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Jackson AN, Sandhu R, Finlayson M. Perspectives on and use of assistive technology by persons with MS: a scoping review. Disabil Rehabil Assist Technol 2024:1-17. [PMID: 39066674 DOI: 10.1080/17483107.2024.2385052] [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: 02/14/2024] [Revised: 06/05/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
Assistive technology (AT) provides persons with Multiple Sclerosis (PwMS) ability to engage in daily activities, however acquiring AT can be challenging. Understanding current state of knowledge about perspectives and use of AT by PwMS may support critical thinking about AT acquisition process. The aim of this scoping review was to map what is known about AT use by PwMS, to identify gaps in knowledge to guide future research and practice for AT matching. A scoping review of qualitative research on perspectives and use of AT by PwMS searched four databases (Medline, CINAHL, PsychNet, and Engineering Village). Papers included focused on non-institutional settings, addressed participant's feelings/perceptions/experiences, and were in English. Initial search October 2021, updated 2022 and 2023. Two reviewers conducted screening, review, and extraction, with a third resolving disagreements. Data extraction guided by the Canadian Model of Occupational Performance and Engagement, categorised AT use by productivity, self-care, and/or leisure occupations. Covidence® was used for extraction. Findings were exported into a spreadsheet to facilitate thematic analysis. Search identified 22 peer-reviewed journals and 11 consumer publications (n = 33). Most common AT was mobility devices. Primary purposes were self-care and leisure. Common use included functional mobility, transportation, personal care, household management, recreation, and socialisation. Perceptions focused on AT need, adjusting to AT, influencing factors, performance and engagement improvements, and seeking acquisition advice. Lack of research on experiences and use of AT beyond mobility equipment, and for engagement of daily activities. Evidence provides some insights for future directions and implications to support AT acquisition for PwMS.
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Affiliation(s)
- Alexandra N Jackson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Rebekah Sandhu
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
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Gann EJ, Mañago MM, Allen DD, Celnikier E, Block VJ. Feasibility of Telerehabilitation-Monitored Functional Electrical Stimulation on Walking and Quality of Life in People With Multiple Sclerosis: A Case Series. Int J MS Care 2024; 26:214-223. [PMID: 39135635 PMCID: PMC11317766 DOI: 10.7224/1537-2073.2023-081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
BACKGROUND Foot drop in people with multiple sclerosis (MS) commonly leads to decreased mobility and quality of life (QOL). Functional electrical stimulation (FES) of the peroneal nerve can improve the gait of people with foot drop, yet various barriers restrict widespread use. The purpose of this case series was to examine the feasibility of a telerehabilitation-monitored FES device and report changes in functional mobility and QOL in people with moderate MS-related disability. METHODS FES use was progressed over 8 weeks via 3 telerehabilitation sessions. Feasibility of telerehabilitation was assessed by percentage of telerehabilitation visits completed and participant-reported satisfaction. At baseline and study completion, functional mobility with and without FES were assessed by the Timed 25-Foot Walk (T25FW), Timed Up and Go (TUG), and 2-Minute Walk Test (2MWT), Multiple Sclerosis Impact Scale (MSIS-29), and the 12-item Multiple Sclerosis Walking Scale (MSWS-12). Fatigue was assessed via the Modified Fatigue Impact Scale (MFIS) before and after the intervention. RESULTS Eleven participants (mean age = 50.4 years [SD 10.8]; 2 males) completed the study. All (33/33) telerehabilitation visits were completed and participants attained high levels of satisfaction with no adverse events. At 8 weeks, compared to baseline, there were clinically meaningful improvements on the T25FW, 2MWT, and TUG for 45%, 55%, and 82% of participants, respectively. Clinically meaningful improvements on the MSIS-29 and MSWS-12 were also recorded for 64% and 36% of participants, respectively. CONCLUSIONS Telerehabilitation was safe and feasible for FES intervention, and improvements in functional mobility and QOL were observed. Telerehabilitation to monitor FES may improve access and reduce patient burden; therefore, studying its efficacy is warranted.
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Affiliation(s)
- Elliot J. Gann
- From the Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Mark M. Mañago
- From the Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Diane D. Allen
- Department of Physical Therapy and Rehabilitation Science, University of California at San Francisco, San Francisco, CA
| | | | - Valerie J. Block
- Department of Physical Therapy and Rehabilitation Science, University of California at San Francisco, San Francisco, CA
- Department of Neurology, University of California at San Francisco, San Francisco, CA
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Andreopoulou G, Busselli G, Street T, Bulley C, Safari R, van der Linden ML, Burridge J. Is functional electrical stimulation effective in improving walking in adults with lower limb impairment due to an upper motor neuron lesion? An umbrella review. Artif Organs 2024; 48:210-231. [PMID: 37259954 DOI: 10.1111/aor.14563] [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: 12/12/2022] [Revised: 04/20/2023] [Accepted: 05/09/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE To conduct an umbrella review of systematic reviews on functional electrical stimulation (FES) to improve walking in adults with an upper motor neuron lesion. METHODS Five electronic databases were searched, focusing on the effect of FES on walking. The methodological quality of reviews was evaluated using AMSTAR2 and certainty of evidence was established through the GRADE approach. RESULTS The methodological quality of the 24 eligible reviews (stroke, n = 16; spinal cord injury (SCI), n = 5; multiple sclerosis (MS); n = 2; mixed population, n = 1) ranged from critically low to high. Stroke reviews concluded that FES improved walking speed through an orthotic (immediate) effect and had a therapeutic benefit (i.e., over time) compared to usual care (low certainty evidence). There was low-to-moderate certainty evidence that FES was no better or worse than an Ankle Foot Orthosis regarding walking speed post 6 months. MS reviews concluded that FES had an orthotic but no therapeutic effect on walking. SCI reviews concluded that FES with or without treadmill training improved speed but combined with an orthosis was no better than orthosis alone. FES may improve quality of life and reduce falls in MS and stroke populations. CONCLUSION FES has orthotic and therapeutic benefits. Certainty of evidence was low-to-moderate, mostly due to high risk of bias, low sample sizes, and wide variation in outcome measures. Future trials must be of higher quality, use agreed outcome measures, including measures other than walking speed, and examine the effects of FES for adults with cerebral palsy, traumatic and acquired brain injury, and Parkinson's disease.
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Affiliation(s)
- Georgia Andreopoulou
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, UK
| | - Giulia Busselli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Tamsyn Street
- Clinical Sciences and Engineering, Salisbury NHS Foundation Trust and Bournemouth University, Salisbury, UK
| | - Cathy Bulley
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, UK
| | - Reza Safari
- College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | | | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Byrnes-Blanco L, Reed K, Dubey R, Carey SL. A systematic literature review of ankle-foot orthosis and functional electrical stimulation foot-drop treatments for persons with multiple sclerosis. Prosthet Orthot Int 2023; 47:358-367. [PMID: 36701192 DOI: 10.1097/pxr.0000000000000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 08/17/2022] [Indexed: 01/27/2023]
Abstract
Foot-drop is one of the most diagnosed and physically limiting symptoms persons with multiple sclerosis (pwMS) experience. Clinicians prescribe ankle-foot orthosis (AFO) and functional electrical stimulation (FES) devices to help alleviate the effects of foot drop, but it is unclear how their clinical and functional gait improvements compare given the user's level of disability, type of multiple sclerosis, walking environment, or desired physical activity. The research questions explored were what is the current state of AFO and FES research for pwMS? What are the prevailing research trends? What definitive clinical and functional device comparisons exist for pwMS? eight databases were systematically searched for relevant literature published between 2009 and 2021. The American Association of Orthotists and Prosthetists and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for systematic literature reviews were followed. A team of 3 researchers critically evaluated 17 articles that passed eligibility criteria. This review discusses the current state and trends of research, provides evidence statements on device effects, and recommends improvements for future studies. A meta-analysis would be informative, but study variability across the literature makes directly comparing AFO and FES device effects unreliable. This review contributes new and useful information to multiple sclerosis literature that can be used by both clinicians and researchers. Clinicians can use the provided insights to prescribe more effective, customized treatments, and other researchers can use them to evaluate and design future studies.
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Carrere LC, Taborda M, Ballario C, Tabernig C. Effects of brain-computer interface with functional electrical stimulation for gait rehabilitation in multiple sclerosis patients: preliminary findings in gait speed and event-related desynchronization onset latency. J Neural Eng 2021; 18. [PMID: 34781272 DOI: 10.1088/1741-2552/ac39b8] [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: 07/02/2021] [Accepted: 11/15/2021] [Indexed: 11/12/2022]
Abstract
Objective.Brain-computer Interfaces (BCI) with functional electrical stimulation (FES) as a feedback device might promote neuroplasticity and hence improve motor function. Novel findings suggested that neuroplasticity could be possible in people with multiple sclerosis (pwMS). This preliminary study explores the effects of using a BCI-FES in therapeutic intervention, as an emerging methodology for gait rehabilitation in pwMS.Approach.People with relapsing-remitting, primary progressive or secondary progressive MS were evaluated with the inclusion criteria to enroll the nine participants required by the statistically computed sample size. Each patient trained with a BCI-FES during 24 sessions distributed in eight weeks. The effects were evaluated on gait speed (Timed 25 Foot Walk), walking ability (12-item Multiple Sclerosis Walking Scale), quality of life measures, the true positive rate as the BCI-FES performance metric and the event-related desynchronization (ERD) onset latency of the sensorimotor rhythms.Main results.Seven patients completed the therapeutic intervention. A statistically and clinically significant post-treatment improvement was observed in gait speed, as a result of a reduction in the time to walk 25 feet (-1.99 s,p= 0.018), and walking ability (-31.25 score points,p= 0.028). The true positive rate showed a statistically significant improvement (+15.87 score points,p= 0.018). An earlier ERD onset latency (-180 ms) after treatment was found.Significance.This is the first study that explored gait rehabilitation using BCI-FES in pwMS. The results showed improvement in gait which might have been promoted by changes in functional brain connections involved in sensorimotor rhythm modulation. Although more studies with a larger sample size and control group are required to validate the efficacy of this approach, these results suggest that BCI-FES technology could have a positive effect on MS gait rehabilitation.
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Affiliation(s)
- L Carolina Carrere
- Rehabilitation Engineering and Neuromuscular and Sensory Research Laboratory, Faculty of Engineering, National University of Entre Ríos, Oro Verde, Entre Ríos, Argentina
| | - Melisa Taborda
- Fundación Rosarina de Neurorehabilitación, Rosario. Santa Fe, Argentina
| | - Carlos Ballario
- Fundación Rosarina de Neurorehabilitación, Rosario. Santa Fe, Argentina.,Instituto Neuro Rosario, Rosario. Santa Fe, Argentina
| | - Carolina Tabernig
- Rehabilitation Engineering and Neuromuscular and Sensory Research Laboratory, Faculty of Engineering, National University of Entre Ríos, Oro Verde, Entre Ríos, Argentina
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Bulley C, Meagher C, Street T, Adonis A, Peace C, Singleton C, Burridge J. Development of clinical guidelines for service provision of functional electrical stimulation to support walking: mixed method exploration of stakeholder views. BMC Neurol 2021; 21:263. [PMID: 34225695 PMCID: PMC8256555 DOI: 10.1186/s12883-021-02299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Over the past 20 years Functional Electrical Stimulation (FES) has grown in clinical use to support walking in people with lower limb weakness or paralysis due to upper motor neuron lesions. Despite growing consensus regarding its benefits, provision across the UK and internationally is variable. This study aimed to explore stakeholder views relating to the value of a clinical guideline focusing on service provision of FES to support walking, how people might use it and what should be included. Methods A mixed methods exploration sought the views of key stakeholders. A pragmatic online survey (n = 223) focusing on the study aim was developed and distributed to the email distribution list of the UK Association for Chartered Physiotherapists Interested in Neurology (ACPIN). In parallel, a qualitative service evaluation and patient public involvement consultation was conducted. Two group, and seven individual interviews were conducted with: FES-users (n = 6), their family and carers (n = 3), physiotherapists (n = 4), service providers/developers (n = 2), researchers (n = 1) and distributors of FES (n = 1). Descriptive analysis of quantitative data and framework analysis of qualitative data were conducted. Results Support for clinical guideline development was clear in the qualitative interviews and the survey results. Survey respondents most strongly endorsed possible uses of the clinical guideline as ensuring best practice and supporting people seeking access to a FES service. Data analysis and synthesis provided clear areas for inclusion in the clinical guidelines, including current research evidence and consensus relating to who is most likely to benefit and optimal service provision as well as pathways to access this. Specific areas for further investigation were summarised for inclusion in the first stage of a Delphi consensus study. Conclusions Key stakeholders believe in the value of a clinical guideline that focuses on the different stages of service provision for FES to support walking. A Delphi consensus study is being planned based on the findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02299-1.
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Affiliation(s)
- C Bulley
- Queen Margaret University, Edinburgh, UK
| | - C Meagher
- University of Southampton, Southampton, UK
| | - T Street
- Salisbury NHS Foundation Trust, Salisbury, UK.
| | - A Adonis
- Imperial College London, London, UK
| | - C Peace
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - C Singleton
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - J Burridge
- University of Southampton, Southampton, UK
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Snowdon N, Booth S, McLean S, Wheat J, Piercy H. Meaning of fabric orthoses to long-term users with multiple sclerosis: An interpretative phenomenological analysis. Prosthet Orthot Int 2021; 45:246-253. [PMID: 33856158 DOI: 10.1097/pxr.0000000000000006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 12/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fabric orthoses are elasticated garments designed to provide support to the musculoskeletal system. They may benefit people with multiple sclerosis; however, in this population, their acceptability is largely unexplored. OBJECTIVES This study aimed to explore the meaning that fabric orthoses hold for people with multiple sclerosis and factors influencing acceptability. STUDY DESIGN This is a qualitative study using an interpretative phenomenological analysis to explore the meaning ascribed to lived experience. METHODS Four people with multiple sclerosis participated in face-to-face semi-structured interviews. Two used upper limb orthotic sleeves for involuntary movement control, one used orthotic shorts, and one used a soft ankle brace. Three participants had fabric orthoses they no longer used. Themes were validated by peer review. FINDINGS Two themes were identified. "Giving back control" describes how perceived physical benefits, such as decreased involuntary movement and improved stability, led to important benefits in autonomy and self-image. Orthoses were not worn longer-term where self-image was not improved. "Learning to live with an orthosis" captures the way in which participants learnt from experience over months or years how to maximize effectiveness and overcome disadvantages. Acceptability was determined specific to the contexts in which the orthoses were used, with the social appropriateness of appearance and the demands of tasks being important considerations. CONCLUSIONS Fabric orthoses can be acceptable to people with multiple sclerosis. Professionals should be mindful of the active learning process that users engage in as they learn about the pros and cons of orthotic use. Further research into effectiveness is needed.
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Affiliation(s)
- Nicola Snowdon
- Department of Allied Health Professions, College of Health, Wellbeing and Life Sciences, Collegiate Crescent Campus, Sheffield Hallam University, Sheffield, S10 2BP
| | - Susan Booth
- Bolton Foundation NHS Trust, Bolton, United Kingdom
| | - Sionnadh McLean
- Department of Allied Health Professions, College of Health, Wellbeing and Life Sciences, Collegiate Crescent Campus, Sheffield Hallam University, Sheffield, S10 2BP
| | - Jon Wheat
- School of Sport and Biological Sciences, University of Bolton, United Kingdom
| | - Hilary Piercy
- Department of Nursing and Midwifery, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
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