Trends and Technologies in Rehabilitation of Foot Drop: A Systematic Review

ABSTRACT

Introduction

Foot Drop (FD) is a condition, which is very commonly found in post-stoke patients; however it can also be seen in patients with multiple sclerosis, and cerebral palsy. It is a sign of neuromuscular damage caused by the weakness of the muscles. There are various approaches of FD’s rehabilitation, such as physiotherapy, surgery, and the use of technological devices. Recently, researchers have worked on developing various technologies to enhance assisting and rehabilitation of FD.

Areas Covered

This review analyzes different types of technologies available for FD. This include devices that are available commercially or still under research. 101 studies published between 2015 and 2020 were identified for the review, many were excluded due to various reasons, e.g., were not robot-based devices, did not include FD as one of the targeted diseases, or was insufficient information. 24 studies that met our inclusion criteria were assessed. These studies were further classified into two different categories: robot-based ankle-foot orthosis (RAFO) and Functional Electrical Stimulation (FES) devices.

Expert Opinion

Studies included showed that both RAFO and FES showed considerable improvement in the gait cycle of the patients. Future trends are inclining towards integrating FES with other neuro-concepts such as muscle-synergies for further developments.

KEYWORDS:

• Foot Drop rehabilitation
• robotic-based Ankle-Foot Orthosis
• functional Electrical Stimulation
• muscle Synergy
• robotic Rehabilitation device

ARTICLE HIGHLIGHTS

• Stroke is one of the leading causes of disability and impairs movement, adversely affecting the life of the patient.

• Due to muscle weakness, walking synchronization is disturbed which results in Foot Drop (FD).

• RAFO is the most commonly used strategy, there are two types of RAFOs; platform-based RAFOs are mostly used for rehabilitation purposes, as they are not portable. The wearable ankle rehabilitation robots actuate movement of the ankle joint and which is utilized in walking with a programmable control.

• FES is applied to lower extremities for improving functional walking in stroke patients; it has been also used as an alternative to RAFOs for the correction of foot drop. They have benefited patients by improving gait speed, muscle strength and other functions.

• Newly developed stimulation algorithms which are utilizing muscle synergy information has proven to produce better walking motion than only relying on stimulation based on foot strike. This approach could be used in treatment of chronic patients with severe weakness or paralysis, resulting in more activated weakened pathways through synergy.

• Researches are suggesting that to a good extent, patients with foot drop problems can potentially restore some of the walking ability through robot-assisted rehabilitation devices.

• Lacking of personalized rehabilitation is one of the main limitations of such existing robotic solutions. Artificial Intelligence (AI) solutions, which is the key for personalized adaptation, could open the door to overcome such limitations.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by the United Arab Emirates University (grant number 31T103 UAEU/SQU.