Quick Overview
A 2013 multicenter randomized trial tested a wearable foot-drop stimulator against a standard brace in 93 adults within 12 months of stroke.
Scientists timed a 4-minute figure-of-8 and a 10-metre walk with the device on and off. They also tracked walking effort, mobility, and perceived safety.
After 6 weeks, stimulator users gained 0.119 m/s on the figure-of-8 with stimulation on. Speed also rose when the device was off. 70% who tried both preferred the stimulator.
Published in Neurorehabilitation and Neural Repair after work at nine US rehab centres, the data suggest targeted EMS can support walking after stroke.
The full post unpacks every number, limit, and what it does not prove.
We always provide direct links to the original research at the end of every article so you can review the evidence yourself.
Could a Wearable Stimulator Help People Walk After Stroke?
Foot drop can turn a simple step into a trip hazard.
After a stroke, the foot may not lift in time.
Walking then becomes slow, tiring, and less safe.
Researchers asked a clear question.
Could functional electrical stimulation, a targeted form of EMS, help as much as a brace?
That was the purpose of this study.
They compared a foot-drop stimulator with a standard ankle-foot orthosis.
They wanted evidence on walking speed, effort, safety, and preference.
This blog summarises that published trial.
It is not medical advice.
It does not tell anyone to buy or start a device.
The paper appeared in Neurorehabilitation and Neural Repair.
SAGE published it in 2013.
The work was a registered clinical trial.
Teams ran it across nine rehabilitation centres in the United States.
Senior authors included scientists from the University of Alberta.
Other sites included major US hospitals and university rehab programmes.
Adults were enrolled within 12 months of stroke.
They had leftover foot drop.
They could walk at least 10 metres, with or without a cane.
One hundred and twenty-one people enrolled.
Ninety-three had full 12-week data for the main analysis.
Average age was 57.
Average time since stroke was 6.4 months.
People were randomly assigned to one of three paths.
Some used the stimulator first, then the brace.
Some used the brace first, then the stimulator.
A third group used a brace in both periods.
Each device period lasted six weeks.
People used the assigned device at home and in the community.
Testers measured walking with the device on and off.
The main walking test was a four-minute figure-of-8.
That course mixes straight walking, turns, and endurance.
They also timed a 10-metre walk.
They tracked a Physiological Cost Index from heart rate.
That score estimates how costly walking feels.
They scored general mobility and asked about perceived safety.
Here is the bright finding on function.
Both devices produced meaningful gains in walking speed.
People walked faster with a device on than with it off.
Speed also rose over weeks when the device was off.
Researchers called that a therapeutic change.
They also measured a combined change from baseline.
After six weeks, combined figure-of-8 gains looked similar.
Stimulator users improved by 0.119 metres per second.
Brace users in the other arms improved by 0.116 and 0.105.
Ten-metre speed rose as well.
Combined six-week gains were 0.168 with the stimulator first.
Brace-first groups gained 0.153 and 0.138 on that short test.
The stimulator showed a larger average “off-device” speed rise at six weeks.
That figure-of-8 change was 0.094 metres per second.
Brace groups showed 0.065 and 0.042 in the same window.
Those arm differences were not statistically significant.
The pattern still favoured practice with stimulation for carry-over.
The brace often gave a bigger instant lift while worn.
An AFO blocks extra plantarflexion.
That can make the next step more predictable right away.
Electrical stimulation instead triggers lift and still lets the ankle move.
People felt safer with either device switched on.
Safety scores did not drift much across the weeks.
At the end, most users who tried both chose the stimulator.
Forty-five of 64 people, or 70 percent, preferred to continue with it.
They cited function, confidence, comfort, and ease of use.
That preference is a practical signal, not a miracle claim.
Mobility scores also climbed across all three groups.
Some of that rise may reflect natural recovery.
Walking practice itself can help in the first year after stroke.
Skin redness under electrodes occurred in about one in ten stimulator users.
None of those cases needed medical treatment in the report.
Two brace users had friction irritation.
This trial does not prove that “more EMS” is always better.
It tested daily use of one fitted stimulator for six-week blocks.
It did not compare high dose against low dose.
It also does not replace physiotherapy, a prescribed brace, or medical care.
Devices in the study were fitted by trained clinicians.
Home use followed that clinical set-up.
The maker of the stimulator sponsored the trial.
Two authors disclosed consultant roles with that company.
Readers can weigh that fact beside the peer-reviewed methods.
The honest takeaway is still useful.
In this large stroke cohort, stimulation and a brace both helped walking.
Gains showed up in timed tests that clinics actually use.
If foot drop is limiting life after stroke, ask a clinician.
Ask whether a trial-fitted stimulator, a brace, or both belong in the plan.
Published evidence can start that conversation.
It cannot finish it for you.
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Research Summary
| Detail | What this paper reported |
|---|---|
| Full title | Effect of a Foot-Drop Stimulator and Ankle-Foot Orthosis on Walking Performance After Stroke: A Multicenter Randomized Controlled Trial |
| Original study links | Journal DOI: https://doi.org/10.1177/1545968313481278 · PubMed: https://pubmed.ncbi.nlm.nih.gov/23558080/ · Trial record: https://clinicaltrials.gov/study/NCT00216320 |
| Journal and publisher | Neurorehabilitation and Neural Repair, 2013, Vol. 27, Issue 7, pages 579–591, published by SAGE |
| Lead authors and centres | Dirk G. Everaert and Richard B. Stein, University of Alberta, with co-authors from major US rehab hospitals and universities across 9 centres |
| Study purpose | Compare walking performance with the WalkAide foot-drop stimulator, a form of functional electrical stimulation, versus a conventional ankle-foot orthosis after stroke |
| Design | Multicenter randomized controlled crossover trial with 3 parallel arms and 2 consecutive 6-week device periods |
| Who took part | Adults with hemiparesis and residual foot drop, enrolled within 12 months after stroke, able to walk at least 10 m, with no prior AFO or stimulator use |
| Numbers analysed | 121 enrolled; 93 people had 12-week data used in the main analysis (arm 1 = 38, arm 2 = 31, arm 3 = 24) |
| Participant profile | Mean age 57 years; mean 6.4 months after stroke; 72% male |
| Devices compared | WalkAide cuff stimulator of the common peroneal nerve versus a clinician-fitted ankle-foot orthosis; arm 3 used an AFO in both periods |
| How walking was measured | Figure-of-8 walk for 4 minutes at fastest safe speed; 10-metre walk; tests done with the device on and off at weeks 0, 3, 6, 9 and 12 |
| Other outcomes | Physiological Cost Index from heart rate, Modified Rivermead Mobility Index, perceived safety on a 0–10 scale, and device preference after both devices had been tried |
| Speed findings | Both devices produced significant orthotic, therapeutic and combined effects on walking speed; combined figure-of-8 gain after 6 weeks was 0.119 m/s with the stimulator and 0.116 / 0.105 m/s in the AFO arms |
| How the two devices differed | The stimulator showed a larger average off-device “therapeutic” speed rise that was not statistically significant; the AFO showed a larger immediate on-device “orthotic” effect, significant at 12 weeks |
| Effort, safety and preference | An AFO had a significant orthotic effect on Physiological Cost Index; users felt as safe with either device on; 45 of 64 people (70%) preferred to continue with the stimulator |
| Adverse events reported | Electrode-site skin irritation in 7 of 69 stimulator users (10.1%), none needing medical treatment; friction irritation in 2 of 93 AFO users; 2 device-related falls among 5 reported falls |
| Authors’ conclusion | Both devices produced equivalent functional gains after 6 weeks of use |
| Key limits noted in the paper | Carry-over from phase 1 into phase 2; some baseline imbalance in arm 3; large between-person variability; possible contribution from natural recovery and walking practice |
| Funding and conflicts | Trial sponsored by Innovative Neurotronics, maker of the WalkAide; Drs Stein and Kufta disclosed consultant roles with that company |
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