the ankle (for a review, see references [8, 9]).”
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“Here, treatments that aim to increase activation, and thus power, must bypass the damaged central nervous system, and one way in which this can be achieved is by direct activation of muscle and nerve with electrical current, a technique that has widespread clinical use under the term functional electrical stimulation…”
BackgroundNeuroprosthetics in amputee and brain injury rehabilitation
Eapen, B. C., Murphy, D. P., & Cifu, D. X. (2016) · Experimental Neurology · doi:10.1016/j.expneurol.2016.08.004 · Cited by 23 · see citing works
“Later that year, a prosthetic device was developed to address foot drop in hemiplegics due to motor loss but it was not until themid-1990's the clinical trials proved functional electrical stimulation (FES) of motor nerves and muscles showed efficacy(Lyons et al., 2002).”
BackgroundChu, J., Song, K., Han, S., Lee, S. H., Kang, J. Y., Hwang, D., Suh, J. F., Choi, K., & Youn, I. (2013) · Physiological Measurement · doi:10.1088/0967-3334/34/5/541 · Cited by 23 · see citing works
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“(14) reviewed technological developments in neural orthoses for correction of foot drop since 1961, when the technique was first proposed by Liberson et al.”
MethodAdaptive Neuro-Fuzzy Sliding Mode Control of Multi-Joint Movement Using Intraspinal Microstimulation
Asadi, A., & Erfanian, A. (2012) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2012.2197828 · Cited by 23 · see citing works
Assessment of a two-channel implantable peroneal nerve stimulator post-stroke
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“using open-loop controller, which is a feed forward controller with preset parameters and without feedback information from sensors [19], [20].”
MethodJung, J.-Y., Lee, D.-W., Son, Y. K., Kim, B. S., & Shin, H. C. (2021) · Sensors · doi:10.3390/s21238015 · Cited by 21 · see citing works
“, hand mobility rehabilitation for stroke patients [1], dorsiflexion rehabilitation for foot drop patients [2], and rehabilitation for spinal cord injury patients [3–5].”
BackgroundRobot-assisted ankle rehabilitation for the treatment of drop foot: A case study
Zhu, G., Zeng, X., Zhang, M., Xie, S. Q., Meng, W., Huang, X., & Xu, Q. (2016) · IEEE/ASME International Conference on Mechatronic and Embedded Systems and Applications · doi:10.1109/mesa.2016.7587130 · Cited by 20 · see citing works
- Authors
- Lyons, G. M., Sinkjaer, T., Burridge, J. H., & Wilcox, D. J.
- Affiliations
- University of Limerick (IE)
- University of Southampton (GB)
- Ollscoil na Gaillimhe – University of Galway (IE)
- ORCID
- Burridge, J.H.
- Venue
- IEEE Transactions on Neural Systems and Rehabilitation Engineering
- Published
- 2002-12
- Volume
- 10
- Issue
- 4
- Pages
- 260-279
- ISSN
- 1534-4320 (ISSN-L)
- 1558-0210
- OpenAlex
- W2165067332
- Cited by
- 277
- References
- 48
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 8 · 2023: 8 · 2022: 10 · 2021: 10 · 2020: 14 · 2019: 9 · 2018: 10 · 2017: 20 · 2016: 17 · 2015: 20 · 2014: 16 · 2013: 19 · 2012: 13
- FWCI
- 5.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- IEEE Transactions on Neural Systems and Rehabilitation Engineering (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Physical Sciences › Engineering › Biomedical Engineering › Prosthetics and Rehabilitation Robotics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neural Engineering
- Keywords
- foot drop, functional electrical stimulation, upper motor neuron lesion, surface stimulation
- MeSH terms
- Electrodes, Implanted, Electric Stimulation Therapy, Equipment Design, Foot, Humans, Microelectrodes, Miniaturization, Orthotic Devices, Peroneal Nerve, Therapy, Computer-Assisted, Transducers, Muscle, Skeletal, Gait Disorders, Neurologic
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