CHECGAIT: A Functional Electrical Stimulation Clinical Pathway to Reduce Foot Drop during Walking in Adult Patients with Upper Motor Neuron Lesions.

Foot drop during the swing phase of gait and at initial foot contact is a current kinematic abnormality that can occur following an upper motor neuron (UMN) lesion. Functional electrical stimulation (FES) of the common peroneal nerve through an assistive device is often used in neuro-rehabilitation to help patients regain mobility. Although there are FES-specific guideline recommendations, it remains a challenge for clinicians to appropriately select patients eligible for the daily use of FES devices, as very few health insurance systems cover its cost in Europe. In Luxembourg, since 2018, successfully completing an FES clinical pathway called CHECGAIT is a prerequisite to receiving financial coverage for FES devices from the national health fund (Caisse Nationale de Santé-CNS). This study describes the structure and steps of CHECGAIT and reports our experience with a cohort of 100 patients enrolled over a three-year period. The clinical and gait outcomes of all patients were retrospectively quantified, and a specific analysis was performed to highlight differences between patients with and without an FES device prescription at the end of a CHECGAIT. Several significant gait differences were found between these groups. These results and CHECGAIT may help clinicians to better select patients who can most benefit from this technology in their daily lives. In addition, CHECGAIT could provide significant savings to public health systems by avoiding unnecessary deliveries of FES devices.

Classification of Stiff-Knee Gait Kinematic Severity after Stroke Using Retrospective k-Means Clustering Algorithm.

Nowadays, a classification system for unilateral stiff-knee gait (SKG) kinematic severity in hemiparetic adult patients after stroke does not exist. However, such classification would be useful to the clinicians. We proposed the use of the k-means method in order to define unilateral SKG severity clusters in hemiparetic adults after stroke. A retrospective k-means cluster analysis was applied to five selected knee kinematic parameters collected during gait in 96 hemiparetic adults and 19 healthy adults from our clinical gait analysis database. A total of five discrete knee kinematic clusters were determined. Three clusters of SKG were identified, based on which a three-level severity classification was defined: unbend-knee gait, braked-knee gait, and frozen-limb gait. Preliminary construct validity of the classification was obtained. All selected knee kinematic parameters defining the five clusters and the majority of usual kinematic parameters of the lower limbs showed statistically significant differences between the different clusters. We recommend diagnosing SKG for values strictly below 40° of knee flexion during the swing phase. Clinicians and researchers are now able to specify the level of kinematic severity of SKG in order to optimize treatment choices and future clinical trial eligibility criteria.