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Kubo H, Asai T, Fukumoto Y, Oshima K, Koyama S, Monjo H, Tajitsu H, Oka T. Value of the 3-min walk test and its association with motor functions in older adults. Physiother Theory Pract 2024; 40:144-152. [PMID: 35957533 DOI: 10.1080/09593985.2022.2110849] [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: 03/01/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The 3-min walk test (3MWT) has been used in the clinical setting. OBJECTIVE To present the 3MWT value and investigate its association with motor and respiratory functions of healthy older adults. METHODS Two hundred six older adults and 27 younger adults were enrolled. The 3MWT was assessed by the walking distance within 3 min. Knee extension muscle strength (KEMS), 5-repetition sit-to-stand (5 R-STS), Timed Up and Go (TUG), forced vital capacity (FVC), forced expiratory volume 1.0 (FEV1.0), maximal expiratory pressure (MEP), and maximal inspiratory pressure (MIP) were measured. The 3MWT distance was examined by age group (18-39, 60-69, 70-79, and 80-89 years). A multivariate regression analysis investigated the association between 3MWT and motor function test. RESULTS The 3MWT values in each age group were 273-385, 233-414, 93-351, and 171-345 m for men and 215-375, 220-349, 198-325, and 174-332 m for women respectively. The 3MWT values were correlated with age, body mass index (BMI), KEMS, 5 R-STS, TUG, FVC, FEV1.0, MEP, and MIP. On the multivariate regression analysis, 3MWT was significantly associated with BMI (standard beta = -0.18; 95% confidence interval [CI], -3.20 to 0.83), KEMS (standard beta = 0.37; 95% CI, 0.06-0.13), 5 R-STS (standard beta = -0.13; 95% CI, -5.70 to -0.13), and TUG (standard beta = -0.36; 95% CI, -17.15 to -7.73) in older adults (adjusted R2 = 0.47). CONCLUSIONS The 3MWT distance decreased with age and was associated with motor and respiratory functions. No range trends were observed among groups. Our findings suggest that 3MWT reflects functional capacity.
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Affiliation(s)
- Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami City, Japan
- Researcher, Kansai Medical University, Hirakata City, Japan
| | - Tsuyoshi Asai
- Faculty of Rehabilitation, Kansai Medical University, Hirakata City, Japan
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Japan
| | - Yoshihiro Fukumoto
- Faculty of Rehabilitation, Kansai Medical University, Hirakata City, Japan
| | | | - Shota Koyama
- Department of Rehabilitation, Saiseikai Hyogoken Hospital, Kobe-City, Japan
| | | | - Hirotsugu Tajitsu
- Department of Rehabilitation, Wakayama National Hospital, Hidakagun, Japan
| | - Tomohiro Oka
- Department of Rehabilitation Science, Faculty of Allied Health Sciences, Osaka Health Science University, Osaka-City, Japan
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Feinstein A, Amato MP, Brichetto G, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell R, Feys P, Filippi M, Freeman J, Inglese M, Meza C, Motl RW, Rocca MA, Sandroff BM, Salter A. Cognitive rehabilitation and aerobic exercise for cognitive impairment in people with progressive multiple sclerosis (CogEx): a randomised, blinded, sham-controlled trial. Lancet Neurol 2023; 22:912-924. [PMID: 37739574 DOI: 10.1016/s1474-4422(23)00280-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Cognitive dysfunction in people with relapsing-remitting multiple sclerosis can improve with cognitive rehabilitation or exercise. Similar effects have not been clearly shown in people with progressive multiple sclerosis. We aimed to investigate the individual and synergistic effects of cognitive rehabilitation and exercise in patients with progressive multiple sclerosis. METHODS CogEx was a randomised, sham-controlled trial completed in 11 hospital clinics, universities, and rehabilitation centres in Belgium, Canada, Denmark, Italy, UK, and USA. Patients with progressive multiple sclerosis were eligible for inclusion if they were aged 25-65 years and had an Expanded Disability Status Scale (EDSS) score of less than 7. All had impaired processing speed defined as a performance of 1·282 SD or greater below normative data on the Symbol Digit modalities Tests (SDMT). Participants were randomly assigned (1:1:1:1), using an interactive web-response system accessed online from each centre, to cognitive rehabilitation plus exercise, cognitive rehabilitation plus sham exercise, exercise plus sham cognitive rehabilitation, or sham exercise plus sham cognitive rehabilitation. The study statistician created the randomisation sequence that was stratified by centre. Participants, outcome assessors, and investigators were blinded to group allocation. The study statistician was masked to treatment during analysis only. Interventions were conducted two times per week for 12 weeks: cognitive rehabilitation used an individualised, computer-based, incremental approach to improve processing speed; sham cognitive rehabilitation consisted of internet training provided individually; the exercise intervention involved individualised aerobic training using a recumbent arm-leg stepper; and the sham exercise involved stretching and balance tasks without inducing cardiovascular strain. The primary outcome measure was processing speed measured by SDMT at 12 weeks; least squares mean differences were compared between groups using linear mixed model in all participants who had a 12-week assessment. The trial is registered with ClinicalTrials.gov, NCT03679468, and is completed. FINDINGS Between Dec 14, 2018, and April 2, 2022, 311 people with progressive multiple sclerosis were enrolled and 284 (91%) completed the 12-week assessment (117/311 [38%] male and 194/311 [62%] female). The least squares mean group differences in SDMT at 12 weeks did not differ between groups (p=0·85). Compared with the sham cognitive rehabilitation and sham exercise group (n=67), differences were -1·30 (95% CI -3·75 to 1·16) for the cognitive rehabilitation plus exercise group (n=70); -2·78 (-5·23 to -0·33) for the sham cognitive rehabilitation plus exercise group (n=71); and -0·71 (-3·11 to 1·70) for the cognitive rehabilitation plus sham exercise group (n=76). 11 adverse events possibly related to the interventions occurred, six in the exercise plus sham cognitive rehabilitation group (pain, dizziness, and falls), two in the cognitive rehabilitation plus sham exercise group (headache and pain), two in the cognitive rehabilitation and exercise group (increased fatigue and pain), and one in the dual sham group (fall). INTERPRETATION Combined cognitive rehabilitation plus exercise does not seem to improve processing speed in people with progressive multiple sclerosis. However, our sham interventions were not inactive. Studies comparing interventions with a non-intervention group are needed to investigate whether clinically meaningful improvements in processing speed might be attainable in people with progressive multiple sclerosis. FUNDING MS Canada.
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Affiliation(s)
- Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy; AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Belgium; UMSC University MS Center Hasselt Pelt, Belgium
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCSS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Brian M Sandroff
- Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
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Reina-Gutiérrez S, Meseguer-Henarejos AB, Torres-Costoso A, Álvarez-Bueno C, Cavero-Redondo I, Núñez de Arenas-Arroyo S, Guzmán-Pavón MJ, Sánchez-López M, Martínez-Vizcaíno V. Effect of different types of exercise on fitness in people with multiple sclerosis: A network meta-analysis. Scand J Med Sci Sports 2023; 33:1916-1928. [PMID: 37226414 DOI: 10.1111/sms.14407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND It is assumed that people with multiple sclerosis (MS) who participate in programs of physical exercise improve their physical fitness. OBJECTIVE The aim of this network meta-analysis (NMA) was to analyze the effect of different types of exercise on muscular fitness and cardiorespiratory fitness (CRF) among people with MS and to determine the best type of exercise according to disease severity. METHODS MEDLINE, the Physiotherapy Evidence Database, the Cochrane Library, SPORTDiscus, Scopus, and Web of Science were searched from inception to April 2022 to identify randomized controlled trials (RCTs) concerning the effect of physical exercise on fitness in people with MS. We ranked the types of physical exercise by calculating the surface under the cumulative ranking (SUCRA). RESULTS We included 72 RCTs involving 2543 MS patients in this NMA. A ranking of five types of physical exercise (aerobic, resistance, combined [aerobic and resistance], sensorimotor training, and mind-body exercises) was achieved. Combined and resistance training had the highest effect sizes (0.94, 95% CI 0.47, 1.41, and 0.93, 95% CI 0.57, 1.29, respectively) and the highest SUCRA (86.2% and 87.0%, respectively) for muscular fitness. The highest effect size (0.66, 95% CI 0.34, 0.99) and SUCRA (86.9%) for CRF was for aerobic exercise. CONCLUSIONS Combined and resistance training seem to be the most effective exercises to improve muscular fitness and aerobic exercise for CRF in people with MS.
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Affiliation(s)
- Sara Reina-Gutiérrez
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | | | - Ana Torres-Costoso
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, Spain
- Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Santiago, Chile
| | | | | | - Mairena Sánchez-López
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- School of Education, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Gaemelke T, Frandsen JJ, Hvid LG, Dalgas U. Participant characteristics of existing exercise studies in persons with multiple sclerosis - A systematic review identifying literature gaps. Mult Scler Relat Disord 2022; 68:104198. [PMID: 36257149 DOI: 10.1016/j.msard.2022.104198] [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: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exercise is a cornerstone in rehabilitation of persons with multiple sclerosis (pwMS), which is known to elicit beneficial effects on various symptoms and to have a potential disease-modifying effect. However, it remains to be elucidated if the existing MS exercise literature covers the full age and disability span of pwMS. OBJECTIVE To systematically review MS exercise studies and provide a detailed mapping of the demographic and clinical characteristics of the included pwMS. METHODS A systematic review of MS exercise studies were performed using MEDLINE and EMBASE. From the resulting MS exercise studies, mean sample characteristics were extracted. RESULTS 4576 records were identified, from which 202 studies were included. Of these, 166 studies (82.2%) enrolled pwMS aged 35-54 years, 10.9% enrolled pwMS <35 years, and 6.9% enrolled pwMS ≥55 years (only 1.5% enrolled pwMS ≥60 years). A total of 118 studies (58.4%) reported Expanded Disability Status Scale (EDSS), with 88.1% of included pwMS having an EDSS between 2.0 and 6.5, while only one study enrolled pwMS with an EDSS ≥7.0. Finally, 80% of the studies included pwMS having a disease duration of 5-14.5 years. CONCLUSION Exercise studies in pwMS included primarily middle-aged (35-54 years) pwMS having an EDSS of 2.0-6.5 and a disease duration of 5-14.5 years. Few exercise studies were identified in young and older pwMS, in pwMS with mild disability and severe disability, and in pwMS having shorter or longer disease durations. These findings highlight the need for further investigation of exercise in these specific subgroups of pwMS as benefits of exercise might not generalize across subpopulations.
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Affiliation(s)
- Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark.
| | - Jens Jakob Frandsen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
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The Effectiveness of Physiotherapy Interventions for Mobility in Severe Multiple Sclerosis: A Systematic Review and Meta-Analysis. Mult Scler Int 2022; 2022:2357785. [PMID: 35860179 PMCID: PMC9293575 DOI: 10.1155/2022/2357785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background People with Multiple Sclerosis (pwMS) prioritise gait as the most valuable function to be affected by MS. Physiotherapy plays a key role in managing gait impairment in MS. There is little evidence on the effectiveness of physiotherapy for severe MS. Objective To undertake a systematic review and meta-analysis of the literature to identify evidence for the effectiveness of physiotherapy for gait impairment in severe MS. Methods. The available literature was systematically searched, using a predetermined protocol, to identify research studies investigating a physiotherapy intervention for mobility in people with severe MS (EDSS ≥ 6.0). Data on mobility related endpoints was extracted. Meta-analysis was performed where a given mobility end point was reported in at least 3 studies. Results 37 relevant papers were identified, which included 788 pwMS. Seven mobility-related endpoints were meta-analysed. Robot-Assisted Gait Training (RAGT) was found to improve performance on the 6-minute walk test, 10-metre walk test, fatigue severity scale, and Berg Balance Scale. Neither body weight supported training nor conventional walking training significantly improved any mobility-related outcomes. Conclusion Physiotherapy interventions are feasible for mobility in severe MS. There is some evidence for the effectiveness of RAGT.
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Taul-Madsen L, Kjeldsen T, Skou ST, Mechlenburg I, Dalgas U. Exercise booster sessions as a mean to maintain the effect of an exercise-intervention - A systematic review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1988816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Laurits Taul-Madsen
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Troels Kjeldsen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren T. Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Tekeoglu Tosun A, Ipek Y, Razak Ozdincler A, Saip S. The efficiency of mirror therapy on drop foot in Multiple Sclerosis Patients. Acta Neurol Scand 2021; 143:545-553. [PMID: 33270229 DOI: 10.1111/ane.13385] [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] [Received: 09/23/2020] [Revised: 11/09/2020] [Accepted: 11/25/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Although the effectiveness of mirror therapy (MT) has been proved in stroke persons, there is no scientific evidence about the results in people with multiple sclerosis. The aim was to investigate whether adding MT to exercise training and neuromuscular electrical stimulation (NMES) has any effect on clinical measurements, mobility, and functionality in people with multiple sclerosis (MS). METHODS Ambulatory people with MS, with unilateral drop foot, were included. MT group (n = 13) applied bilateral ankle exercise program with mirror following NMES for 3 days a week at hospital and exercise program for 2 days a week at home. Control group (n = 13) performed same treatment without mirror box (6 weeks). The later 6 weeks both groups performed only exercise program. Clinical measurements included proprioception, muscle tone of plantar flexor muscles (MAS), muscle strength of dorsiflexor, ankle angular velocity, and range of motion (ROM) of ankle. Functionality (Functional Independence Measurement-FIM), mobility (Rivermead Mobility Index-RMI), ambulation (Functional Ambulation Scale-FAS), duration of stair climb test, and 25-foot walking velocity were assessed at the beginning, in 6th and 12th weeks. RESULTS More positive improvements were obtained in MT group than control group in terms of range of motion (0.012), muscle strength (0.008), proprioception (0.001), 25 feet walking duration (0.015), step test duration (0.001), FAS (0.005), RMI (0.001), and FIM (0.001) after 6 weeks treatment. It was seen that this improvement maintained to 12th week on all clinical and functional measurements (p < .05). CONCLUSION The trial revealed that adding MT to exercise training and NMES has more beneficial effects on clinical measurements, mobility, and functionality in people with multiple sclerosis with unilateral drop foot.
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Affiliation(s)
- Anıl Tekeoglu Tosun
- Division of Physiotherapy and Rehabilitation Faculty of Health Sciences Fenerbahce University Istanbul Turkey
| | - Yeldan Ipek
- Division of Physiotherapy and Rehabilitation Faculty of Health Sciences Istanbul University‐Cerrahpasa Istanbul Turkey
| | - Arzu Razak Ozdincler
- Division of Physiotherapy and Rehabilitation Faculty of Health Sciences Biruni University Istanbul Turkey
| | - Sabahattin Saip
- Department of Neurology Medical School of Cerrahpasa Istanbul University‐Cerrahpasa Istanbul Turkey
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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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Feinstein A, Amato MP, Brichetto G, Chataway J, Chiaravalloti N, Dalgas U, DeLuca J, Feys P, Filippi M, Freeman J, Meza C, Inglese M, Motl RW, Rocca MA, Sandroff BM, Salter A, Cutter G. Study protocol: improving cognition in people with progressive multiple sclerosis: a multi-arm, randomized, blinded, sham-controlled trial of cognitive rehabilitation and aerobic exercise (COGEx). BMC Neurol 2020; 20:204. [PMID: 32443981 PMCID: PMC7245035 DOI: 10.1186/s12883-020-01772-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cognitive dysfunction affects up to 70% of people with progressive MS (PMS). It can exert a deleterious effect on activities of daily living, employment and relationships. Preliminary evidence suggests that performance can improve with cognitive rehabilitation (CR) and aerobic exercise (EX), but existing data are predominantly from people with relapsing-remitting MS without cognitive impairment. There is therefore a need to investigate whether this is also the case in people with progressive forms of the disease who have objectively identified cognitive impairment. It is hypothesized that CR and EX are effective treatments for people with PMS who have cognitive impairment, in particular processing speed (PS) deficits, and that a combination of these two treatments is more effective than each individual treatment given alone. We further hypothesize that improvements in PS will be associated with modifications of functional and/or structural plasticity within specific brain networks/regions involved in PS measured with advanced MRI techniques. METHODS This study is a multisite, randomized, double-blinded, sham controlled clinical trial of CR and aerobic exercise. Three hundred and sixty subjects from 11 sites will be randomly assigned into one of four groups: CR plus aerobic exercise; CR plus sham exercise; CR sham plus aerobic exercise and CR sham plus sham exercise. Subjects will participate in the assigned treatments for 12 weeks, twice a week. All subjects will have a cognitive and physical assessment at baseline, 12 weeks and 24 weeks. In an embedded sub-study, approximately 30% of subjects will undergo structural and functional MRI to investigate the neural mechanisms underlying the behavioral response. The primary outcome is the Symbol Digit Modalities Test (SDMT) measuring PS. Secondary outcome measures include: indices of verbal and non-verbal memory, depression, walking speed and a dual cognitive-motor task and MRI. DISCUSSION The study is being undertaken in 6 countries (11 centres) in multiple languages (English, Italian, Danish, Dutch); with testing material validated and standardized in these languages. The rationale for this approach is to obtain a robustly powered sample size and to demonstrate that these two interventions can be given effectively in multiple countries and in different languages. TRIAL REGISTRATION The trial was registered on September 20th 2018 at www.clinicaltrials.gov having identifier NCT03679468. Registration was performed before recruitment was initiated.
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Affiliation(s)
- Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society (AISM), Via Operai 30, 16149, Genoa, Italy
| | - Jeremy Chataway
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - Nancy Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, DK-8000, Aarhus, Denmark.
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Peter Feys
- Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Freeman
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Devon, UK
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, USA
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, USA
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
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Prokopiusova T, Pavlikova M, Markova M, Rasova K. Randomized comparison of functional electric stimulation in posturally corrected position and motor program activating therapy: treating foot drop in people with multiple sclerosis. Eur J Phys Rehabil Med 2020; 56:394-402. [PMID: 32383574 DOI: 10.23736/s1973-9087.20.06104-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Functional electric stimulation (FES) is recommended for foot drop in multiple sclerosis, although little is known about its therapeutic effect. AIM The aim of this study is to evaluate a therapeutic effect immediately and two months after program termination (persistent and delayed effect) of a new approach using FES in combination with correcting the patients' postural system. More specifically, we evaluate the effects of this approach on the patients' clinical functions and compared it with individual physiotherapy. DESIGN Parallel randomized blind trial. SETTING Two-month-long treatments, functional electric stimulation in posturally corrected position (group 1) and neuroproprioceptive facilitation and inhibition physiotherapy called motor program activating therapy (group 2). POPULATION Forty-four subjects with multiple sclerosis. METHODS Primary outcomes: gait (the 2-Minute Walk Test; Timed 25-Foot Walk test; Multiple Sclerosis Walking Scale-12) and balance (by e.g. Berg Balance Scale [BBS], the Activities-Specific Balance Confidence Scale [ABC], Timed Up-and-Go Test [TUG]). SECONDARY OUTCOMES mobility, cognition, fatigue and subjects' perceptions (e.g. Multiple Sclerosis Impact Scale [MSIS], Euroqol-5 dimensions-5 levels [EQ-5D-5L]). RESULTS Group 1 showed immediate therapeutic effect in BBS (P=0.008), ABC (P=0.04) and EQ-5D-5L (self-care, P=0.019, mobility P=0.005). The improvement in EQ-5D-5L persisted and in TUG-cognitive we documented a delayed effect (P=0.005). Group 2 showed an immediate improvement in BBS (P=0.025), MSIS (P=0.043) and several aspects of daily life (the effect on health today was significantly higher than in group 1, significant difference between groups P=0.038). CONCLUSIONS FES in the posturally corrected position has an immediate therapeutic effect on balance and patients' perceptions comparable to motor program activating therapy, and higher persistent and even delayed therapeutic effect. CLINICAL REHABILITATION IMPACT The study results point to the importance of correcting the patients' posture when applying FES, the possibility to treat foot drop by individual physiotherapy and the activation of the patients' auto reparative processes.
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Affiliation(s)
- Terezie Prokopiusova
- Department of Rehabilitation, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic
| | - Marketa Pavlikova
- Department of Rehabilitation, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic.,Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - Magdalena Markova
- Department of Rehabilitation, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic
| | - Kamila Rasova
- Department of Rehabilitation, Third Faculty of Medicine, Kralovske Vinohrady University Hospital, 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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12
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Hochsprung A, Granja Domínguez A, Magni E, Escudero Uribe S, Moreno García A. Effect of visual biofeedback cycling training on gait in patients with multiple sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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13
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Snyder KJ, Patsakos E, White J, Ditor DS. Accessible exercise equipment and individuals with multiple sclerosis: Aerobic demands and preferences. NeuroRehabilitation 2019; 45:359-367. [PMID: 31796702 DOI: 10.3233/nre-192861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although exercise training has benefits for individuals with multiple sclerosis (MS), research regarding the type of exercise equipment that requires the greatest aerobic demand, and consumer-based preferences, is lacking. OBJECTIVE To determine the aerobic demands of various pieces of accessible exercise equipment and consumer-based preferences on several domains. METHODS Ten individuals with moderate-severity MS had their VO2 measured during 10 minutes of moderate-intensity arm ergometry (AE), body-weight support treadmill training (BWSTT), recumbent arm-leg exercise (NuStep), FES-arm exercise (RT300), FES-leg exercise (RT300) and FES arm-leg exercise (RT200). VO2peak test was also measured on the NuStep and the RT200. Equipment preferences were determined by questionnaire after moderate exercise sessions. RESULTS AE required a lower VO2 compared to the NuStep (p = 0.02), and FES-arm exercise required a lower VO2 compared to the NuStep (p = 0.01) and FES arm-leg exercise (p = 0.04). There was no difference in VO2peak when using the NuStep or FES arm-leg exercise. AE was perceived as safer than BWSTT, but otherwise there were no preferences for any equipment. CONCLUSIONS For individuals with moderate-severity MS, arm-only exercise requires less aerobic demands than combined arm-leg exercise at a moderate intensity. Perceived risks may be greater when exercise requires a transfer, upright positioning, or assistance.
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Affiliation(s)
- Kaitlyn J Snyder
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, Brock University, St. Catharines, Ontario, Canada
| | - Eleni Patsakos
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, Brock University, St. Catharines, Ontario, Canada
| | - John White
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, Brock University, St. Catharines, Ontario, Canada
| | - David S Ditor
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, Brock University, St. Catharines, Ontario, Canada
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Iodice P, Boncompagni S, Pietrangelo L, Galli L, Pierantozzi E, Rossi D, Fusella A, Caulo M, Kern H, Sorrentino V, Protasi F. Functional Electrical Stimulation: A Possible Strategy to Improve Muscle Function in Central Core Disease? Front Neurol 2019; 10:479. [PMID: 31191425 PMCID: PMC6548841 DOI: 10.3389/fneur.2019.00479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/23/2019] [Indexed: 01/01/2023] Open
Abstract
Central Core Disease (CCD) is a congenital myopathy characterized by presence of amorphous central areas (or cores) lacking glycolytic/oxidative enzymes and mitochondria in skeletal muscle fibers. Most CCD families are linked to mutations in ryanodine receptor type-1 (RYR1), the gene encoding for the sarcoplasmic reticulum (SR) Ca2+ release channel of skeletal muscle. As no treatments are available for CCD, currently management of patients is essentially based on a physiotherapic approaches. Functional electrical stimulation (FES) is a technique used to deliver low energy electrical impulses to artificially stimulate selected skeletal muscle groups. Here we tested the efficacy of FES in counteracting muscle loss and improve function in the lower extremities of a 55-year-old female patient which was diagnosed with CCD at the age of 44. Genetic screening of the RyR1 gene identified a missense mutation (c.7354C>T) in exon 46 resulting in an amino acid substitution (p.R2452W) and a duplication (c.12853_12864dup12) in exon 91. The patient was treated with FES for 26 months and subjected before, during, and after training to a series of functional and structural assessments: measurement of maximum isometric force of leg extensor muscles, magnetic resonance imaging, a complete set of functional tests to assess mobility in activities of daily living, and analysis of muscle biopsies by histology and electron microscopy. All results point to an improvement in muscle structure and function induced by FES suggesting that this approach could be considered as an additional supportive measure to maintain/improve muscle function (and possibly reduce muscle loss) in CCD patients.
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Affiliation(s)
- Pierpaolo Iodice
- CeSI-Met-Center for Research on Ageing and Translational Medicine, University G. d'Annunzio, Chieti, Italy.,CETAPS-EA3832, University of Rouen Normandy, Mont-Saint-Aignan, France
| | - Simona Boncompagni
- CeSI-Met-Center for Research on Ageing and Translational Medicine, University G. d'Annunzio, Chieti, Italy
| | - Laura Pietrangelo
- CeSI-Met-Center for Research on Ageing and Translational Medicine, University G. d'Annunzio, Chieti, Italy
| | - Lucia Galli
- Department of Molecular and Developmental Medicine, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Enrico Pierantozzi
- Department of Molecular and Developmental Medicine, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Daniela Rossi
- Department of Molecular and Developmental Medicine, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Aurora Fusella
- CeSI-Met-Center for Research on Ageing and Translational Medicine, University G. d'Annunzio, Chieti, Italy
| | - Massimo Caulo
- DNICS, Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - Helmut Kern
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
| | - Vincenzo Sorrentino
- Department of Molecular and Developmental Medicine, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Feliciano Protasi
- CeSI-Met-Center for Research on Ageing and Translational Medicine, University G. d'Annunzio, Chieti, Italy.,Department of Medicine and Aging Science, University G. d'Annunzio, Chieti, Italy
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15
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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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16
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Street T, Singleton C. Five-Year Follow-up of a Longitudinal Cohort Study of the Effectiveness of Functional Electrical Stimulation for People with Multiple Sclerosis. Int J MS Care 2018; 20:224-230. [PMID: 30374252 DOI: 10.7224/1537-2073.2016-094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Few studies have examined the long-term consequences of using peroneal nerve functional electrical stimulation (FES) for people with multiple sclerosis (MS). This study examines orthotic effects on a longitudinal cohort and explores additional benefits of FES on self-reported measures such as joint pain. Methods One hundred forty-five people with foot drop and MS were included (mean age, 52 [range, 28-74] years). Orthotic effects, unassisted walking speed, and clinically important differences (ie, ≥0.05 and ≥0.10 m/s) were derived from walking speed over 10 m. Visual analogue scales examined joint pain, walking effort, trips, confidence, and quality of life. Measures were taken on day 1, after 6 months, and at 2, 3, 4, and 5 years. Results A significant difference was found overall for walking with FES compared with walking without FES for the 5-year period (P < .001). Despite a significant decline in overall unassisted walking speed at baseline (0.58 m/s) compared with 5 years later (0.46 m/s) (P < .001), participants achieved an orthotic effect with (0.52 m/s) versus without (0.46 m/s) FES after 5 years (P < .001). A significant decrease in joint pain was found after 6 months compared with day 1 (P = .004), which was maintained after 5 years (P < .001). Conclusions Despite progression of MS, long-term users of FES still benefit from an orthotic effect after using FES for 5 years. The study highlights the need for further work to assess the perceived benefits of FES regarding the experience of joint pain.
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17
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Ankle Kinematics and Temporal Gait Characteristics over the Duration of a 6-Minute Walk Test in People with Multiple Sclerosis Who Experience Foot Drop. Rehabil Res Pract 2018; 2018:1260852. [PMID: 30057817 PMCID: PMC6051004 DOI: 10.1155/2018/1260852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/30/2018] [Accepted: 06/03/2018] [Indexed: 11/18/2022] Open
Abstract
Foot drop is a common gait impairment in people with MS (pwMS) but in some foot drop may only occur after a period of prolonged walking and may be a sign of motor fatigability. The purpose of the study was to explore whether, for pwMS, an adapted six-minute walk test (6minWT) would result in an increase in foot drop as measured using electrogoniometry. Sagittal ankle kinematics were recorded for fifteen participants (10 females and 5 males, aged 37-64) with MS (EDSS 4-6) throughout the 6minWT. Ankle kinematics and temporal stride parameters were compared between the first and last 10 gait cycles of the 6minWT. Peak dorsiflexion in swing was significantly reduced at the end of the 6minWT compared to the start, with six of the fifteen participants having a decrease of two degrees or more. Statistically significant changes in temporal stride parameters suggested a decrease in walking speed. Our results suggest that with the protocol used in this study it is feasible to identify patients who experience increased foot drop as a result of a prolonged exercise task.
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18
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Abstract
Neuromodulation, or the utilization of advanced technology for targeted electrical or chemical neuronal stimulation or inhibition, has been expanding in several neurological subspecialties. In the past decades, immune-modulating therapy has been the main focus of multiple sclerosis (MS) research with little attention to neuromodulation. However, with the recent advances in disease-modifying therapies, it is time to shift the focus of MS research to neuromodulation and restoration of function as with other neurological subspecialties. Preliminary research supports the value of intrathecal baclofen pump and functional electrical stimulation in improving spasticity and motor function in MS patients. Deep brain stimulation can improve MS-related tremor and trigeminal neuralgia. Spinal cord stimulation has been shown to be effective against MS-related pain and bladder dysfunction. Bladder overactivity also responds to sacral neuromodulation and posterior tibial nerve stimulation. Despite limited data in MS, transcranial magnetic stimulation and brain-computer interface are promising neuromodulatory techniques for symptom mitigation and neurorehabilitation of MS patients. In this review, we provide an overview of the available neuromodulatory techniques and the evidence for their use in MS.
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Affiliation(s)
- Hesham Abboud
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, OH, USA/School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Neurology Department, Alexandria University, Alexandria, Egypt
| | - Eddie Hill
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Junaid Siddiqui
- Movement Disorders, University of Missouri- School of Medicine, Columbia, MO, USA
| | - Alessandro Serra
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, OH, USA/School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Multiple Sclerosis Center of Excellence, Cleveland VA Medical Center Hub Site, East Cleveland, OH, USA
| | - Benjamin Walter
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA/Parkinson's and Movement Disorders Center, University Hospitals of Cleveland, Cleveland, OH, USA
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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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20
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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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Functional Electrical Stimulation and Its Use During Cycling for the Rehabilitation of Individuals with Stroke. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/978-3-319-72736-3_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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23
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Effect of visual biofeedback cycling training on gait in patients with multiple sclerosis. Neurologia 2017; 35:89-95. [PMID: 28888468 DOI: 10.1016/j.nrl.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/02/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Gait alterations are present in a high percentage of patients with multiple sclerosis (MS). They appear from early stages of the disease and can limit patients' capacity to perform basic activities of daily living, affecting their quality of life. Visual biofeedback cycling training appears to be a useful tool in treating these impairments. This study aims to evaluate the short-term effect of visual biofeedback cycling training on gait in patients with MS. MATERIAL AND METHODS A total of 61 patients with mild to moderate MS were randomly assigned to a control group and an intervention group. The intervention group received visual biofeedback cycling training (MOTOmed viva2 system) once per week for 3 months, and a home exercise program. The control group only received the home exercise program. Both groups were evaluated using the GAITRite® Walkway gait assessment system before the intervention, during the first month of the programme, and after the intervention. RESULTS In the intervention group, the analysis revealed statistically significant differences between Functional Ambulation Profile (FAP) scores before and during the intervention (P=.014), and before and after the intervention (P=.002). A statistically significant improvement was observed in step length in the intervention group between pre- and post-intervention scores (P=.001) and between first-month and post-intervention scores (P=.004). CONCLUSIONS Visual biofeedback cycling training improved specific gait parameters in the short term and appears to be a therapeutic option for gait retraining in patients with MS.
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Feasibility of Restoring Walking in Multiple Sclerosis with Multichannel Implanted Electrical Stimulation. Am J Phys Med Rehabil 2017; 96:e170-e172. [PMID: 28151761 DOI: 10.1097/phm.0000000000000692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A patient with multiple sclerosis-related gait dysfunction was followed over the course of his disease. Despite aggressive treatment, he developed significant weakness in ankle dorsiflexors and hip and knee flexors and was no longer capable of consistently taking a step on his own. With electrical stimulation of hip and knee flexors and ankle dorsiflexors using implanted electrodes, he was able to consistently walk short distances as far as 30 m, thus significantly improving his Expanded Disability Status Scale score. This case study supports further exploration into the potential benefits of an implanted pulse generator to ameliorate gait dysfunction and improve quality of life for people with multiple sclerosis.
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25
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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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Bisht B, Darling WG, White EC, White KA, Shivapour ET, Zimmerman MB, Wahls TL. Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study. Degener Neurol Neuromuscul Dis 2017; 7:79-93. [PMID: 30050380 PMCID: PMC6053103 DOI: 10.2147/dnnd.s128872] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the effects of a multimodal intervention including a modified Paleolithic diet, nutritional supplements, stretching, strengthening exercises with electrical stimulation of trunk and lower limb muscles, meditation and massage on walking performance and balance of subjects with progressive multiple sclerosis (MS). MATERIALS AND METHODS Twenty subjects with mean (standard deviation) age of 51.7 (6.4) years and Expanded Disability Status Scale score of 6.2 (1) participated in a 12-month study. Assessments were completed at baseline, 3, 6, 9, and 12 months. RESULTS The entire cohort did not show significant changes in any of the assessments over 12 months except higher speed of walking toward the 10 feet mark during timed up and go (TUG) test at 6 months compared with baseline (mean change 7.9 cm/s [95% confidence interval {CI}]: 0.3, 15.2; p=0.041). Sub-group analysis revealed that 50% subjects (n=10) showed decrease in TUG time from baseline to at least 3 of 4 time-points post-intervention and were considered as responders (TUG-Res), the remaining 10 subjects were considered as nonresponders (TUG-NRes). Over 12 months, TUG-Res showed decreased mean TUG time by 31% (95% CI: -52%, -2%), increased median Berg Balance Scale scores (42 to 47), 30% increase in mean timed 25-foot walk speed (>20% considered clinically significant) and increased speed of walk toward 10 feet mark during TUG by 11.6 cm/s (95% CI: -3.0, 25.9) associated with increases in step lengths and decrease in step duration. TUG-NRes showed deterioration in walking ability over 12 months. Comparison of TUG-Res and TUG-NRes showed no significant differences in adherence to intervention but better stride duration and longer step length at baseline for TUG-Res than for TUG-NRes (p<0.05). CONCLUSION A multimodal lifestyle intervention may improve walking performance and balance in subjects with progressive MS who have mild-to-moderate gait impairment, whereas subjects with severe gait impairments may not respond to this intervention. Future trials should assess effects of this intervention in subjects with MS during early stages of the disease.
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Affiliation(s)
- Babita Bisht
- Department of Internal Medicine, Carver College of Medicine,
- Department of Health and Human Physiology, UI College of Liberal Arts and Sciences
| | - Warren G Darling
- Department of Health and Human Physiology, UI College of Liberal Arts and Sciences
| | - Emily C White
- Department of Health and Human Physiology, UI College of Liberal Arts and Sciences
| | - Kaitlin A White
- Department of Health and Human Physiology, UI College of Liberal Arts and Sciences
| | | | | | - Terry L Wahls
- Department of Internal Medicine, Carver College of Medicine,
- Department of Extended Care and Rehabilitation Service Line, Iowa City VA Health Care System, Iowa City, IA, USA,
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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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Fakolade A, Bisson EJ, Pétrin J, Lamarre J, Finlayson M. Effect of Comorbidities on Outcomes of Neurorehabilitation Interventions in Multiple Sclerosis: A Scoping Review. Int J MS Care 2016; 18:282-290. [PMID: 27999522 DOI: 10.7224/1537-2073.2016-015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Interest in comorbidities has increased in the past few years, but the effect of comorbidities on outcomes of multiple sclerosis (MS) neurorehabilitation interventions is unclear. The aim of this review was to identify and summarize the existing evidence regarding the effect of comorbidities on outcomes of neurorehabilitation interventions targeting people with MS. Methods: Five databases (Embase, MEDLINE through Ovid, PubMed Central, Cumulative Index to Nursing and Allied Health Literature, and Web of Science) were searched using index terms and keywords relating to MS and a wide range of rehabilitation interventions. Studies screened were limited to English-language randomized controlled trials. Information related to included and excluded comorbidities and how they were reported and described was extracted from the included studies. Results: Fifty-four neurorehabilitation randomized controlled trials were included and were grouped into categories: robotics/technology-enhanced (n = 7), task-oriented training/neurorehabilitation principles (n = 7), electrical stimulation (n = 12), temperature regulation (n = 6), magnetic field therapy (n = 5), vibration (n = 9), and miscellaneous (n = 8). Although the issue of comorbidity was considered in 40 studies, it was limited to excluding individuals from participating in the trials. Only two studies reported on comorbidity, but neither examined the possible mediating or moderating effect of comorbidities on intervention outcomes. Conclusions: This review documents important knowledge gaps about the effect of comorbidity on neurorehabilitation outcomes and identifies a critical need for future studies to address this issue. Without this information, we limit our understanding of the mechanisms of comorbidity and its effects on relevant clinical and research outcomes specific to neurorehabilitation.
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Imatz-Ojanguren E, Irigoyen E, Valencia-Blanco D, Keller T. Neuro-fuzzy models for hand movements induced by functional electrical stimulation in able-bodied and hemiplegic subjects. Med Eng Phys 2016; 38:1214-1222. [PMID: 27346491 DOI: 10.1016/j.medengphy.2016.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 05/13/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
Abstract
Functional Electrical Stimulation (FES) may be effective as a therapeutic treatment for improving functional reaching and grasping. Upper-limb FES models for predicting joint torques/angles from stimulation parameters can be useful to support the iterative design and development of neuroprostheses. Most such models focused on shoulder or elbow joints and were defined for fixed electrode configurations. This work proposes the use of a Recurrent Fuzzy Neural Network (RFNN) for modeling FES induced wrist, thumb, and finger movements based on surface multi-field electrodes and kinematic data from able-bodied and neurologically impaired subjects. Different combinations of structure parameters comprising fuzzy term numbers and feedback approaches were tested and analyzed in order to see their effect on the model performance for six subjects. The results showed mean success rates in the range from 60% to 99% and best success rates in the range from 78% to 100% on test data for all subjects. No common trend was found across subjects regarding structure parameters. The model showed the ability to successfully reproduce the response to FES for both able-bodied and hemiplegic subjects at least with one of the tested combinations.
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Affiliation(s)
- Eukene Imatz-Ojanguren
- TECNALIA Research & Innovation, Health Division, Mikeletegi Pasealekua 1-3, 20009 Donostia-San Sebastián, Spain .
| | - Eloy Irigoyen
- UPV/EHU - University of the Basque Country, Intelligent Control Research Group, Alameda Urquijo 48013, Bilbao.
| | - David Valencia-Blanco
- TECNALIA Research & Innovation, Health Division, Mikeletegi Pasealekua 1-3, 20009 Donostia-San Sebastián, Spain .
| | - Thierry Keller
- TECNALIA Research & Innovation, Health Division, Mikeletegi Pasealekua 1-3, 20009 Donostia-San Sebastián, Spain .
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Effects of Pilates-Based Core Stability Training in Ambulant People With Multiple Sclerosis: Multicenter, Assessor-Blinded, Randomized Controlled Trial. Phys Ther 2016; 96:1170-8. [PMID: 26893507 DOI: 10.2522/ptj.20150166] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 01/25/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pilates exercise is often undertaken by people with multiple sclerosis (MS) who have balance and mobility difficulties. OBJECTIVES The primary aim of the study was to compare the effects of 12 weeks of Pilates exercises with relaxation on balance and mobility. Secondary aims were: (1) to compare standardized exercises with relaxation and (2) to compare Pilates exercises with standardized exercises. METHODS A multicenter, assessor-blinded, randomized controlled trial was conducted. Participants with Expanded Disability Status Scale scores of 4.0 to 6.5 were randomly allocated to groups receiving 12 weeks of Pilates exercises, standardized exercises, or relaxation. Assessments were undertaken at baseline and weeks 12 and 16 (primary outcome measure: 10-Meter Timed Walk Test [10MTW]). RESULTS One hundred participants (mean age=54 years, 74% female) were randomized to study groups. Six participants relapsed (withdrew from the study), leaving 94 participants for intention-to-treat analysis. There was no significant difference in mean 10MTW measurements between the Pilates and relaxation groups. At 12 weeks, there was a mean reduction of 4.2 seconds for the standardized exercise group compared with the relaxation group (95% confidence interval [relaxation group minus standardized exercise group measurements]=0.0, 8.4) and a mean reduction of 3.7 seconds for the Pilates group compared with the standardized exercise group (95% confidence interval [Pilates group minus standardized exercise group measurements]=-0.4 to 7.8). At 16 weeks, mean 10MTW times for the standardized exercise group remained quicker than those for the Pilates and relaxation groups, although the differences were nonsignificant. There were no significant differences between the Pilates and relaxation groups for any secondary outcome measure. LIMITATIONS In this study, therapists were limited to a standardized basket of exercises that may have affected the study outcomes. Furthermore, choosing measures such as posturography to assess balance, accelerometry to assess walking, or a specific trunk assessment scale might have been more responsive in detecting changes in outcome. CONCLUSION Participants did not improve significantly, either in the short term or at the 4-week follow-up, on the 10MTW after 12 weeks of Pilates exercises compared with 12 weeks of relaxation.
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Plummer P. Critical Appraisal of Evidence for Improving Gait Speed in People with Multiple Sclerosis: Dalfampridine Versus Gait Training. Int J MS Care 2016; 18:105-15. [PMID: 27252597 DOI: 10.7224/1537-2073.2014-114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Research has not yet compared the treatment effects of dalfampridine with traditional rehabilitation of gait impairments in multiple sclerosis (MS). The purpose of this review was to critically appraise the evidence for dalfampridine and gait training for increasing gait speed in people with MS. METHODS A systematic search of the research literature was conducted. Consideration was given to only randomized controlled trials (RCTs), systematic reviews, and meta-analyses. For selection of gait training studies, only studies involving task-specific gait training interventions and measuring treatment effects on gait speed were considered. RESULTS Treatment effects on gait speed were extracted from four studies examining the efficacy of dalfampridine and six gait training RCTs. Overall mean increase in gait speed with dalfampridine was 0.07 m/s (95% confidence interval [CI], 0.04-0.09 m/s) compared to 0.06 m/s (95% CI, 0.02-0.10 m/s) for gait training. Among dalfampridine responders (38% of participants in RCTs), the mean increase in gait speed was 0.16 m/s (95% CI, 0.13-0.18 m/s). Mean increases for individual gait training interventions ranged from 0.01 to 0.39 m/s; however, CIs were wide due to small sample sizes. CONCLUSIONS Current evidence is insufficient to conclude whether dalfampridine or gait training is superior for improving gait speed in people with MS. These findings should be viewed cautiously due to differences in study populations and small sample sizes in gait training studies. Both treatment approaches provide only short-lived improvements. Head-to-head comparison trials and studies combining both treatment modalities are needed.
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Affiliation(s)
- Prudence Plummer
- Division of Physical Therapy, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Talis V, Ballay Y, Grishin A, Pozzo T. Functional Electrical Stimulation Alters the Postural Component of Locomotor Activity in Healthy Humans. Front Neurosci 2016; 9:478. [PMID: 26733791 PMCID: PMC4683188 DOI: 10.3389/fnins.2015.00478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/30/2015] [Indexed: 11/13/2022] Open
Abstract
Knowledge of the effects of Functional Electrical Stimulation (FES) of different intensity on postural stability during walking in healthy subjects is necessary before these relationships in patients with postural disorders can be assessed and understood. We examined healthy subjects in Control group walking on a treadmill for 40 min and in FES group-provided with 30 min of stimulation, which intensity increased every 10 min. The main difference between Control and FES group was the progressive increase of trunk oscillations in sagittal, frontal, and horizontal planes and an increase of relative stance duration in parallel with FES intensity increase. Both Control and FES groups exhibited shank elevation angle increase as an after-effect. It is concluded, that high intensity FES significantly changes the postural component of locomotor activity, but the fatigue signs afterwards were not FES specific.
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Affiliation(s)
- Vera Talis
- Institute for Information Transmission Problems Moscow, Russia
| | - Yves Ballay
- Institut National de la Santé et de la Recherche Médicale, U1093, Cognition Action Plasticité Sensorimotrice Dijon, France
| | | | - Thierry Pozzo
- Institut National de la Santé et de la Recherche Médicale, U1093, Cognition Action Plasticité SensorimotriceDijon, France; Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di TecnologiaGenova, Italy; Université de Bourgogne, UFR STAPS (Sciences du Sport)Dijon, France
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Campbell E, Coulter EH, Mattison PG, Miller L, McFadyen A, Paul L. Physiotherapy Rehabilitation for People With Progressive Multiple Sclerosis: A Systematic Review. Arch Phys Med Rehabil 2016; 97:141-51.e3. [DOI: 10.1016/j.apmr.2015.07.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/08/2015] [Accepted: 07/29/2015] [Indexed: 01/29/2023]
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Popa L, Taylor P. Functional electrical stimulation may reduce bradykinesia in Parkinson's disease: A feasibility study. J Rehabil Assist Technol Eng 2015; 2:2055668315607836. [PMID: 31191918 PMCID: PMC6531801 DOI: 10.1177/2055668315607836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/04/2015] [Indexed: 11/21/2022] Open
Abstract
Objectives This feasibility study investigated the effect of combined upper and lower
limb functional electrical stimulation (FES) to reduce bradykinesia in
Parkinson’s disease (PD). Method Eleven people with PD and Hoehn and Yahr score 2–3 used FES to assist
dorsiflexion and hand opening or fine hand movements for 2 weeks. Outcome
measures were the nine-hole peg test, box and block test, 10 m walking test,
Tinetti balance scale, modified Parkinson’s disease quality of life
questionnaire (PDQL), SPES/SCOPA scale, and compliance. All tests were
carried out without FES. Comparisons were tested using the Student paired
t-test. Results Two participants dropped out due to difficulty in using the equipment. Mean
walking speed increased by 0.29 m s−1
(p = 0.002), step length by 0.09 m
(p = 0.007), and cadence by 19.8 steps min−1
(p = 0.045). Tinetti balance score increased by 2.9
(p = 0.006). There was an increase in the box and block
test of 5.1 (p = 0.025). The PD symptoms score of the PDQL
improved by 4.9 (p = 0.013) and a reduction in SPES/SCOPA
score of 5.7 (p = 0.005) indicated a reduced impact of
PD. Conclusions FES produced clinically meaningful improvements in gait and upper limb
function. Some participants found using both interventions challenging and
we would recommend that their introduction be staggered.
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Affiliation(s)
- Livia Popa
- The National Clinical FES Centre, Salisbury District Hospital, UK
| | - Paul Taylor
- The National Clinical FES Centre, Salisbury District Hospital, UK
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37
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Heine M, van de Port I, Rietberg MB, van Wegen EEH, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev 2015; 2015:CD009956. [PMID: 26358158 PMCID: PMC9554249 DOI: 10.1002/14651858.cd009956.pub2] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system affecting an estimated 1.3 million people worldwide. It is characterised by a variety of disabling symptoms of which excessive fatigue is the most frequent. Fatigue is often reported as the most invalidating symptom in people with MS. Various mechanisms directly and indirectly related to the disease and physical inactivity have been proposed to contribute to the degree of fatigue. Exercise therapy can induce physiological and psychological changes that may counter these mechanisms and reduce fatigue in MS. OBJECTIVES To determine the effectiveness and safety of exercise therapy compared to a no-exercise control condition or another intervention on fatigue, measured with self-reported questionnaires, of people with MS. SEARCH METHODS We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group Trials Specialised Register, which, among other sources, contains trials from: the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 10), MEDLINE (from 1966 to October 2014), EMBASE (from 1974 to October 2014), CINAHL (from 1981 to October 2014), LILACS (from 1982 to October 2014), PEDro (from 1999 to October 2014), and Clinical trials registries (October 2014). Two review authors independently screened the reference lists of identified trials and related reviews. SELECTION CRITERIA We included randomized controlled trials (RCTs) evaluating the efficacy of exercise therapy compared to no exercise therapy or other interventions for adults with MS that included subjective fatigue as an outcome. In these trials, fatigue should have been measured using questionnaires that primarily assessed fatigue or sub-scales of questionnaires that measured fatigue or sub-scales of questionnaires not primarily designed for the assessment of fatigue but explicitly used as such. DATA COLLECTION AND ANALYSIS Two review authors independently selected the articles, extracted data, and determined methodological quality of the included trials. Methodological quality was determined by means of the Cochrane 'risk of bias' tool and the PEDro scale. The combined body of evidence was summarised using the GRADE approach. The results were aggregated using meta-analysis for those trials that provided sufficient data to do so. MAIN RESULTS Forty-five trials, studying 69 exercise interventions, were eligible for this review, including 2250 people with MS. The prescribed exercise interventions were categorised as endurance training (23 interventions), muscle power training (nine interventions), task-oriented training (five interventions), mixed training (15 interventions), or 'other' (e.g. yoga; 17 interventions). Thirty-six included trials (1603 participants) provided sufficient data on the outcome of fatigue for meta-analysis. In general, exercise interventions were studied in mostly participants with the relapsing-remitting MS phenotype, and with an Expanded Disability Status Scale less than 6.0. Based on 26 trials that used a non-exercise control, we found a significant effect on fatigue in favour of exercise therapy (standardized mean difference (SMD) -0.53, 95% confidence interval (CI) -0.73 to -0.33; P value < 0.01). However, there was significant heterogeneity between trials (I(2) > 58%). The mean methodological quality, as well as the combined body of evidence, was moderate. When considering the different types of exercise therapy, we found a significant effect on fatigue in favour of exercise therapy compared to no exercise for endurance training (SMDfixed effect -0.43, 95% CI -0.69 to -0.17; P value < 0.01), mixed training (SMDrandom effect -0.73, 95% CI -1.23 to -0.23; P value < 0.01), and 'other' training (SMDfixed effect -0.54, 95% CI -0.79 to -0.29; P value < 0.01). Across all studies, one fall was reported. Given the number of MS relapses reported for the exercise condition (N = 25) and non-exercise control condition (N = 26), exercise does not seem to be associated with a significant risk of a MS relapse. However, in general, MS relapses were defined and reported poorly. AUTHORS' CONCLUSIONS Exercise therapy can be prescribed in people with MS without harm. Exercise therapy, and particularly endurance, mixed, or 'other' training, may reduce self reported fatigue. However, there are still some important methodological issues to overcome. Unfortunately, most trials did not explicitly include people who experienced fatigue, did not target the therapy on fatigue specifically, and did not use a validated measure of fatigue as the primary measurement of outcome.
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Affiliation(s)
- Martin Heine
- University Medical Center Utrecht and Rehabilitation Center De HoogstraatBrain Center Rudolf Magnus and Center of Excellence for Rehabilitation MedicineRembrandkade 10UtrechtUtrechtNetherlands3583TM
| | - Ingrid van de Port
- University Medical Center Utrecht and Rehabilitation Center De HoogstraatBrain Center Rudolf Magnus and Center of Excellence for Rehabilitation MedicineRembrandkade 10UtrechtUtrechtNetherlands3583TM
| | - Marc B Rietberg
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Erwin EH van Wegen
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Gert Kwakkel
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
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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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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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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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Prenton S, Kenney LP, Stapleton C, Cooper G, Reeves ML, Heller BW, Sobuh M, Barker AT, Healey J, Good TR, Thies SB, Howard D, Williamson T. Feasibility study of a take-home array-based functional electrical stimulation system with automated setup for current functional electrical stimulation users with foot-drop. Arch Phys Med Rehabil 2014; 95:1870-7. [PMID: 24845222 DOI: 10.1016/j.apmr.2014.04.027] [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: 02/19/2014] [Revised: 04/11/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the feasibility of unsupervised community use of an array-based automated setup functional electrical stimulator for current foot-drop functional electrical stimulation (FES) users. DESIGN Feasibility study. SETTING Gait laboratory and community use. PARTICIPANTS Participants (N=7) with diagnosis of unilateral foot-drop of central neurologic origin (>6mo) who were regular users of a foot-drop FES system (>3mo). INTERVENTION Array-based automated setup FES system for foot-drop (ShefStim). MAIN OUTCOME MEASURES Logged usage, logged automated setup times for the array-based automated setup FES system and diary recording of problems experienced, all collected in the community environment. Walking speed, ankle angles at initial contact, foot clearance during swing, and the Quebec User Evaluation of Satisfaction with Assistive Technology version 2.0 (QUEST version 2.0) questionnaire, all collected in the gait laboratory. RESULTS All participants were able to use the array-based automated setup FES system. Total setup time took longer than participants' own FES systems, and automated setup time was longer than in a previous study of a similar system. Some problems were experienced, but overall, participants were as satisfied with this system as their own FES system. The increase in walking speed (N=7) relative to no stimulation was comparable between both systems, and appropriate ankle angles at initial contact (N=7) and foot clearance during swing (n=5) were greater with the array-based automated setup FES system. CONCLUSIONS This study demonstrates that an array-based automated setup FES system for foot-drop can be successfully used unsupervised. Despite setup's taking longer and some problems, users are satisfied with the system and it would appear as effective, if not better, at addressing the foot-drop impairment. Further product development of this unique system, followed by a larger-scale and longer-term study, is required before firm conclusions about its efficacy can be reached.
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Affiliation(s)
| | | | | | | | - Mark L Reeves
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | | | | | - Anthony T Barker
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Jamie Healey
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Timothy R Good
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
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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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Ambrosini E, Ferrante S, Schauer T, Klauer C, Gaffuri M, Ferrigno G, Pedrocchi A. A myocontrolled neuroprosthesis integrated with a passive exoskeleton to support upper limb activities. J Electromyogr Kinesiol 2014; 24:307-17. [DOI: 10.1016/j.jelekin.2014.01.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 12/13/2013] [Accepted: 01/17/2014] [Indexed: 12/01/2022] Open
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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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Abstract
PURPOSE OF REVIEW Ambulation, and more broadly mobility, is frequently affected by multiple sclerosis (MS). The purpose of this review is to present recent developments regarding the impact, outcome measures, and management of gait disorders in MS. RECENT FINDINGS Recently published surveys have confirmed the high prevalence of walking limitations in MS and their impact on the functional status and quality of life of MS patients and their families. Validated clinical outcome measures include the Timed 25-Foot Walk, 6-Minute Walk, and Multiple Sclerosis Walking Scale-12. Further characterization of gait disorders is allowed by gait analysis systems, as well as pedometers and oscillometers that measure walking in the patient's daily life. A growing body of evidence demonstrates the benefits of various rehabilitation interventions on walking performance. Dalfampridine, an extended-release formulation of 4-aminopyridine, is the first symptomatic medication indicated to improve walking in patients with MS. Newer assistive devices, such as the hip flexion assist device and functional electrical stimulation devices, show promising results in preliminary studies. Various treatments for spasticity can be used without compromising ambulation, but their ability to enhance gait needs to be further assessed. SUMMARY Gait disorders need to be identified and managed early in the course of MS, using a multimodal approach that needs to be adjusted over time based on the results of periodic assessments.
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Affiliation(s)
- Francois Bethoux
- Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk U10, Cleveland, OH 44195, USA.
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Zackowski KM, Cameron M, Wagner JM. 2nd International Symposium on Gait and Balance in Multiple Sclerosis: interventions for gait and balance in MS. Disabil Rehabil 2013; 36:1128-32. [DOI: 10.3109/09638288.2013.833306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Multiple sclerosis (MS) is an immune-mediated disease that causes demyelination and degeneration within the brain and spinal cord. This may result in many impairments, including impaired ambulation, muscle weakness, abnormal tone, visual disturbances, decreased sensation, and fatigue. Rehabilitation helps patients with MS maximize independence by helping to manage and minimize impairments. Deficits seen in ambulation should be addressed to improve energy efficiency and reduce falls. Compensation through appropriate prescription of assistive devices, bracing, and wheelchairs will help improve safety. Rehabilitation can make a significant impact on achieving and maintaining quality of life and independence.
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