Foot Drop System Patient Assessment

I. Basic Information

Name

E-mail

Age

Gender

Male

Female

Initial Diagnosis

Stroke

Traumatic Brain Injury

Multiple Sclerosis

Cerebral Palsy

Incomplete Spinal Cord Injury

Other

Follow-up Diagnosis

Hemiplegia

Talipes Equinovarus

Other

II. Indications, Contraindications, Precautions

Indications

Upper motor neuron injury (stroke, TBI, MS, CP, incomplete SCI, etc.)

Insufficient dorsiflexion during swing phase

Ankle and knee stability during stance phase

Has cognitive and communication abilities

Stable physical condition, patient is able to stand for extended periods

Appropriate response to electrical stimulation

Good mobility and support ability

All of the Above

Contraindications

Severe cardiac disease or implanted cardiac pacemaker

Malignant tumor in the area of device placement

History of epilepsy

History of thrombosis in the area of device placement

None of the above

Precautions

Severe sensory or consciousness impairment

History of systemic skin allergies

Requires corrective therapy combined with FES therapy

Limited walking ability

None of the above

Not recommended and requires clinical evidence support

Lower motor neuron injury

Pregnant

III. Clinical Manifestations

Condition Type

Acute

Chronic

Affected Limb(s)

Left

Right

Bilateral

Physical Activity Level Before Onset

Sedentary

Mild

Moderate

High

Physical Activity Level After Onset

Sedentary

Mild

Moderate

High

IV. Current Walking Ability

Physical Activity:Cannot produce functional movement. Requires assistance to stand. (Requires rehabilitation training to restore walking ability)

Restricted Household Ambulation:Limited by endurance, strength, or safety to ambulation only within the home. (Can perform a small amount of activity at home, but not in the community)

Unrestricted Household Ambulation:Can walk continuously for a distance at home. However, requires assistance for stairs at home and ramps outdoors. May use a wheelchair for outdoor activities. (Irregular activity at home / rarely active in the community)

Restricted Community Ambulation:Able to walk outdoors, open doors, and navigate slopes. Can use a wheelchair for long distances. (Walks frequently at home / irregularly active in the community)

Unrestricted Community Ambulation:Can walk continuously for nearly 400 meters at half the speed of a normal person. Can handle various safety situations while walking, such as stairs, opening/closing doors, etc. (Can be frequently active in the community, almost without needing a wheelchair)

Functional Goals of Using the XFT Foot Drop System

Improve walking ability

Improve safety during walking

Improve dynamic stability of joints or muscles

Biomechanical assistance to reduce energy consumption

Improve ability to walk on uneven or complex terrain

Improve mobility or independence in Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs)

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Foot Drop System Patient Assessment

I. Basic Information

II. Indications, Contraindications, Precautions

III. Clinical Manifestations

IV. Current Walking Ability

V. Other information you want us to know

Country/region

Foot Drop System Patient Assessment

I. Basic Information

II. Indications, Contraindications, Precautions

III. Clinical Manifestations

IV. Current Walking Ability

V. Other information you want us to know