The use of electrical stimulation for correction of dropped foot in subjects with upper motor neurone lesions

The concept of Functional Electrical Stimulation (FES) was put forward by Liberson 2 in 1960 when he and his team produced the first electrical stimulation device for the correction of dropped foot due to an upper motor neurone lesion. His concept was that by applying electrical stimulation to paralysed muscles, functional movement could be produced, providing the user with a useful orthotic device. Liberson’s device was a portable neuromuscular stimulator which produced pulses of between 20 and 250μs at a frequency of 30-100Hz and current amplitudes of up to 90mA. Stimulation was timed using a switch placed under the heel of the affected side. When weight was taken from the switch, stimulation was delivered to carbon rubber electrodes placed over the common peroneal nerve as it passes over the head of fibula, causing dorsiflexion. Liberson reported that the gait of hemiplegics was significantly improved by use of the device and that on several occasions users acquired the ability of voluntary dorsiflexion for short periods after its use. Since that time several groups have developed similar systems and the devices have received some clinical use, most notably in the former Yugoslavia. However, until recently, the technique has not been widely used in the UK and there has been a shortage of evidence to support its use.