Abstract
BackgroundPeople 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 FindingsNine 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.ConclusionAlthough 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 RegistrationClinicalTrials.gov NCT01977287
Highlights
Multiple Sclerosis (MS) is a progressive autoimmune disease of the central nervous system
In a preliminary trial with new users of Functional Electrical Stimulation (FES), Scheffler [14] did not find a statistically significant effect of FES for the timed 5 m level walk tests over different surfaces and the Timed Up and Go test, but the performance on the stair ascent and descent test was significantly improved with the assistance of FES
Two participants did not return after their first visit as they did not wish to continue with FES therapy, resulting in nine participants being available for follow-up and who were included in the data analysis
Summary
Multiple Sclerosis (MS) is a progressive autoimmune disease of the central nervous system. A common gait problem even in minimally impaired pwMS is decreased dorsiflexion in the swing phase of the gait cycle, i.e. the phase when the foot is not in contact with the ground [4,5,6] This means that the toe drags or is close to the ground during the swing phase (i.e. foot-drop), which increases the risk of tripping, stumbling and falling. FES for people with a stroke has received considerable attention [8], it is only relatively recently that the effects of FES to treat foot-drop have been investigated in pwMS. 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
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