The long-term effects of an implantable drop foot stimulator on gait in hemiparetic patients.

Drop foot is a frequent abnormality in gait after central nervous system lesions. Different treatment strategies are available to functionally restore dorsal extension during swing phase in gait. Orthoses as well as surface and implantable devices for electrical stimulation of the peroneal nerve may be used in patients who do not regain good dorsal extension. While several studies investigated the effects of implanted systems on walking speed and gait endurance, only a few studies have focussed on the system's impact on kinematics and long-term outcomes. Therefore, our aim was to further investigate the effects of the implanted system ActiGait on gait kinematics and spatiotemporal parameters for the first time with a 1-year follow-up period. 10 patients were implanted with an ActiGait stimulator, with 8 patients completing baseline and follow-up assessments. Assessments included a 10-m walking test, video-based gait analysis and a Visual Analogue Scale (VAS) for health status. At baseline, gait analysis was performed without any assistive device as well as with surface electrical stimulation. At follow-up patients walked with the ActiGait system switched off and on. The maximum dorsal extension of the ankle at initial contact increased significantly between baseline without stimulation and follow-up with ActiGait (p = 0.018). While the spatio-temporal parameters did not seem to change much with the use of ActiGait in convenient walking speed, patients did walk faster when using surface stimulation or ActiGait compared to no stimulation at the 10-m walking test at their fastest possible walking speed. Patients rated their health better at the 1-year follow-up. In summary, a global improvement in gait kinematics compared to no stimulation was observed and the long-term safety of the device could be confirmed.

Clinical trial of the D.E.L.P.H.I.N. speech treatment for children and adolescents who stutter.

Purpose: The present trial investigated the D.E.L.P.H.I.N. (Deblockierungsimpuls, Entspannung, Logopädie, Phonetik, Hör-Wahrnehmungstraining, Intensität, nasaler Schwingungsakzent) speech treatment for children and adolescents who stutter, an approach using fluency shaping with an intensive time schedule and group sessions. Methods: Participants were 42 male and 14 female persons who stuttered with a median age of 13.0 years. Participants and their parents completed the strength and difficulties questionnaire at the beginning of the therapy and 1 year later. Participants completed the Speech Questionnaire, an instrument to measure the impact of stuttering, twice before and twice after completing the therapy. The stuttering rate and mean length of the three longest stuttering events were studied four times in videos of interviews, reading texts and three telephone calls. Outcomes are reported for the 56 children and young adults who stuttered and who completed D.E.L.P.H.I.N. The main analysis was performed using linear mixed models. Results: Quality of life as measured in the Strength and Difficulties Questionnaire (SDQ) - filled in by the participants/their parents - increased significantly from before the start of the therapy to 1 year after completion of the therapy. The subjective rating of the impact of stuttering also improved significantly. The stuttering rate and mean length of the longest stuttering event decreased significantly for all three modes from pre-treatment to 12 months post-treatment. Conclusions: After D.E.L.P.H.I.N., a significant improvement of the relevant endpoints quality of life, impact of stuttering, and severity of stuttering is observed.