NESS® L300™ FOOT DROP STIMULATION TECHNOLOGY FOR IMPROVED GAIT IN A PATIENT WITH CHRONIC HEMIPARESIS: A CASE REPORT. Kyle Covington* 1. Martinat Outpatient Rehabilitation Center, Novant Health; 2. Doctor of Physical Therapy Program, Duke University UNIQUE: The Ness® L300™ allows patients with chronic hemiparesis the ability to easily utilize functional electrical stimulation (FES) due to technological and design advances previously not available with other foot drop stimulators (FDS). These advances include wireless radio communication, adaptive sensing of calcaneal movement and force generation, and an ergonomic orthosis that allows independent and consistent donning. PURPOSE: investigate the functional improvements of a chronic stroke patient with hemiparesis who utilized the Ness® L300™ FDS system, through a therapy directed home-based protocol. FOUNDATION: Historically, FES has been used in clinical applications for neurological re-education following stroke. Regarding foot drop, strong evidence for the use of peroneal nerve stimulators to improve hemiplegic gait has been reported through multiple studies and systematic reviews. The cumbersome nature of these devices and their time consuming application have made independent home use difficult for patients. However, technological advances have recently allowed patients to benefit functionally from peroneal nerve stimulation in their home and community. DESCRIPTION: A 35 year old female with left hemiparesis 18 months status post CVA used the Ness® L300™ FES neuroprosthesis for 114 consecutive days. The patient spent an average of 255 minutes ambulating and took an average of 4500 steps each day. OBSERVATIONS: The patient’s gait speed improved in each of the components of the Modified Emory Ambulation Profile (MEAP). At baseline the patient’s composite MEAP score without the L300™ was 50 seconds. Improvement was found with the initial implementation of the L300™ (39 seconds) and continued after 114 days (32 seconds). Additionally, the patient’s score improved without the device after the 114 days of using the L300™ with a decrease in all aspects of the MEAP for a composite score of 33 seconds. Knee flexor tone decreased from 1+ to 0 on the Modified Ashworth scale. Passive dorsiflexion range of motion increased from 10 to 20 degrees. Active dorsiflexion increased from trace movement to 5 degrees. In addition, the patient subjectively reported increased confidence in her ambulation during functional tasks, hiking, and fitness activities, as well as improved feelings about the aesthetic appearance of her gait. CONCLUSIONS: The effect of daily long-term use of a neuroprosthesis for peroneal stimulation in this patient allowed for improved gait speed, increased ROM, and decreased spasticity. The results indicate that after 114 days of use, functional gait abilities improved both with and without the L300™. Future studies are warranted to investigate the long term acceptance, clinical efficacy and the mechanisms of both the neuroprosthetic and therapeutic benefit. FUNDING SOURCE: The Ness® L300™ utilized by the patient at home was funded privately by the patient. Clinical application equipment and therapist training was funded by the Martinat Outpatient Rehabilitation Center of Novant Health in Winston-Salem, North Carolina. KEYWORDS: Gait, Functional Electrical Stimulation, Cerebral Vascular Accident Copyright 2010 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.