A Novel Functional Electrical Stimulation Device Plus Telerehabilitation Improves Walking in People with Multiple Sclerosis: A Case Series

Abstract

Background and purpose Foot drop in people with multiple sclerosis (PwMS) commonly leads to decreased mobility and quality of life (QOL). Functional electrical stimulation (FES) of the peroneal nerve can improve gait but access to wearable FES devices is limited by cost and burden of in-person visits for device optimization. Therefore, the purpose of this case series was to assess the effectiveness and feasibility of a telehealth-monitored FES device. Methods Ten PwMS (50.2 years [SD 11.3]; 2 males) with moderate disability (median EDSS 4.75; IQR 3.75 – 5.75) were provided an EvoWalk FES device. Participants were prescribed an 8-week wear-schedule. A wearable accelerometer (ActiGraph) recorded daily step count at week 0 and 8. For week 0 activity levels, the EvoWalk was donned but not activated, and settings were progressed over three bi-weekly telehealth sessions. Effectiveness was assessed by Timed-25 Foot Walk (T25FW), 2-Minute Walk test (2MWT), Timed-Up and Go (TUG), and self-report of walking, fatigue, and QOL collected in-person at baseline and study end. Feasibility was assessed by percentage of telehealth visits completed and participant-reported satisfaction. Results All (100%) telehealth visits were completed with high levels of satisfaction reported, mean score 4.7/5 (SD .51). ActiGraph data were available for 3 participants: average daily step count pre (2,996; SD 1,235) was lower than post (3,930: SD 1,157) EvoWalk use. At study completion, use of FES resulted in a larger orthotic effect in gait speed for T25FW (-14.2%), TUG (-17.0%) and distance on the 2MWT (14.6%). Post-trial self-report measures showed improvements in subjective walking (-15.6%), QOL (-13.6%) and fatigue (-7.5%). Discussion Telehealth was safe and feasible for progressing FES intervention. Gait speed, walking distance, and QOL improved following the intervention. Using telerehabilitation to monitor FES intervention may simultaneously improve access and reduce patient burden. Future research should include follow-up to assess long-term effects Foot drop in people with multiple sclerosis (PwMS) commonly leads to decreased mobility and quality of life (QOL). Functional electrical stimulation (FES) of the peroneal nerve can improve gait but access to wearable FES devices is limited by cost and burden of in-person visits for device optimization. Therefore, the purpose of this case series was to assess the effectiveness and feasibility of a telehealth-monitored FES device. Ten PwMS (50.2 years [SD 11.3]; 2 males) with moderate disability (median EDSS 4.75; IQR 3.75 – 5.75) were provided an EvoWalk FES device. Participants were prescribed an 8-week wear-schedule. A wearable accelerometer (ActiGraph) recorded daily step count at week 0 and 8. For week 0 activity levels, the EvoWalk was donned but not activated, and settings were progressed over three bi-weekly telehealth sessions. Effectiveness was assessed by Timed-25 Foot Walk (T25FW), 2-Minute Walk test (2MWT), Timed-Up and Go (TUG), and self-report of walking, fatigue, and QOL collected in-person at baseline and study end. Feasibility was assessed by percentage of telehealth visits completed and participant-reported satisfaction. All (100%) telehealth visits were completed with high levels of satisfaction reported, mean score 4.7/5 (SD .51). ActiGraph data were available for 3 participants: average daily step count pre (2,996; SD 1,235) was lower than post (3,930: SD 1,157) EvoWalk use. At study completion, use of FES resulted in a larger orthotic effect in gait speed for T25FW (-14.2%), TUG (-17.0%) and distance on the 2MWT (14.6%). Post-trial self-report measures showed improvements in subjective walking (-15.6%), QOL (-13.6%) and fatigue (-7.5%). Telehealth was safe and feasible for progressing FES intervention. Gait speed, walking distance, and QOL improved following the intervention. Using telerehabilitation to monitor FES intervention may simultaneously improve access and reduce patient burden. Future research should include follow-up to assess long-term effects