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Aout T, Begon M, Peyrot N, Caderby T. Société de Biomécanique young investigator award 2022: Effects of applying functional electrical stimulation to ankle plantarflexor muscles on forward propulsion during walking in young healthy adults. J Biomech 2024; 168:112114. [PMID: 38677030 DOI: 10.1016/j.jbiomech.2024.112114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
The triceps surae muscle, composed of the gastrocnemius and soleus muscles, plays a major role in forward propulsion during walking. By generating positive ankle power during the push-off phase, these muscles produce the propulsive force required for forward progression. This study aimed to test the hypothesis that applying functional electrical stimulation (FES) to these muscles (soleus, gastrocnemius or the combination of the two) during the push-off phase would increase the ankle power generation and, consequently, enhance forward propulsion during walking in able-bodied adults. Fifteen young adults walked at their self-selected speed under four conditions: no stimulation, with bilateral stimulation of the soleus, gastrocnemius, and both muscles simultaneously. Muscles were stimulated just below the discomfort threshold during push-off, i.e., from heel-off to toe-off. FES significantly increased ankle power (+22 to 28 % depending on conditions), propulsive force (+15 to 18 %) and forward progression parameters such as walking speed (+14 to 20 %). Furthermore, walking speed was significantly higher (+5%) for combined soleus and gastrocnemius stimulation compared with gastrocnemius stimulation alone, with no further effect on other gait parameters. In conclusion, our results demonstrate that applying FES to the gastrocnemius and soleus, separately or simultaneously during the push-off phase, enhanced ankle power generation and, consequently, forward propulsion during walking in able-bodied adults. Combined stimulation of the soleus and gastrocnemius provided the greatest walking speed enhancement, without affecting other propulsion parameters. These findings could be useful for designing FES-based solutions for improving gait in healthy people with propulsion impairment, such as the elderly.
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Affiliation(s)
- Thomas Aout
- Laboratoire IRISSE, EA 4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 97430 Le Tampon, Réunion
| | - Mickaël Begon
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l'Activité Physique, Université de Montréal, Québec, Canada; Centre de Recherche du CHU Sainte-Justine, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Nicolas Peyrot
- Laboratoire IRISSE, EA 4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 97430 Le Tampon, Réunion; Mouvement - Interactions - Performance, MIP, Le Mans Université, EA 4334, 72000 Le Mans, France
| | - Teddy Caderby
- Laboratoire IRISSE, EA 4075, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 97430 Le Tampon, Réunion.
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Parsaei M, Amanollahi M, TaghaviZanjani F, Khanmohammadi S, Jameie M, Naser Moghadasi A. Effects of non-pharmacological interventions on gait and balance of persons with Multiple Sclerosis: A narrative review. Mult Scler Relat Disord 2024; 82:105415. [PMID: 38211505 DOI: 10.1016/j.msard.2023.105415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Multiple Sclerosis (MS) is among the most common reasons for disability in young adults. Mobility impairment, primarily related to gait and balance, is ranked as the preeminent concern among persons with MS (PwMS). Gait and balance dysfunction can directly affect the quality of life and activities of daily life in PwMS, hence the importance of effective treatment strategies. Previous studies have demonstrated the positive effect of various non-pharmacological rehabilitation methods, including physiotherapy and electrical stimulation, on gait and mobility in PwMS. Non-pharmacological methods can be tailored to the individual needs and abilities of each patient, allowing healthcare providers to create personalized training programs. Furthermore, these methods typically result in minimal or no side effects. PURPOSE This review provides a comprehensive overview of an array of non-pharmacological treatment approaches aimed at enhancing ambulatory performance in PwMS. METHODS We performed a narrative review of the original papers available in PubMed, investigating the effects of different nonmedical approaches on the gait and balance performance of the PwMS. Reviewed treatment approaches include "exercise, physical rehabilitation, dual-task (DT) rehabilitation, robot-assisted rehabilitation, virtual reality-assisted rehabilitation, game training, electrical stimulation devices, auditory stimulation, visual feedback, and shoe insoles". RESULTS AND CONCLUSIONS Eighty articles were meticulously reviewed. Our study highlights the positive effects of non-pharmacological interventions on patients' quality of life, reducing disability, fatigue, and muscle spasticity. While some methods, including exercise and physiotherapy, showed substantial promise, further research is needed to evaluate whether visual biofeedback and auditory stimulation are preferable over conventional approaches. Additionally, approaches such as functional electrical stimulation, non-invasive brain stimulation, and shoe insoles demonstrate substantial short-term benefits, prompting further investigation into their long-term effects. Non-pharmacological interventions can serve as a valuable complement to medication-based approaches.
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Affiliation(s)
- Mohammadamin Parsaei
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mobina Amanollahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Melika Jameie
- Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran; Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Byrnes-Blanco L, Reed K, Dubey R, Carey SL. A systematic literature review of ankle-foot orthosis and functional electrical stimulation foot-drop treatments for persons with multiple sclerosis. Prosthet Orthot Int 2023; 47:358-367. [PMID: 36701192 DOI: 10.1097/pxr.0000000000000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 08/17/2022] [Indexed: 01/27/2023]
Abstract
Foot-drop is one of the most diagnosed and physically limiting symptoms persons with multiple sclerosis (pwMS) experience. Clinicians prescribe ankle-foot orthosis (AFO) and functional electrical stimulation (FES) devices to help alleviate the effects of foot drop, but it is unclear how their clinical and functional gait improvements compare given the user's level of disability, type of multiple sclerosis, walking environment, or desired physical activity. The research questions explored were what is the current state of AFO and FES research for pwMS? What are the prevailing research trends? What definitive clinical and functional device comparisons exist for pwMS? eight databases were systematically searched for relevant literature published between 2009 and 2021. The American Association of Orthotists and Prosthetists and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for systematic literature reviews were followed. A team of 3 researchers critically evaluated 17 articles that passed eligibility criteria. This review discusses the current state and trends of research, provides evidence statements on device effects, and recommends improvements for future studies. A meta-analysis would be informative, but study variability across the literature makes directly comparing AFO and FES device effects unreliable. This review contributes new and useful information to multiple sclerosis literature that can be used by both clinicians and researchers. Clinicians can use the provided insights to prescribe more effective, customized treatments, and other researchers can use them to evaluate and design future studies.
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Theunissen K, Plasqui G, Boonen A, Brauwers B, Timmermans A, Meyns P, Meijer K, Feys P. The Relationship Between Walking Speed and the Energetic Cost of Walking in Persons With Multiple Sclerosis and Healthy Controls: A Systematic Review. Neurorehabil Neural Repair 2021; 35:486-500. [PMID: 33847188 PMCID: PMC8135251 DOI: 10.1177/15459683211005028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (pwMS) experience walking impairments, characterized by decreased walking speeds. In healthy subjects, the self-selected walking speed is the energetically most optimal. In pwMS, the energetically most optimal walking speed remains underexposed. Therefore, this review aimed to determine the relationship between walking speed and energetic cost of walking (Cw) in pwMS, compared with healthy subjects, thereby assessing the walking speed with the lowest energetic cost. As it is unclear whether the Cw in pwMS differs between overground and treadmill walking, as reported in healthy subjects, a second review aim was to compare both conditions. METHOD PubMed and Web of Science were systematically searched. Studies assessing pwMS, reporting walking speed (converted to meters per second), and reporting oxygen consumption were included. Study quality was assessed with a modified National Heart, Lung and Blood Institute checklist. The relationship between Cw and walking speed was calculated with a second-order polynomial function and compared between groups and conditions. RESULTS Twenty-nine studies were included (n = 1535 pwMS) of which 8 included healthy subjects (n = 179 healthy subjects). PwMS showed a similar energetically most optimal walking speed of 1.44 m/s with a Cw of 0.16, compared with 0.14 mL O2/kg/m in healthy subjects. The most optimal walking speed in treadmill was 1.48 m/s, compared with 1.28 m/s in overground walking with a similar Cw. CONCLUSION Overall, the Cw is elevated in pwMS but with a similar energetically most optimal walking speed, compared with healthy subjects. Treadmill walking showed a similar most optimal Cw but a higher speed, compared with overground walking.
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Affiliation(s)
- Kyra Theunissen
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands.,Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Care and Public Health Research Institute, The Netherlands.,Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Guy Plasqui
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Care and Public Health Research Institute, The Netherlands
| | - Bente Brauwers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands
| | - Annick Timmermans
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Pieter Meyns
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands
| | - Peter Feys
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium.,Universitair MS Centrum, Belgium
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Hsieh KL, Mirelman A, Shema-Shiratzky S, Galperin I, Regev K, Shen S, Schmitz-Hübsch T, Karni A, Paul F, Devos H, Sosnoff JJ, Hausdorff JM. A multi-modal virtual reality treadmill intervention for enhancing mobility and cognitive function in people with multiple sclerosis: Protocol for a randomized controlled trial. Contemp Clin Trials 2020; 97:106122. [PMID: 32858229 DOI: 10.1016/j.cct.2020.106122] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gait and cognitive impairments are common in individuals with Multiple Sclerosis (MS) and can interfere with everyday function. Those with MS have difficulties executing cognitive tasks and walking simultaneously, a reflection of dual-task interference. Therefore, dual-task training may improve functional ambulation. Additionally, using technology such as virtual reality can provide personalized rehabilitation while mimicking real-world environments. The purpose of this randomized controlled trial is to establish the benefits of a combined cognitive-motor virtual reality training on MS symptoms compared to conventional treadmill training. METHODS This study will be a single-blinded, two arm RCT with a six-week intervention period. 144 people with MS will be randomized into a treadmill training alone group or treadmill training with virtual reality group. Both groups will receive 18 sessions of training while walking on a treadmill, with the virtual reality group receiving feedback from the virtual system. Primary outcome measures include dual-task gait speed and information processing speed, which will be measured prior to training, one-week post-training, and three months following training. DISCUSSION This study will provide insight into the ability of a multi-modal cognitive-motor intervention to reduce dual-task cost and to enhance information processing speed in those with MS. This is one of the first studies that is powered to understand whether targeted dual-task training can improve MS symptoms and increase functional ambulation. We anticipate that those in the virtual reality group will have a significantly greater increase in dual-task gait speed and information processing speed than those achieved via treadmill training alone.
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Affiliation(s)
- K L Hsieh
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - A Mirelman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Shema-Shiratzky
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - I Galperin
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - K Regev
- Neuroimmunology and Multiple Sclerosis Unit of the Neurology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Shen
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - T Schmitz-Hübsch
- NeuroCure, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - A Karni
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neuroimmunology and Multiple Sclerosis Unit of the Neurology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - F Paul
- NeuroCure, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin, Berlin, Germany; Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - H Devos
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - J J Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - J M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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6
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Smith AD, Prokopiusova T, Jones R, Burge T, Rasova K. Functional electrical stimulation for foot drop in people with multiple sclerosis: The relevance and importance of addressing quality of movement. Mult Scler 2020; 27:653-660. [PMID: 32833562 DOI: 10.1177/1352458520923958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Impaired mobility is common in people with multiple sclerosis (MS). Changes in gait have different causes and require individualised gait rehabilitation. A common and often early cause of mobility impairment is footdrop, inability to lift the foot during the swing phase of gait, with increased risk of falls, effortful walking and fatigue. Using literature review, we have characterised published data on footdrop treatment in MS, specifically functional electrical stimulation (FES) to better understand the reported outcomes relevant to the user. We discuss the strengths and weaknesses of FES and how far it meets the needs of people with footdrop. Physiotherapy combined with FES may further enhance the benefits of FES. MS studies emphasise the value of maintaining activity levels in early MS but discussion on how to achieve this is lacking. We emphasise the value of qualitative measures to broaden our understanding and improve treatment and adherence and identify areas for further research. Supplementary video material illustrates key features of MS gait and its correction using FES and physiotherapy.
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Affiliation(s)
| | - Terezie Prokopiusova
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Rosemary Jones
- The Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Tania Burge
- The Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Kamila Rasova
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Gil-Castillo J, Alnajjar F, Koutsou A, Torricelli D, Moreno JC. Advances in neuroprosthetic management of foot drop: a review. J Neuroeng Rehabil 2020; 17:46. [PMID: 32213196 PMCID: PMC7093967 DOI: 10.1186/s12984-020-00668-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
This paper reviews the technological advances and clinical results obtained in the neuroprosthetic management of foot drop. Functional electrical stimulation has been widely applied owing to its corrective abilities in patients suffering from a stroke, multiple sclerosis, or spinal cord injury among other pathologies. This review aims at identifying the progress made in this area over the last two decades, addressing two main questions: What is the status of neuroprosthetic technology in terms of architecture, sensorization, and control algorithms?. What is the current evidence on its functional and clinical efficacy? The results reveal the importance of systems capable of self-adjustment and the need for closed-loop control systems to adequately modulate assistance in individual conditions. Other advanced strategies, such as combining variable and constant frequency pulses, could also play an important role in reducing fatigue and obtaining better therapeutic results. The field not only would benefit from a deeper understanding of the kinematic, kinetic and neuromuscular implications and effects of more promising assistance strategies, but also there is a clear lack of long-term clinical studies addressing the therapeutic potential of these systems. This review paper provides an overview of current system design and control architectures choices with regard to their clinical effectiveness. Shortcomings and recommendations for future directions are identified.
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Affiliation(s)
- Javier Gil-Castillo
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Fady Alnajjar
- College of Information Technology (CIT), The United Arab Emirates University, P.O. Box 15551, Al Ain, UAE.
| | - Aikaterini Koutsou
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
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8
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Buoite Stella A, Morelli ME, Giudici F, Sartori A, Manganotti P, di Prampero PE. Comfortable walking speed and energy cost of locomotion in patients with multiple sclerosis. Eur J Appl Physiol 2020; 120:551-566. [PMID: 31919582 DOI: 10.1007/s00421-019-04295-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022]
Abstract
Comfortable walking speed and energy cost of walking are physiological markers of metabolic activity during gait. People with multiple sclerosis are characterized by altered gait biomechanics and energetics, related to the degree of disability and spasticity, which lead to an increased energy cost of walking. Several studies concerning the energy cost of walking in multiple sclerosis have been published. Nevertheless, differences in protocols and characteristics of the sample have led to different outcomes. The aim of the present meta-analysis is to summarize results from studies with specific inclusion characteristics, and to present data about the comfortable walking speed and the energy cost of walking at that speed. Moreover, a detailed discussion of the potential mechanisms involved in the altered metabolic activity during exercise was included. A total of 19 studies were considered, 12 of which were also part of the quantitative analysis. Despite the strict selection process, high between-group heterogeneity was found for both outcomes. Nevertheless, the overall results suggest a pooled mean comfortable walking speed of 1.12 m/s (95% CI 1.05-1.18) and energy cost of 0.19 mLO2/kg/m (95% CI 0.17-0.21). These findings support the results of previous studies suggesting that energy cost of walking may be increased by 2-3 times compared to healthy controls (HC), and encourage the use of this marker in association with other parameters of the disease.
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Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
| | - Maria Elisa Morelli
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Fabiola Giudici
- Unit of Statistics, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Pietro Enrico di Prampero
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
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Miller Renfrew L, Lord AC, Warren J, Hunter R. Evaluating the Effect of Functional Electrical Stimulation Used for Foot Drop on Aspects of Health-Related Quality of Life in People with Multiple Sclerosis: A Systematic Review. Int J MS Care 2019; 21:173-182. [PMID: 31474810 DOI: 10.7224/1537-2073.2018-015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Multiple sclerosis (MS) is a common degenerative neurologic condition resulting in walking difficulties. Foot drop is a common walking impairment in MS that can affect health-related quality of life (HRQOL). Functional electrical stimulation (FES) can improve walking in people with MS, but its effect on HRQOL is not well established. This review investigated the effect of FES used for foot drop on HRQOL in adults with MS. Methods A systematic search was performed using CINAHL, MEDLINE, Cochrane Library, PubMed, and PEDro online databases. Inclusion and exclusion criteria were applied to select eligible studies. Data were extracted, and two reviewers independently rated the quality of the studies using the Effective Public Health Practice Project assessment tool. Results Eight studies were eligible for review; seven were of moderate-to-strong methodological quality and one was weak. Seven studies demonstrated significant positive effects of FES on different aspects of HRQOL as measured by the 29-item Multiple Sclerosis Impact Scale, 36-item Short Form Health Status Survey, Canadian Occupational Performance Measure, and Psychosocial Impact of Assistive Devices Scale. Conclusions This review provides preliminary evidence that FES has a positive effect on aspects of HRQOL in people with MS; however, the variety of HRQOL outcomes used makes it difficult to determine definitive conclusions. Future larger-scale randomized studies with long-term follow-up are recommended to better understand the effect of FES on HRQOL. This will inform prescribing decisions and support compliance with FES over the longer-term.
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Renfrew LM, Paul L, McFadyen A, Rafferty D, Moseley O, Lord AC, Bowers R, Mattison P. The clinical- and cost-effectiveness of functional electrical stimulation and ankle-foot orthoses for foot drop in Multiple Sclerosis: a multicentre randomized trial. Clin Rehabil 2019; 33:1150-1162. [PMID: 30974955 DOI: 10.1177/0269215519842254] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the clinical- and cost-effectiveness of ankle-foot orthoses (AFOs) and functional electrical stimulation (FES) over 12 months in people with Multiple Sclerosis with foot drop. DESIGN Multicentre, powered, non-blinded, randomized trial. SETTING Seven Multiple Sclerosis outpatient centres across Scotland. SUBJECTS Eighty-five treatment-naïve people with Multiple Sclerosis with persistent (>three months) foot drop. INTERVENTIONS Participants randomized to receive a custom-made, AFO (n = 43) or FES device (n = 42). OUTCOME MEASURES Assessed at 0, 3, 6 and 12 months; 5-minute self-selected walk test (primary), Timed 25 Foot Walk, oxygen cost of walking, Multiple Sclerosis Impact Scale-29, Multiple Sclerosis Walking Scale-12, Modified Fatigue Impact Scale, Euroqol five-dimension five-level questionnaire, Activities-specific Balance and Confidence Scale, Psychological Impact of Assistive Devices Score, and equipment and National Health Service staff time costs of interventions. RESULTS Groups were similar for age (AFO, 51.4 (11.2); FES, 50.4(10.4) years) and baseline walking speed (AFO, 0.62 (0.21); FES 0.73 (0.27) m/s). In all, 38% dropped out by 12 months (AFO, n = 21; FES, n = 11). Both groups walked faster at 12 months with device (P < 0.001; AFO, 0.73 (0.24); FES, 0.79 (0.24) m/s) but no difference between groups. Significantly higher Psychological Impact of Assistive Devices Scores were found for FES for Competence (P = 0.016; AFO, 0.85(1.05); FES, 1.53(1.05)), Adaptability (P = 0.001; AFO, 0.38(0.97); FES 1.53 (0.98)) and Self-Esteem (P = 0.006; AFO, 0.45 (0.67); FES 1 (0.68)). Effects were comparable for other measures. FES may offer value for money alternative to usual care. CONCLUSION AFOs and FES have comparable effects on walking performance and patient-reported outcomes; however, high drop-outs introduces uncertainty.
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Affiliation(s)
- Linda Miller Renfrew
- 1 Douglas Grant Rehabilitation Centre, Ayrshire Central Hospital, NHS Ayrshire & Arran, Irvine, UK
| | - Lorna Paul
- 2 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Danny Rafferty
- 2 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Anna C Lord
- 1 Douglas Grant Rehabilitation Centre, Ayrshire Central Hospital, NHS Ayrshire & Arran, Irvine, UK
| | - Roy Bowers
- 5 Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Paul Mattison
- 1 Douglas Grant Rehabilitation Centre, Ayrshire Central Hospital, NHS Ayrshire & Arran, Irvine, UK
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11
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Miller Renfrew L, Flowers P, Lord AC, Rafferty D, McFadyen AK, Bowers R, Mattison P, Paul L. An exploration of the experiences and utility of functional electrical stimulation for foot drop in people with multiple sclerosis. Disabil Rehabil 2018; 42:510-518. [PMID: 30299176 DOI: 10.1080/09638288.2018.1501100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: Functional electrical stimulation (FES) is effective in improving walking in people with multiple sclerosis (MS) with foot drop. There is limited research exploring people's experiences of using this device. This study aims to explore the utility, efficacy, acceptability, and impact on daily life of the device in people with MS.Methods: An interpretative phenomenological approach was employed. Ten participants who had used FES for 12 months were interviewed. Transcripts were analysed, and emergent themes identified.Results: Nine participants continued to use the device. Three relevant super-ordinate themes were identified; impact of functional electrical stimulation, sticking with functional electrical stimulation, and autonomy and control. Participants reported challenges using the device; however, all reported positive physical and psychological benefits. Intrinsic and external influences such as; access to professional help, the influence of others, an individual's ability to adapt, and experiences using the device, influenced their decisions to continue with the device. A thematic model of these factors was developed.Conclusions: This study has contributed to our understanding of people with MS experiences of using the device and will help inform prescribing decisions and support the continued, appropriate use of FES over the longer term.Implications for RehabilitationPeople with multiple sclerosis using functional electrical stimulation report benefits in many aspects of walking, improved psychological well-being and increased engagement in valued activities.A number of challenges impact on functional electrical stimulation use. Factors such as; a positive experience using the device, access to professional help, the influence of others, a strong sense of personal autonomy and an individual's ability to adapt, influence an individual's decision to continue using functional electrical stimulation.Clinicians prescribing functional electrical stimulation should be aware of these factors so that the right support and guidance can be provided to people with multiple sclerosis, thus improving outcomes and compliance over the long term.
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Affiliation(s)
- Linda Miller Renfrew
- MS Service, Douglas Grant Rehabilitation Centre, Irvine, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Paul Flowers
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Anna C Lord
- MS Service, Douglas Grant Rehabilitation Centre, Irvine, UK
| | - Danny Rafferty
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Roy Bowers
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Paul Mattison
- MS Service, Douglas Grant Rehabilitation Centre, Irvine, UK
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Andreopoulou G, Mercer TH, van der Linden ML. Walking measures to evaluate assistive technology for foot drop in multiple sclerosis: A systematic review of psychometric properties. Gait Posture 2018; 61:55-66. [PMID: 29304511 DOI: 10.1016/j.gaitpost.2017.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Foot drop in people with multiple sclerosis (pwMS) often managed with assistive technologies, such as functional electrical stimulation and ankle foot orthoses. No evidence synthesis exists for the psychometric properties of outcomes used to evaluate the efficacy of these interventions. OBJECTIVE This systematic review aimed to identify the outcome measures reported to assess the benefits of assistive technology for pwMS and then synthesize the psychometric evidence in pwMS for a subset of these measures. METHODS Two searches in eight databases were conducted up to May 2017. Methodological quality was rated using the COSMIN guidelines. Overall level of evidence was scored according to the Cochrane criteria. RESULTS The first search identified 27 measures, with the 10 m walk test, gait kinematics and Physiological Cost Index (PCI) most frequently used. The second search resulted in 41 studies evaluating 10 measures related to walking performance. Strong levels of evidence were found for the internal consistency and test-retest reliability of the Multiple Sclerosis Walking Scale-12 and for the construct validity for Timed 25 Foot Walk. No psychometric studies were identified for gait kinematics and PCI in pwMS. There was a lack of evidence for measurement error and responsiveness. CONCLUSION Although a strong level of evidence exists for some measures included in this review, there was an absence of psychometric studies on commonly used measures such as gait kinematics. Future psychometric studies should evaluate a wider range of walking related measures used to assess the efficacy of interventions to treat foot drop in pwMS.
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Affiliation(s)
- Georgia Andreopoulou
- Centre for Health Activity and Rehabilitation Research,Queen Margaret University, Edinburgh, EH21 6UU, Scotland, UK.
| | - Thomas H Mercer
- Centre for Health Activity and Rehabilitation Research,Queen Margaret University, Edinburgh, EH21 6UU, Scotland, UK.
| | - Marietta L van der Linden
- Centre for Health Activity and Rehabilitation Research,Queen Margaret University, Edinburgh, EH21 6UU, Scotland, UK.
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Miller Renfrew L, Lord AC, McFadyen AK, Rafferty D, Hunter R, Bowers R, Mattison P, Moseley O, Paul L. A comparison of the initial orthotic effects of functional electrical stimulation and ankle-foot orthoses on the speed and oxygen cost of gait in multiple sclerosis. J Rehabil Assist Technol Eng 2018; 5:2055668318755071. [PMID: 31191925 PMCID: PMC6453037 DOI: 10.1177/2055668318755071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/14/2017] [Indexed: 11/17/2022] Open
Abstract
Background Foot drop affects walking in people with multiple sclerosis (pwMS). This study compares the initial orthotic effects of two treatments for foot drop: ankle-foot orthoses (AFO) and functional electrical stimulation (FES), on the speed and oxygen cost of walking in MS. Method and materials Seventy-eight pwMS were randomised to receive AFO or FES (ODFS PACE (OML, Salisbury, UK)). Participants completed the 25-ft walk test (25ftWT) and 5-min self-selected walk test (5minSSWT), from which oxygen cost was determined, with and without their device. Between-, within- and sub-group analyses (based on baseline walking speed of <0.8 m/s (slow) or ≥0.8 m/s (fast)) were undertaken. Results No significant differences between baseline measures were observed. The AFO group walked significantly slower than the FES group (5minSSWT, p = 0.037, 0.11 m/s). The AFO group walked significantly slower with than without AFO (25ftWT, p = 0.037), particularly in the fast-walking group ( p = 0.011). The slow-walking FES group walked significantly faster with FES than without (25ftWT; p = 0.029, 5minSSWT; p = 0.037). There were no differences in the fast-walking FES group or in the oxygen cost for either device. Conclusion AFO reduced walking speed, particularly in fast walkers. FES increased walking speed in slow, but not fast walkers.
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Affiliation(s)
- Linda Miller Renfrew
- Douglas Grant Rehabilitation Unit, Irvine, UK.,2School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Anna C Lord
- Douglas Grant Rehabilitation Unit, Irvine, UK
| | | | - Danny Rafferty
- 2School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Roy Bowers
- 4Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | | | | | - Lorna Paul
- 2School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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15
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Street T. Management of the symptoms of multiple sclerosis using functional electrical stimulation and exercise. Neurodegener Dis Manag 2017; 7:253-259. [DOI: 10.2217/nmt-2017-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Previously, it was believed that exercise-related activity was likely to lead to the symptoms of multiple sclerosis (MS) becoming worse. More recently, it has been acknowledged that the consequences of not exercising are detrimental and may exacerbate symptoms of MS. In addition, it has been recognized that some of the disability that occurs after MS is likely to be due to deconditioning from a reduction in physical activity. The current paper will explore the potential role of functional electrical stimulation of the peroneal nerve, for facilitating neurorehabilitation, through increasing mobility and overcoming barriers to accessing exercise. The paper will also examine the impact of using exercise-related activity to manage the symptoms of MS along with the potential neuroprotective effects.
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Affiliation(s)
- Tamsyn Street
- Salisbury NHS Foundation Trust, Department of Clinical Science & Engineering, Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ, UK
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Springer S, Khamis S. Effects of functional electrical stimulation on gait in people with multiple sclerosis - A systematic review. Mult Scler Relat Disord 2017; 13:4-12. [PMID: 28427700 DOI: 10.1016/j.msard.2017.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/05/2017] [Accepted: 01/17/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Functional electrical stimulation (FES) is commonly used to ameliorate gait deficits in patients with multiple sclerosis (PwMS). This review critically evaluates the literature describing the orthotic and therapeutic effects of FES on gait in PwMS. METHODS The PubMed, CINAHL, and ProQuest databases were searched. Included were studies that evaluated therapeutic and/or orthotic effects of FES in PwMS with at least one outcome measure related to gait. Methodology was assessed using the Downs and Black checklist. RESULTS Twelve relevant studies were reviewed. Their methodological quality ranged from 14 to 21 of 28. Eleven studies reported the effects of peroneal stimulation. Most found a significant orthotic effect (measured during stimulation), mainly on walking speed. Only three assessed the therapeutic effect (carry-over), which was not significant. CONCLUSIONS The evidence presented in this review suggests that FES has a positive orthotic effect on walking in PwMS. Yet, more robust trials are needed to substantiate this finding. Therapeutic efficacy of FES was not demonstrated, and almost all studies tested a single channel peroneal stimulator. Future studies involving FES technological innovations with advanced clinical approaches might contribute to a carry-over effect from FES and increase the percentage of PwMS who benefit from this technology.
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Affiliation(s)
- Shmuel Springer
- Physical Therapy Department, Faculty of Health Sciences Ariel University, Ariel, Israel.
| | - Sam Khamis
- Gait and Motion Analysis Laboratory, Dana Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel
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Miller L, McFadyen A, Lord AC, Hunter R, Paul L, Rafferty D, Bowers R, Mattison P. Functional Electrical Stimulation for Foot Drop in Multiple Sclerosis: A Systematic Review and Meta-Analysis of the Effect on Gait Speed. Arch Phys Med Rehabil 2017; 98:1435-1452. [PMID: 28088382 DOI: 10.1016/j.apmr.2016.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/01/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the efficacy of functional electrical stimulation (FES) used for foot drop in people with multiple sclerosis (pwMS) on gait speed in short and long walking performance tests. DATA SOURCES Five databases (Cochrane Library, CINAHL, Embase, MEDLINE, and PubMed) and reference lists were searched. STUDY SELECTION Studies of both observational and experimental design where gait speed data in pwMS could be extracted were included. DATA EXTRACTION Data were independently extracted and recorded. Methodologic quality was assessed using the Effective Public Health Practice Project tool. DATA SYNTHESIS Nineteen studies (described in 20 articles) recruiting 490 pwMS were identified and rated as moderate or weak, with none gaining a strong rating. All studies rated weak for blinding. Initial and ongoing orthotic and therapeutic effects were assessed regarding the effect of FES on gait speed in short and long walking tests. Meta-analyses of the short walk tests revealed a significant initial orthotic effect (t=2.14, P=.016), with a mean increase in gait speed of .05m/s, and ongoing orthotic effect (t=2.81, P=.003), with a mean increase of .08m/s. There were no initial or ongoing effects on gait speed in long walk tests and no therapeutic effect on gait speed in either short or long walk tests. CONCLUSIONS FES used for foot drop has a positive initial and ongoing effect on gait speed in short walking tests. Further fully powered randomized controlled trials comparing FES with alternative treatments are required.
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Affiliation(s)
- Linda Miller
- Multiple Sclerosis Service, NHS Ayrshire and Arran, Irvine, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | | | - Anna C Lord
- Multiple Sclerosis Service, NHS Ayrshire and Arran, Irvine, UK
| | - Rebecca Hunter
- Multiple Sclerosis Service, NHS Ayrshire and Arran, Irvine, UK
| | - Lorna Paul
- School of Medicine, Glasgow University, Glasgow, UK
| | - Danny Rafferty
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Roy Bowers
- Department of Biomedical Engineering, Strathclyde University, Glasgow, UK
| | - Paul Mattison
- Multiple Sclerosis Service, NHS Ayrshire and Arran, Irvine, UK
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Newsome SD, Aliotta PJ, Bainbridge J, Bennett SE, Cutter G, Fenton K, Lublin F, Northrop D, Rintell D, Walker BD, Weigel M, Zackowski K, Jones DE. A Framework of Care in Multiple Sclerosis, Part 2: Symptomatic Care and Beyond. Int J MS Care 2017; 19:42-56. [PMID: 28243186 PMCID: PMC5315323 DOI: 10.7224/1537-2073.2016-062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The Consortium of Multiple Sclerosis Centers (CMSC) convened a Framework Taskforce composed of a multidisciplinary group of clinicians and researchers to examine and evaluate the current models of care in multiple sclerosis (MS). The methodology of this project included analysis of a needs assessment survey and an extensive literature review. The outcome of this work is a two-part continuing education series of articles. Part 1, published previously, covered the updated disease phenotypes of MS along with recommendations for the use of disease-modifying therapies. Part 2, presented herein, reviews the variety of symptoms and potential complications of MS. Mobility impairment, spasticity, pain, fatigue, bladder/bowel/sexual dysfunction, cognitive dysfunction, and neuropsychiatric issues are examined, and both pharmacologic and nonpharmacologic interventions are described. Because bladder and bowel symptoms substantially affect health-related quality of life, detailed information about elimination dysfunction is provided. In addition, a detailed discussion about mental health and cognitive dysfunction in people with MS is presented. Part 2 concludes with a focus on the role of rehabilitation in MS. The goal of this work is to facilitate the highest levels of independence or interdependence, function, and quality of life for people with MS.
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Leonard G. Noninvasive tongue stimulation combined with intensive cognitive and physical rehabilitation induces neuroplastic changes in patients with multiple sclerosis: A multimodal neuroimaging study. Mult Scler J Exp Transl Clin 2017; 3:2055217317690561. [PMID: 28607750 PMCID: PMC5466147 DOI: 10.1177/2055217317690561] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/23/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) patients have central nervous system (CNS) lesions that may impede cognitive and sensorimotor function. Few rehabilitative therapies are available. OBJECTIVES The objective of this paper is to study effects of noninvasive tongue stimulation using the Portable Neuromodulation Stimulator (PoNS™) combined with intensive cognitive and physical rehabilitation on working memory, gait, balance and concomitant changes in the brain. METHODS Fourteen MS patients, seven each in an active and a sham stimulation group, participated. Participants received intensive physical therapy and working memory training for 14 weeks. Functional magnetic resonance imaging (fMRI) using motor imagery and working-memory tasks were completed prior to and following therapy, as were sensory organization tests (SOT), motor performance measures, and neuropsychological assessment. RESULTS On the SOT, the active group showed significant improvement from baseline. fMRI revealed significant blood oxygen level-dependent signal changes in the left primary motor cortex for the Active Group, while the sham group had increased activity in bilateral premotor cortices. All individuals improved on working-memory tasks, but only the active group showed increased dorsolateral prefrontal cortex activity. CONCLUSIONS In this cohort of MS patients, the results suggest that PoNS stimulation can enhance motor performance and working memory while also driving neuroplasticity. Further studies are warranted to explore these findings.
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Affiliation(s)
- Gabriel Leonard
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Canada; Cognitive Neuroscience, Montreal Neurological Institute, Canada
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Gervasoni E, Parelli R, Uszynski M, Crippa A, Marzegan A, Montesano A, Cattaneo D. Effects of Functional Electrical Stimulation on Reducing Falls and Improving Gait Parameters in Multiple Sclerosis and Stroke. PM R 2016; 9:339-347.e1. [PMID: 27825837 DOI: 10.1016/j.pmrj.2016.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 10/17/2016] [Accepted: 10/25/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Loss of neuromuscular control of the ankle joint is a common impairment in neurologic conditions, leading to abnormal gait and a greater risk of falling. Limited information, however, is available on the effectiveness of functional electrical stimulation (FES) on reducing falls, and no studies have investigated its usefulness in improving lower limbs kinematics related to foot clearance and energy recovery. SETTING Clinical setting. STUDY DESIGN Prospective longitudinal study. PARTICIPANTS Twenty-four subjects, 14 people with multiple sclerosis (mean age ± standard deviation 50.93 ± 8.72 years) and 10 people with stroke (55.38 ± 14.55 years). METHODS The number of falls was assessed at baseline and after 8 weeks, and a clinical assessment was performed at the baseline, 4-week, and 8-week time points. A subsample of the 24 subjects comprising 5 people with multiple sclerosis and 5 people with stroke performed a gait analysis assessment at baseline and after 4 weeks. After receiving the equipment and the training schedule, subjects performed daily home walking training using FES for 8 weeks. MAIN OUTCOME MEASUREMENTS The main outcomes were (1) the number of falls, (2) foot clearance, and (3) energy recovery. RESULTS A reduction in the number of falls was observed from baseline (n = 10) to the 8-week assessment (n = 2), P = .02. Foot clearance increased (+5.26 mm, P = .04) between the baseline without FES and at 4 weeks with FES (total effect). No statistically significant differences were found in energy recovery between baseline and 4 weeks. CONCLUSIONS The use of FES had an impact on gait, specifically reducing the number of falls and improving walking. A specific effect at the ankle joint was observed, increasing foot clearance during the swing phase of gait. This effect was not accompanied with a reduction in the energetic expenditure during walking in subjects with multiple sclerosis and stroke.
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Affiliation(s)
- Elisa Gervasoni
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(∗)
| | - Riccardo Parelli
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(†)
| | - Marcin Uszynski
- Multiple Sclerosis of Ireland, Western Regional Office, Galway, Ireland(‡)
| | - Alessandro Crippa
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, and SaFLo: Gait Analysis Laboratory, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(§)
| | - Alberto Marzegan
- SaFLo: Gait Analysis Laboratory, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(¶)
| | - Angelo Montesano
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(#)
| | - Davide Cattaneo
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Capecelatro 66 - 20148 Milano, Italy(∗∗).
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Perceived Exertion Is Lower When Using a Functional Electrical Stimulation Neuroprosthesis Compared With an Ankle-Foot Orthosis in Persons With Multiple Sclerosis: A Preliminary Study. Am J Phys Med Rehabil 2016; 96:133-139. [PMID: 27680426 DOI: 10.1097/phm.0000000000000626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study investigates the direct comparison of energy cost, efficiency, and effort between an ankle-foot orthosis (AFO) and a functional electrical stimulation (FES) device for foot drop in ambulatory patients with multiple sclerosis. DESIGN Twenty adults (32-74 years old; 55% female) with a diagnosis of multiple sclerosis resulting in foot drop participated in a crossover, counterbalanced preliminary study. Each participant was tested on different days, with each session consisting of a separate walk trial per prosthetic device. Heart rate, oxygen consumption, speed, distance, and self-reported exertion were measured independently for each device walk trial. Repeated-measures analysis of variance with device and visit number as within-participants independent variables were run for the primary outcome variables of perceived exertion, energy, and metabolic efficiency. RESULTS A significant main effect of device was found for perceived exertion (P = 0.01), with participants reporting decreased exertion levels (Borg Scale) when using the FES compared with the AFO (mean difference, 1.63; 95% confidence interval, 0.49-2.76). Energy and efficiency did not significantly differ by device. CONCLUSION Results suggest that further investigation of the potential advantages of FES devices over traditional AFO is warranted. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) describe the potential differences between an AFO and FES for the treatment of foot drop in patients with multiple sclerosis, (2) understand the mechanisms and prevalence of foot drop in patients with multiple sclerosis, and (3) recognize the potential benefit of improved perceived exertion found when using FES for the treatment of foot drop in patients with multiple sclerosis. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Taylor PN, Wilkinson Hart IA, Khan MS, Slade-Sharman DE. Correction of Footdrop Due to Multiple Sclerosis Using the STIMuSTEP Implanted Dropped Foot Stimulator. Int J MS Care 2016; 18:239-247. [PMID: 27803639 PMCID: PMC5087579 DOI: 10.7224/1537-2073.2015-038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Footdrop is a significant problem in multiple sclerosis, reducing the safety and efficiency of walking. Functional electrical stimulation (FES) can produce dorsiflexion, correcting footdrop. The purpose of this retrospective analysis of clinical study data was to compare the effect of external and implanted FES devices for the correction of footdrop. Methods: External FES was used for a minimum of 6 months before implantation. Walking performance was assessed using 10-m walking speed, 3-minute walking distance, the Physiological Cost Index, and health- and device-related quality of life and device-use questionnaires. Assessments were made before implantation and a mean (SD) of 128 (24) days after surgery, with additional walking speed measurements at 3 years. Results: Twenty-three people with multiple sclerosis received the STIMuSTEP implant. Both devices enabled statistically significant increases in walking speed and walking distance, with a strong trend toward a reduced Physiological Cost Index, indicating that walking required less effort (P = .07). Both devices improved device-related quality of life. Walking speed gain with FES was maintained at 3 years. Three implants failed after falls, and there was one case of neuropraxia. The implant was used more days per week and was quicker to put on each day than the external FES device. Conclusions: The STIMuSTEP implanted dropped foot stimulator is an effective long-term intervention for the correction of footdrop.
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Martin KD, Polanski WH, Schulz AK, Jöbges M, Ziemssen T, Schackert G, Pinzer T, Sobottka SB. ActiGait implantable drop foot stimulator in multiple sclerosis: a new indication. J Neurosurg 2016; 126:1685-1690. [PMID: 27367245 DOI: 10.3171/2016.4.jns1660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Direct stimulation of the peroneal nerve by the ActiGait implantable drop foot stimulator is a potent therapy that was described previously for stroke-related drop foot. The authors report here successful long-term application of the ActiGait implantable drop foot stimulator in patients with multiple sclerosis (MS). METHODS Six patients with MS and 2 years of persisting central leg paresis received an implantable ActiGait drop foot stimulator after successful surface test stimulation. Ten weeks and 1 year after surgery, their gait speed, endurance, and safety were evaluated. Patient satisfaction was assessed with a questionnaire. RESULTS In the 20-m gait test, stimulation with the ActiGait stimulator significantly reduced the time needed, on average, by approximately 23.6% 10 weeks after surgery, and the time improved further by 36.3% after 1 year. The median distance covered by patients with the stimulator after 6 minutes of walking increased significantly from 217 m to 321 m and remained stable for 1 year; the distance covered by patients after surface stimulation was 264 m. Patients with an implanted ActiGait stimulator noticed pronounced improvement in their mobility, social participation, and quality of life. CONCLUSIONS The ActiGait implantable drop foot stimulator improved gait speed, endurance, and quality of life in all patients over a period of 1 year. It may serve as a new therapeutic option for patients with MS-related drop foot.
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Affiliation(s)
| | | | | | - Michael Jöbges
- Neurologic Rehabilitation Centre, Brandenburg Klinik, Bernau-Waldsiedlung, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl-Gustav-Carus, Technical University of Dresden; and
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Berniker M, Jarc A, Kording K, Tresch M. A Probabilistic Analysis of Muscle Force Uncertainty for Control. IEEE Trans Biomed Eng 2016; 63:2359-2367. [PMID: 26890530 DOI: 10.1109/tbme.2016.2531083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We control the movements of our body and limbs through our muscles. However, the forces produced by our muscles depend unpredictably on the commands sent to them. This uncertainty has two sources: irreducible noise in the motor system's processes (i.e., motor noise) and variability in the relationship between muscle commands and muscle outputs (i.e., model uncertainty). Any controller, neural or artificial, benefits from estimating these uncertainties when choosing commands. METHODS To examine these benefits, we used an experimental preparation of the rat hindlimb to electrically stimulate muscles and measure the resulting isometric forces. We compare a functional electric stimulation (FES) controller that represents and compensates for uncertainty in muscle forces with a standard FES controller that neglects uncertainty. RESULTS Accounting for uncertainty substantially increased the precision of force control. CONCLUSION Our study demonstrates the theoretical and practical benefits of representing muscle uncertainty when computing muscle commands. SIGNIFICANCE The findings are relevant beyond FES as they highlight the benefits of estimating statistical properties of muscles for both artificial controllers and the nervous system.
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Affiliation(s)
| | - A Jarc
- Intuitive Surgical Inc., Sunnyvale, CA
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Sampson P, Freeman C, Coote S, Demain S, Feys P, Meadmore K, Hughes AM. Using Functional Electrical Stimulation Mediated by Iterative Learning Control and Robotics to Improve Arm Movement for People With Multiple Sclerosis. IEEE Trans Neural Syst Rehabil Eng 2016; 24:235-48. [DOI: 10.1109/tnsre.2015.2413906] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hausmann J, Sweeney-Reed CM, Sobieray U, Matzke M, Heinze HJ, Voges J, Buentjen L. Functional electrical stimulation through direct 4-channel nerve stimulation to improve gait in multiple sclerosis: a feasibility study. J Neuroeng Rehabil 2015; 12:100. [PMID: 26577467 PMCID: PMC4650371 DOI: 10.1186/s12984-015-0096-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 11/06/2015] [Indexed: 11/13/2022] Open
Abstract
Background Gait dysfunction due to lower limb central paralysis, frequently involving drop foot, is a common cause of disability in multiple sclerosis and has been treated with transcutaneous functional electrical stimulation (FES). We provide here the first report of 4-channel semi-implantable FES of the peroneal nerve which has been successfully used for rehabilitation in patients following stroke. Methods FES was implemented via a 4-channel semi-implantable closed-loop system (ActiGait®, ©Ottobock), generating dorsiflexion in drop foot. Walking distance, gait symmetry (temporospatial gait analyses, Vicon Motion Systems®), gait velocity (10 m walking test) and quality of life (SF-36 questionnaire) were measured to evaluate the therapeutic benefit of this system in two patients with progressive MS. Results Walking distance increased from 517 to 1884 m in Patient 1 and from 52 to 506 m in Patient 2. Gait velocity did not change significantly in Patient 1 and increased from 0.6 to 0.8 m/s in Patient 2. Maximum deviations of center of mass from the midline to each side changed significantly after 3 months of stimulation compared to baseline, decreasing from 15 to 12 mm in Patient 1 and from 47 to 37 mm in Patient 2. Both patients experienced reduced pain and fatigue and benefits to quality of life. Adverse events did not occur during the observation period. Conclusion We conclude that implantable 4-channel FES systems are not only feasible but present a promising new alternative for treating central drop foot in MS patients.
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Affiliation(s)
- Janet Hausmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Catherine M Sweeney-Reed
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. .,Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Uwe Sobieray
- German Center for Neurodegenerative Diseases (DZNE), Site Magdeburg, Leipziger Str. 44, Magdeburg, Germany.
| | - Mike Matzke
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Jürgen Voges
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Lars Buentjen
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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McLoughlin JV, Barr CJ, Patritti B, Crotty M, Lord SR, Sturnieks DL. Fatigue induced changes to kinematic and kinetic gait parameters following six minutes of walking in people with multiple sclerosis. Disabil Rehabil 2015; 38:535-43. [DOI: 10.3109/09638288.2015.1047969] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Miller L, Rafferty D, Paul L, Mattison P. The impact of walking speed on the effects of functional electrical stimulation for foot drop in people with multiple sclerosis. Disabil Rehabil Assist Technol 2015; 11:478-83. [PMID: 25826047 DOI: 10.3109/17483107.2015.1027296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Functional electrical stimulation (FES) is effective in assisting people with multiple sclerosis (pwMS) with gait. Previous studies have investigated the effects of FES in pwMS with slow self-selected walking speeds (SSWS). This study reports on the effect of the Odstock Dropped Foot Stimulator (ODFS) on the speed and oxygen (O2) cost of gait in pwMS walking at a range of SSWS. METHODS Twenty pwMS (mean age 50.4 ± 7.3 years) currently using FES walked at their SSWS for 5 min with and without FES. O2 cost of gait was measured using a gas analysis system, and gait speed was calculated. Data were analysed for all participants, and comparisons were made between those with a SSWS < and >0.8 m/s (walking speed required for community ambulation). RESULTS Significant improvements in the speed and O2 cost of gait were seen using FES in the group with SSWS <0.8 m/s (n = 11, p = 0.005). When participants' SSWS >0.8 m/s, no difference in gait speed was noted, and a significant increase in O2 cost of gait using FES (n = 9, p = 0.004) was noted. CONCLUSION FES has a different effect on the speed and O2 cost of gait dependent on the SSWS of pwMS. This requires further investigation. Implications for Rehabilitation Functional electrical stimulation (FES) used for foot drop is effective in improving the speed and oxygen cost of walking in pwMS walking at SSWS <0.8 m/s. FES does not seem to have a beneficial effect on the speed and oxygen cost of walking in pwMS walking at SSWS >0.8 m/s. Further research is needed to understand the possible mechanisms involved so that FES for foot drop can be efficiently prescribed.
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Affiliation(s)
- L Miller
- a MS Service, NHS Ayrshire and Arran , Scotland, UK .,b School of Health and Life Sciences, Glasgow Caledonian University , Glasgow , Scotland, UK , and
| | - D Rafferty
- b School of Health and Life Sciences, Glasgow Caledonian University , Glasgow , Scotland, UK , and
| | - L Paul
- c School of Medicine, University of Glasgow , Glasgow , Scotland, UK
| | - P Mattison
- a MS Service, NHS Ayrshire and Arran , Scotland, UK
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Mayer L, Warring T, Agrella S, Rogers HL, Fox EJ. Effects of functional electrical stimulation on gait function and quality of life for people with multiple sclerosis taking dalfampridine. Int J MS Care 2015; 17:35-41. [PMID: 25741225 DOI: 10.7224/1537-2073.2013-033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) can adversely affect gait, causing gait slowing, loss of balance, decreased functional mobility, and gait deficits, such as footdrop. Current treatments for gait dysfunction due to MS are pharmacologic, using dalfampridine, or orthotic, using an ankle-foot orthosis. Functional electrical stimulation (FES) to the fibular nerve stimulates active dorsiflexion and provides an alternative treatment for gait dysfunction caused by footdrop. The objective of this study was to determine the effect of FES on gait function and the impact of MS on walking and quality of life for people with MS taking a stable dalfampridine dose. METHODS Participants demonstrating gait slowing and footdrop completed the Timed 25-Foot Walk (T25FW) test, 6-Minute Walk (6MW) test, GaitRite Functional Ambulation Profile, 12-item Multiple Sclerosis Walking Scale (MSWS-12), and 36-item Short Form Health Status Survey (SF-36) at screening without FES; the measures were repeated with FES at baseline, 1 month, and 3 months. RESULTS Twenty participants (8 men and 12 women) completed this unblinded case series study. The mean age, duration of MS, and time taking dalfampridine were 51.7, 15.8, and 1.4 years, respectively. Changes from screening to baseline and screening to 3 months were analyzed. Significant improvement was noted from screening to baseline for the MSWS-12 (P = .024) and SF-36 Physical Function domain (P = .028) and from screening to 3 months for the T25FW (P = .015), MSWS-12 (P = .003), and SF-36 Physical Function (P = .032) and Role Limitation-Physical Health (P = .012) domains. CONCLUSIONS Improvements above those induced pharmacologically suggest that FES can augment pharmacologic intervention and significantly improve gait function, decrease the impact of MS on walking, and improve quality of life for people with MS.
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Affiliation(s)
- Lori Mayer
- Multiple Sclerosis Clinic of Central Texas, Central Texas Neurology Consultants, Round Rock, TX, USA (LM, TW, SA, EJF); and Innovative Neurotronics, Austin, TX, USA (HLR)
| | - Tina Warring
- Multiple Sclerosis Clinic of Central Texas, Central Texas Neurology Consultants, Round Rock, TX, USA (LM, TW, SA, EJF); and Innovative Neurotronics, Austin, TX, USA (HLR)
| | - Stephanie Agrella
- Multiple Sclerosis Clinic of Central Texas, Central Texas Neurology Consultants, Round Rock, TX, USA (LM, TW, SA, EJF); and Innovative Neurotronics, Austin, TX, USA (HLR)
| | - Helen L Rogers
- Multiple Sclerosis Clinic of Central Texas, Central Texas Neurology Consultants, Round Rock, TX, USA (LM, TW, SA, EJF); and Innovative Neurotronics, Austin, TX, USA (HLR)
| | - Edward J Fox
- Multiple Sclerosis Clinic of Central Texas, Central Texas Neurology Consultants, Round Rock, TX, USA (LM, TW, SA, EJF); and Innovative Neurotronics, Austin, TX, USA (HLR)
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Effectiveness of functional electrical stimulation on walking speed, functional walking category, and clinically meaningful changes for people with multiple sclerosis. Arch Phys Med Rehabil 2014; 96:667-72. [PMID: 25499688 DOI: 10.1016/j.apmr.2014.11.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/18/2014] [Accepted: 11/21/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effectiveness of functional electrical stimulation (FES) on drop foot in patients with multiple sclerosis (MS), using data from standard clinical practice. DESIGN Case series with a consecutive sample of FES users collected between 2008 and 2013. SETTING Specialist FES center at a district general hospital. PARTICIPANTS Patients with MS who have drop foot (N=187) (117 women, 70 men; mean age, 55y [range, 27-80y]; mean duration since diagnosis, 11.7y [range, 1-56y]). A total of 166 patients were still using FES after 20 weeks, with 153 patients completing the follow-up measures. INTERVENTIONS FES of the common peroneal nerve (178 unilateral, 9 bilateral FES users). MAIN OUTCOME MEASURES Clinically meaningful changes (ie, >.05m/s and >0.1m/s) and functional walking category derived from 10-m walking speed. RESULTS An increase in walking speed was found to be highly significant (P<.001), both initially where a minimum clinically meaningful change was observed (.07m/s) and after 20 weeks with a substantial clinically meaningful change (.11m/s). After 20 weeks, treatment responders displayed a 27% average improvement in their walking speed. No significant training effect was found. Overall functional walking category was maintained or improved in 95% of treatment responders. CONCLUSIONS FES of the dorsiflexors is a well-accepted intervention that enables clinically meaningful changes in walking speed, leading to a preserved or an increased functional walking category.
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Robinson BS, Williamson EM, Cook JL, Harrison KS, Lord EM. Examination of the use of a dual-channel functional electrical stimulation system on gait, balance and balance confidence of an adult with spastic diplegic cerebral palsy. Physiother Theory Pract 2014; 31:214-20. [PMID: 25412562 DOI: 10.3109/09593985.2014.982774] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this case report is to determine the effects of a dual-channel functional electrical stimulation (FES) system on gait and balance of a 57-year-old male diagnosed with spastic diplegic cerebral palsy (CP). Outcome measures included the: Activities-specific Balance Confidence Scale (ABC); Dynamic Gait Index (DGI); Observational Gait Scale (OGS) and Tinetti Performance Oriented Mobility Assessment (POMA). Assessments were completed with and without use of FES during the initial examination and after two, four and six weeks of intervention with FES. ABC Scale scores improved from 32.8 to 48.1% during the 6-week intervention. Scores on the DGI improved from 6/24 to 9/24 without FES and from 9/24 to 14/24 with FES. OGS scores improved on both legs with and without FES. Tinetti POMA scores improved from 12/28 to 15/28 without FES and decreased from 16/28 to 15/28 with FES. The patient demonstrated improvement in both objective and subjective measures. The use of FES facilitated improved gait and balance; however, the patient was still at increased risk for falls after the 6-week intervention despite improved scores on the ABC Scale, DGI, OGS and Tinetti POMA.
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Affiliation(s)
- Barbara S Robinson
- Department of Physical Therapy, Missouri State University , Springfield, MO , USA
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Downing A, Van Ryn D, Fecko A, Aiken C, McGowan S, Sawers S, McInerny T, Moore K, Passariello L, Rogers H. Effect of a 2-week trial of functional electrical stimulation on gait function and quality of life in people with multiple sclerosis. Int J MS Care 2014; 16:146-52. [PMID: 25337057 DOI: 10.7224/1537-2073.2013-032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Footdrop is a common gait deviation in people with multiple sclerosis (MS) leading to impaired gait and balance as well as decreased functional mobility. Functional electrical stimulation (FES) provides an alternative to the current standard of care for footdrop, an ankle-foot orthosis (AFO). FES stimulates the peroneal nerve and activates the dorsiflexor muscles, producing an active toe clearance and a more normal gait. This study was undertaken to determine the effects of a 2-week FES Home Assessment Program on gait speed, perceived walking ability, and quality of life (QOL) among people with MS-related footdrop. METHODS Participants completed the Timed 25-Foot Walk test (T25FW) and two self-report measures: 12-item Multiple Sclerosis Walking Scale (MSWS-12) and 29-item Multiple Sclerosis Impact Scale (MSIS-29). Measures were taken without FES before and with FES after 2 weeks of full-time FES wear. RESULTS A total of 19 participants (10 female, 9 male) completed the study; mean age and duration of disease were 51.77 ± 10.16 and 9.01 ± 7.90 years, respectively. Use of FES for 2 weeks resulted in a significant decrease in time to complete the T25FW (P < .0001), the MSWS-12 standardized score (P < .0001), and the MSIS-29 total (P < .0001), Physical subscale (P < .0001), and Psychological subscale (P = .0006) scores. CONCLUSIONS These results suggest that use of FES can significantly improve gait speed, decrease the impact of MS on walking ability, and improve QOL in people with MS-related footdrop even over a short period of time.
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Affiliation(s)
- Abbey Downing
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - David Van Ryn
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Anne Fecko
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Christopher Aiken
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Sean McGowan
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Sarah Sawers
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Thomas McInerny
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Katie Moore
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Louis Passariello
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Helen Rogers
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
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Dorsiflexion assist orthosis reduces the physiological cost and mitigates deterioration in strength and balance associated with walking in people with multiple sclerosis. Arch Phys Med Rehabil 2014; 96:226-232.e1. [PMID: 25264109 DOI: 10.1016/j.apmr.2014.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/01/2014] [Accepted: 09/03/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of wearing a dorsiflexion assist orthosis (DAO) on walking distance, physiological cost, fatigue, and strength and balance measures after a modified 6-minute walk test (6MWT) in people with multiple sclerosis (MS). DESIGN Randomized crossover trial. SETTING Hospital Movement Laboratory. PARTICIPANTS People with moderate MS and Expanded Disability Status Scale score of 3.7±0.7 (N=34; 26 women). INTERVENTIONS Modified 6MWT with and without a DAO worn on the weaker leg. MAIN OUTCOME MEASURES Distance walked, perceived fatigue, and the physiological cost of walking were compared between walking conditions. Pre- and postwalk changes in knee extensor and ankle dorsiflexor isometric strength and standing postural sway with eyes open and closed were compared between walking conditions. RESULTS There were no differences in distance walked or perceived fatigue between the 2 walking conditions. However, there was a reduced physiological cost of walking (P<.05), a smaller reduction in knee extensor strength (P<.05), and a smaller increase in standing postural sway with eyes open (P<.01) after walking while wearing the DAO compared with walking without wearing the DAO. CONCLUSIONS Despite not increasing walking distance or reducing perceived fatigue, the DAO reduced the physiological cost of walking and maintained knee strength and standing balance, which may have important implications for physical rehabilitation in people with MS. Further trials are required to determine whether the beneficial effects of wearing a DAO found here are maintained for longer periods.
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van der Linden ML, Hooper JE, Cowan P, Weller BB, Mercer TH. Habitual functional electrical stimulation therapy improves gait kinematics and walking performance, but not patient-reported functional outcomes, of people with multiple sclerosis who present with foot-drop. PLoS One 2014; 9:e103368. [PMID: 25133535 PMCID: PMC4136777 DOI: 10.1371/journal.pone.0103368] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 06/29/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND People with Multiple Sclerosis (pwMS) often experience a disturbed gait function such as foot-drop. The objective of this pilot study was to investigate the medium term effects of using Functional Electrical Stimulation (FES) to treat foot-drop over a period 12 weeks on gait and patient reported outcomes of pwMS. METHODS AND FINDINGS Nine pwMS aged 35 to 64 (2 males, 7 females) were assessed on four occasions; four weeks before baseline, at baseline and after six weeks and twelve weeks of FES use. Joint kinematics and performance on the 10 meter and 2 minute walk tests (10WT, 2 minWT) were assessed with and without FES. Participants also completed the MS walking Scale (MSWS), MS impact scale (MSIS29), Fatigue Severity Score (FSS) and wore an activity monitor for seven days after each assessment. Compared to unassisted walking, FES resulted in statistically significant improvements in peak dorsiflexion in swing (p = 0.006), 10MWT (p = 0.006) and 2 minWT (p = 0.002). Effect sizes for the training effect, defined as the change from unassisted walking at baseline to that at 12 weeks, indicated improved ankle angle at initial contact (2.6°, 95% CI -1° to 4°, d = 0.78), and a decrease in perceived exertion over the 2 min walking tests (-1.2 points, 95% CI -5.7 to 3.4, d = -0.86). Five participants exceeded the Minimally Detectable Change (MDC) for a training effect on the 10mWT, but only two did so for the 2 minWT. No effects of the use of FES for 12 weeks were found for MSWS, MSIS29, FSS or step count. CONCLUSION Although FES to treat foot-drop appears to offer the potential for a medium term training effect on ankle kinematics and walking speed, this was not reflected in the patient reported outcomes. This observed lack of relationship between objective walking performance and patient reported outcomes warrants further investigation. TRIAL REGISTRATION ClinicalTrials.gov NCT01977287.
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Affiliation(s)
| | - Julie E. Hooper
- Slateford Physiotherapy Clinic, NHS Lothian, Edinburgh, United Kingdom
| | - Paula Cowan
- Kenilworth Medical Centre, NHS Lanarkshire, Cumbernauld, United Kingdom
| | - Belinda B. Weller
- Anne Rowling regenerative neurology clinic, Edinburgh, United Kingdom
| | - Thomas H. Mercer
- Rehabilitation Sciences, Queen Margaret University, Musselburgh, United Kingdom
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Bulley C, Mercer TH, Hooper JE, Cowan P, Scott S, van der Linden ML. Experiences of functional electrical stimulation (FES) and ankle foot orthoses (AFOs) for foot-drop in people with multiple sclerosis. Disabil Rehabil Assist Technol 2014; 10:458-467. [PMID: 24796365 DOI: 10.3109/17483107.2014.913713] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE A constructivist phenomenological study explored impacts of ankle foot orthoses (AFOs) or functional electrical stimulation (FES) on people with foot-drop from multiple sclerosis (MS). METHOD Focus groups following topic guides were analysed using interpretative phenomenological analysis, with researcher reflexivity, participant verification and peer checking of analysis. Participants with sustained use of the devices (under 2 y) were invited from two quantitative studies that (a) investigated immediate FES effects (n = 12) and (b) compared habitual use of AFO (n = 7) or FES (n = 6). Two focus groups addressed AFO (n = 4) and FES (n = 6) experiences. RESULTS Similar numbers of positive and negative aspects were described for AFO and FES. Both reduced fatigue, improved gait, reduced trips and falls, increased participation, and increased confidence; greater balance/stability was reported for AFOs, and increased walking distance, fitness and physical activity for FES. Barriers to both included avoiding reliance on devices and implications for shoes and clothing; a non-normal gait pattern was reported for AFO, and difficulties of application and limitations in the design of FES. However, participants felt the positives outweighed the negatives. CONCLUSIONS Participants felt benefits outweighed the drawbacks for AFO and FES; greater understanding of user preferences and satisfaction may increase likelihood of usage and efficacy. Implications for Rehabilitation Interventions to reduce the impacts of foot-drop in people with multiple sclerosis (MS) are important to optimise physical activity participation and participation in life; they include ankle foot orthoses (AFOs) and functional electrical stimulation (FES). Research is lacking regarding user satisfaction and perceived outcomes, therefore, two separate focus groups were conducted from a constructivist phenomenological perspective to explore the impacts of AFOs (n = 4) and FES (n = 6) on people with foot-drop from MS. Some similar positive aspects of AFO and FES use were described, including reduced fatigue, improved gait and fewer trips and falls, while common barriers included finding the device cumbersome, uncomfortable, and inconvenient, with some psychological barriers to their use. On balance, the impacts of the devices on improving activities and participation were more important for participants than practical barriers, highlighting the importance of combining understanding of individual experiences and preferences with clinical decision-making when prescribing a device to manage foot-drop.
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Affiliation(s)
- Catherine Bulley
- a School of Health Sciences, Queen Margaret University , Edinburgh , UK
| | - Thomas H Mercer
- a School of Health Sciences, Queen Margaret University , Edinburgh , UK
| | | | - Paula Cowan
- c Kenilworth Medical Centre , Cumbernauld , UK
| | - Sasha Scott
- a School of Health Sciences, Queen Margaret University , Edinburgh , UK
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Tyler ME, Kaczmarek KA, Rust KL, Subbotin AM, Skinner KL, Danilov YP. Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial. J Neuroeng Rehabil 2014; 11:79. [PMID: 24885412 PMCID: PMC4017705 DOI: 10.1186/1743-0003-11-79] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 04/24/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study sought to examine the effect of targeted physical therapy with and without cranial nerve non-invasive neuromodulation (CN-NINM), on the walking ability of people with MS who exhibited a dysfunctional gait. We hypothesized that subjects who received electrical stimulation would have greater improvement than those who had a control device after a 14-week intervention. Gait disturbance is a common problem for people with multiple sclerosis (MS). Current management may include exercise, pharmacology, functional electrical stimulation, compensatory strategies, use of assistive devices, and implanted electrical devices. We have developed an effective rehabilitative strategy using neuromodulation of the cranial nerves via electrical stimulation of the tongue to enhance the plasticity of the brain. METHODS The study is a within-subject blinded randomized control design. Twenty chronic MS subjects with an identified gait disturbance were assigned to either an active or control group. Both groups completed a 14-week intervention program using a standardized combination of exercise and a device that provided electrical stimulation to the tongue. Those in the active group received electrical stimulation on the tongue that they could perceive. Those in the control group used a device that did not provide a physiologically significant stimulus and was not perceivable. Subjects were assessed with the Dynamic Gait Index (DGI). RESULTS The DGI scores improved for both groups. There were significant between-group differences, with the active group showing statistically greater improvement than the control group mean. CONCLUSION People with MS demonstrated improved gait with CN-NINM training in a pilot randomized controlled trial. This study suggests that tongue-based neurostimulation may amplify the benefits of exercise for improving gait in people with chronic MS.
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Affiliation(s)
- Mitchell E Tyler
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kurt A Kaczmarek
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kathy L Rust
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Alla M Subbotin
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kimberly L Skinner
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA
| | - Yuri P Danilov
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
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Miller L, Rafferty D, Paul L, Mattison P. A comparison of the orthotic effect of the Odstock Dropped Foot Stimulator and the Walkaide functional electrical stimulation systems on energy cost and speed of walking in Multiple Sclerosis. Disabil Rehabil Assist Technol 2014; 10:482-485. [DOI: 10.3109/17483107.2014.898340] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Coote S, O'Dwyer C. Energy expenditure during everyday activities--a study comparing people with varying mobility limitations due to multiple sclerosis and healthy controls. Disabil Rehabil 2014; 36:2059-64. [PMID: 24564325 DOI: 10.3109/09638288.2014.890676] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate energy expenditure of people with multiple sclerosis (MS) during everyday activities. METHODS Fifteen healthy controls, 19 people with MS who used at most a stick to walk outdoors (MS-A), and 11 people with MS who used bilateral support for gait (MS-B) completed scripted everyday activities. A portable indirect calorimetry unit calculated energy expenditure. Steps were counted from video. RESULTS There was no significant difference in kcal between the three groups (ANOVA: F(2, 42) = 2.877, p = 0.067). There was a significant difference in steps: F(2, 42) = 17.93, p < 0.001. (Controls-MS-A 470.5, 95% CI 85.2, 855.7, Control-MS-B 1091.3, 95% CI 648.5, 1534.1, MS-A-MS-B 620.8, 95% CI 198.2, 1043.4.) Energy cost of movement was estimated by dividing kcal by steps. The Kruskal-Wallis analysis found significant difference for total (x(2 )= 11.726, df2, p = 0.003), Walking (x(2 )= 9.01, p = 0.011), Stairs (x(2 )= 16.436, 2, p < 0.001). Post-hoc analysis revealed significant differences between MS-B group and control and MS-A groups. CONCLUSIONS People with MS do not use more energy than healthy controls during everyday activities at a self-selected pace. People with MS take significantly fewer steps during activities of daily living's. People who use bilateral support for gait have greater energy cost per step for walking and stairs activities. Implications for Rehabilitation This study found that the energy cost of movement is greater for people with MS with significant disability. Energy expenditure is an important consideration when prescribing physical activity and structured exercise for people with disability. It may be more appropriate to have energy, rather than movement, targets when prescribing physical activity for this population.
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Affiliation(s)
- Susan Coote
- Department of Clinical Therapies, Centre for Physical Activity and Health Research, University of Limerick , Limerick , Ireland
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IJzerman MJ, Renzenbrink GJ, Geurts ACH. Neuromuscular stimulation after stroke: from technology to clinical deployment. Expert Rev Neurother 2014; 9:541-52. [DOI: 10.1586/ern.09.6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wening J, Ford J, Jouett LD. Orthotics and FES for maintenance of walking in patients with MS. Dis Mon 2013; 59:284-9. [DOI: 10.1016/j.disamonth.2013.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Paul L, Rafferty D, Marshall-McKenna R, Gill JMR, McInnes I, Porter D, Woodburn J. Oxygen cost of walking, physical activity, and sedentary behaviours in rheumatoid arthritis. Scand J Rheumatol 2013; 43:28-34. [DOI: 10.3109/03009742.2013.802009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Taylor P, Barrett C, Mann G, Wareham W, Swain I. A Feasibility Study to Investigate the Effect of Functional Electrical Stimulation and Physiotherapy Exercise on the Quality of Gait of People With Multiple Sclerosis. Neuromodulation 2013; 17:75-84; discussion 84. [DOI: 10.1111/ner.12048] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/22/2013] [Accepted: 01/24/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Paul Taylor
- Department of Clinical Science and Engineering; Salisbury District Hospital; Salisbury UK
| | - Catherine Barrett
- Trust Headquarters; Southern Health NHS Foundation Trust; Southampton UK
| | - Geraldine Mann
- Department of Clinical Science and Engineering; Salisbury District Hospital; Salisbury UK
| | - Wendy Wareham
- Department of Clinical Science and Engineering; Salisbury District Hospital; Salisbury UK
| | - Ian Swain
- Department of Clinical Science and Engineering; Salisbury District Hospital; Salisbury UK
- School of Design, Engineering and Computing; Bournemouth University; Poole House, Talbot Campus Poole UK
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Cameron MH, Wagner JM. Gait Abnormalities in Multiple Sclerosis: Pathogenesis, Evaluation, and Advances in Treatment. Curr Neurol Neurosci Rep 2011; 11:507-15. [DOI: 10.1007/s11910-011-0214-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Recent Findings Regarding the Efficacy of Functional Electrical Stimulation in Patients With Chronic Hemiplegia and Multiple Sclerosis: A Narrative Literature Review. ACTA ACUST UNITED AC 2010. [DOI: 10.1097/jpo.0b013e3181e90370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Postans N, Wright P, Bromwich W, Wilkinson I, Farmer SE, Swain I. The combined effect of Dynamic splinting and Neuromuscular electrical stimulation in reducing wrist and elbow contractures in six children with Cerebral palsy. Prosthet Orthot Int 2010; 34:10-9. [PMID: 20141494 DOI: 10.3109/03093640903051808] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this pilot study was to investigate the feasibility of applying the combination of Dynamic splinting (DS) and Neuromuscular electrical stimulation (NMES) in order to improve wrist and elbow function, and range of motion, in children with upper limb contractures due to Cerebral palsy (CP). Six children aged seven to 16, with contractures at the wrist or elbow, were recruited. Following a 12-week baseline period all participants underwent a 12-week treatment period where DS was used for one hour per day and combined with NMES for the second half of the 1-h treatment. A 12-week follow-up period then ensued. Upper limb function was assessed with the Melbourne assessment, physical disability with the Paediatric Evaluation of Disability Index and the Activity Scale for Kids, and quality of life with the Pediatric Quality of Life Scale. Passive and active range of motion at the wrist and elbow were measured using manual and electrical goniometers. The technique of using combined NMES and DS was demonstrated to be feasible and compliance with the intervention was good. There was an increase in passive elbow extension in two participants treated for elbow contractures, although no accompanying change in upper limb function was demonstrated. Wrist range of movement improved in one participant treated for wrist contracture.
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Affiliation(s)
- Neil Postans
- The Robert Jones & Agnes Hunt (RJAH) Orthopaedic and District Hospital NHS Trust, Orthotic Research & Locomotor Assessment Unit (ORLAU), Oswestry, Shropshire, UK.
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Stein RB, Everaert DG, Thompson AK, Chong SL, Whittaker M, Robertson J, Kuether G. Long-term therapeutic and orthotic effects of a foot drop stimulator on walking performance in progressive and nonprogressive neurological disorders. Neurorehabil Neural Repair 2009; 24:152-67. [PMID: 19846759 DOI: 10.1177/1545968309347681] [Citation(s) in RCA: 142] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stimulators applying functional electrical stimulation (FES) to the common peroneal nerve improve walking with a foot drop, which occurs in several disorders. OBJECTIVE To compare the orthotic and therapeutic effects of a foot drop stimulator on walking performance of subjects with chronic nonprogressive (eg, stroke) and progressive (eg, multiple sclerosis) disorders. METHODS Subjects with nonprogressive (41) and progressive (32) conditions used a foot drop stimulator for 3 to 12 months while walking in the community. Walking speed was measured with a 10-m test and a 4-minute figure-8 test; physiological cost index (PCI) and device usage were also measured. The subjects were tested with FES on and off (orthotic effect) before and after (therapeutic effect) stimulator use. RESULTS After 3 months of FES use, the nonprogressive and progressive groups had a similar, significant orthotic effect (5.0% and 5.7%, respectively, P < .003; percentage change in mean values) and therapeutic effect with FES off (17.8% and 9.1%, respectively, P < .005) on figure-8 walking speed. Overall, PCI showed a decreasing trend (P = .031). The therapeutic effect on figure-8 speed diverged later between both groups to 28.0% (P < .001) and 7.9% at 11 months. The combined therapeutic plus orthotic effect on figure-8 speed at 11 months was, respectively, 37.8% (P < .001) and 13.1% (P = .012); PCI decreased 18.2% (P = .038) and 6.5%, respectively. CONCLUSIONS Subjects with progressive and nonprogressive disorders had an orthotic benefit from FES up to 11 months. The therapeutic effect increased for 11 months in nonprogressive disorders but only for 3 months in progressive disorders. The combined effect remained significant and clinically relevant.
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Sheffler LR, Hennessey MT, Knutson JS, Chae J. Neuroprosthetic effect of peroneal nerve stimulation in multiple sclerosis: a preliminary study. Arch Phys Med Rehabil 2009; 90:362-5. [PMID: 19236994 DOI: 10.1016/j.apmr.2008.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 10/15/2008] [Accepted: 10/15/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the neuroprosthetic effect of a peroneal nerve stimulator on tasks of functional ambulation in multiple sclerosis (MS). DESIGN A single point-in-time assessment of functional ambulation tasks under the conditions of no device and peroneal nerve stimulator. SETTING Outpatient academic medical center. PARTICIPANTS Participants (N=11) with diagnosis of MS (>6mo), dorsiflexion weakness, and prior usage of an ankle-foot orthosis. INTERVENTION Surface peroneal nerve stimulator for ambulation. MAIN OUTCOME MEASURES Timed 25-foot Walk portion of the MS Functional Composite; Floor, Carpet, Up and Go, Obstacle, and Stair components of the Modified Emory Functional Ambulation Profile. RESULTS Peroneal nerve stimulator-Stair performance was significantly enhanced (P=.05) versus no device, and statistical significance was approached for peroneal nerve stimulator-Obstacles (P=.09) versus no device. There were no significant differences between peroneal nerve stimulator and no device conditions in the remaining outcome measures. CONCLUSIONS The neuroprosthetic effect of the peroneal nerve stimulator is modest relative to no device in the performance of specific functional tasks of ambulation in MS gait. A longitudinal, controlled trial is needed to show effectiveness.
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Affiliation(s)
- Lynne R Sheffler
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA.
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Almeida SRM, Loureiro AB, Maki T. Equiscala: versão brasileira e estudo de confiabilidade e validade da Equiscale. FISIOTERAPIA E PESQUISA 2008. [DOI: 10.1590/s1809-29502008000300009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo consistiu na tradução para o português e na verificação da confiabilidade e validade do teste original de equilíbrio Equiscale. A versão brasileira foi testada em 11 indivíduos com esclerose múltipla selecionados aleatoriamente, que foram inicialmente avaliados pela Escala de Equilíbrio de Berg (EEB), Medida de Independência Funcional e pela Escala do Estado de Deficiência Expandida (EDSS). Foram feitas duas avaliações usando a Equiscala (teste-reteste) por três fisioterapeutas, para verificar a confiabilidade interexaminador. A confiabilidade teste-reteste e interexaminador foi verificada pelo coeficiente de correlação intra-classe (CCI); e a relação entre a Equiscala e as demais escalas, pelo coeficiente de correlação de Spearman. Foi demonstrada adequada confiabilidade teste-reteste (CCI=0,882; 0,906) e interexaminador(CCI=0,947; 0,933; 0,962). Também foi encontrada boa correlação da Equiscala com a Escala de Equilíbrio de Berg (rs=0,8940; p=0,0002) e a EDSS (rs=-0,7139; p=0,0136). Os resultados indicam que a Equiscala apresenta adequada confiabilidade e validade, podendo ser aplicada na avaliação do equilíbrio em pacientes com esclerose múltipla.
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