Psychometric properties of the modified Emory Functional Ambulation Profile in stroke patients

Predictors of ambulatory recovery and walking proficiency in community-dwelling stroke survivors: a cross-sectional study

Background

Although the major goal of rehabilitation is to return a stroke survivor (SSv) to as close to their pre-stroke functioning, limitation in ambulatory recovery and walking proficiency is the major impediment. Despite the importance of walking to the outcomes in stroke, factors predicting its recovery remain unclear. This study therefore was aimed at exploring the predictors of ambulatory recovery and walking proficiency in community-dwelling SSv.

Methods

This study involved 164 (83females) SSv from four tertiary health institutions in Nigeria. Ambulatory level and status was assessed using Functional Ambulatory Classification, motor function using the Fugl-Myer Assessment scale (lower limb), and ambulatory/waking endurance using the 6-min walk test. Ambulatory capability was assessed using the Lower Extremity Functional Scale, ambulatory self-confidence using the Ambulatory Self-Confidence Questionnaire, and functional ambulatory profile using the Modified Emory Functional Ambulation Profile. Mobility was assessed using the Modified Rivermead Mobility Index, functional mobility using Time Up and Go, balance using the Berg Balance Scale, and cognitive function using the modified Mini-Mental State Examination. Spatial indexes were assessed using the Footprint method and temporal variables using a stopwatch and gait speed on a 10-m walkway. Data was analyzed using multiple regression analysis at p ≤ 0.05.

Results

Participants (mean age = 54.3±11.36 years) have had stroke for 12.9 ± 17.39 months and spent 9.82 ± 13.19 months in hospital admissions. More (65.2%) had ischemic stroke with 54.3% of them having left hemispheric stroke. The predictors of ambulatory onset in SSv were stroke duration and length of stay in hospital admission contributing 40.3% (β = 0.403) and 17.6% (β = 0.176) respectively to the variance. Mobility (β = 0.249, p < 0.001), gait speed (β = 0.185, p = 0.012), paretic double-limb support time (β = 0.155, p = 0.03), balance (β = 0.334, p < 0.001), and cognition (β = 0.155, p = 0.01) were predictors of ambulatory self-confidence contributing 59.5% to the variance. Balance (β = 0.363, p < 0.001) and mobility (β = 0.155, p = 0.015) were predictors of ambulatory capability contributing 52.9% to the variance. Balance (β = −0.489, p < 0.001), paretic double-limb support time (β = 0.223, p = 0.003), gait speed (β = −0.181, p = 0.022), and paretic swing phase duration (β = 0.177, p = 0.01) were predictors of functional ambulatory profile (p < 0.05) contributing 52.9% to the variance. Gait speed (β = −0.648, p < 0.001) and step length (β = −0.157, p = 0.003) were predictors of walking endurance contributing 76.5% to the variance.

Conclusion

Ambulatory recovery and walking proficiency depend on the interplay among duration of stroke and length of hospitalization on the one hand and balance performance, cognitive function, and the spatiotemporal integrity of the affected limb on the other hand.

A Clinical Practice Guideline for the Use of Ankle-Foot Orthoses and Functional Electrical Stimulation Post-Stroke

BACKGROUND

Level of ambulation following stroke is a long-term predictor of participation and disability. Decreased lower extremity motor control can impact ambulation and overall mobility. The purpose of this clinical practice guideline (CPG) is to provide evidence to guide clinical decision-making for the use of either ankle-foot orthosis (AFO) or functional electrical stimulation (FES) as an intervention to improve body function and structure, activity, and participation as defined by the International Classification of Functioning, Disability and Health (ICF) for individuals with poststroke hemiplegia with decreased lower extremity motor control.

METHODS

A review of literature published through November 2019 was performed across 7 databases for all studies involving stroke and AFO or FES. Data extracted included time post-stroke, participant characteristics, device types, outcomes assessed, and intervention parameters. Outcomes were examined upon initial application and after training. Recommendations were determined on the basis of the strength of the evidence and the potential benefits, harm, risks, or costs of providing AFO or FES.

RESULTS/DISCUSSION

One-hundred twenty-two meta-analyses, systematic reviews, randomized controlled trials, and cohort studies were included. Strong evidence exists that AFO and FES can each increase gait speed, mobility, and dynamic balance. Moderate evidence exists that AFO and FES increase quality of life, walking endurance, and muscle activation, and weak evidence exists for improving gait kinematics. AFO or FES should not be used to decrease plantarflexor spasticity. Studies that directly compare AFO and FES do not indicate overall superiority of one over the other. But evidence suggests that AFO may lead to more compensatory effects while FES may lead to more therapeutic effects. Due to the potential for gains at any phase post-stroke, the most appropriate device for an individual may change, and reassessments should be completed to ensure the device is meeting the individual's needs.

LIMITATIONS

This CPG cannot address the effects of one type of AFO over another for the majority of outcomes, as studies used a variety of AFO types and rarely differentiated effects. The recommendations also do not address the severity of hemiparesis, and most studies included participants with varied baseline ambulation ability.

SUMMARY

This CPG suggests that AFO and FES both lead to improvements post-stroke. Future studies should examine timing of provision, device types, intervention duration and delivery, longer term follow-up, responders versus nonresponders, and individuals with greater impairments.

DISCLAIMER

These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for people with poststroke hemiplegia who have decreased lower extremity motor control that impacts ambulation and overall mobility.A Video Abstract is available as supplemental digital content from the authors (available at: http://links.lww.com/JNPT/A335).

Identifying Instruments to Assess Care Quality for Individuals With Custom Ankle Foot Orthoses: A Scoping Review

OBJECTIVES

We conducted 2 complementary scoping reviews to identify instruments that assess the experience and outcomes of custom ankle-foot orthosis (AFO) care in individuals with neurologic and traumatic conditions and to determine to what extent they might be psychometrically sound for AFO users. A stakeholder advisory committee considered to what extent the identified and psychometrically sound instruments might be feasible for use in developing quality measures for custom AFO users.

DATA SOURCES

Both scoping reviews were conducted using PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, and Cochrane Systematic Reviews. The following were used for the first scoping review only: Cochrane Central Register of Controlled Trials and the Physiotherapy Evidence Database.

STUDY SELECTION

The initial scoping review yielded 79 articles with 82 instruments, 16 of which were used in 4 or more studies. The second scoping review yielded 57 articles reporting psychometric properties.

DATA EXTRACTION

Psychometric properties for populations who use AFOs were summarized for 15 of the 16 instruments. The advisory committee eliminated 2 insrtruments, noted overlap between 4 instruments in terms of the constructs measured, and suggested 6 potential contemporary substitutes.

DATA SYNTHESIS

Most instruments assessed activity (specifically mobility) and pertained to the National Quality Forum domain of "Health-Related Quality of Life." The 10-meter walk test, 6-minute walk test, Berg Balance Scale, Timed Up and Go, and Rivermead Mobility Index were reported to have adequate reliability and validity, and were considered feasible for administration in a clinical setting.

CONCLUSIONS

Complementary scoping reviews demonstrated that some instruments with reasonable psychometric properties are available that are feasible to use in developing quality measures for custom AFO care. However, experience of care instruments suitable for this population were not identified but are needed for a comprehensive evaluation of care quality for AFO users.

Early robot-assisted gait retraining in non-ambulatory patients with stroke: a single blind randomized controlled trial

BACKGROUND

Restoration of walking function is a primary concern of neurorehabilitation with respect to the aspired social and vocational reintegration. To date, the best practice for improving gait early after stroke is still object of debate. On one hand, repetitive task-specific approaches with higher intensities of walking have been observed to result in greater improvements of gait after stroke. Conversely there is some evidence that conventional gait training would be more effective for facilitating walking ability after stroke.

AIM

To compare the effects of an early treatment protocol of add-on robot-assisted gait training with add-on conventional overground physiotherapy for improving locomotion in non-ambulatory adult stroke patients.

DESIGN

Single-blind randomized controlled trial.

SETTING

Neurorehabilitation hospital.

POPULATION

Seventy-four subacute patients with first-ever ischemic stroke.

METHODS

The patients were randomized into two groups. The training program consisted of forty, 2-hour sessions (including 45 minutes basic training, 45 minutes add-on training plus rest periods), 5 days a week, for 8 consecutive weeks. Patients allocated to the add-on robot-assisted gait training were treated by means of the Lokomat. Patients allocated to the add-on conventional overground gait training aimed at improving postural control during gait, body weight transfer, stability during the stance phase, free swing phase, adequate heel contact and gait pattern. Primary outcome was the modified Emory Functional Ambulation Profile. Secondary outcomes were the Rivermead Motor Index, the Mobility Milestones and the Hochzirl Walking Aids Profile.

RESULTS

No significant difference was observed between groups with regards to age (P=0.661), time from stroke onset (P=0.413) and the primary outcome (P=0.854) at baseline evaluation. As to the primary outcome, no significant differences were found between groups at the end of the study. As During the 8-week training, within-group comparisons showed significant improvements of mean modified Emory Functional Ambulation Profile in both groups (P<0.001).

CONCLUSIONS

Our results support the hypothesis that an early treatment protocol of robot-assisted gait retraining is not superior to add-on conventional gait training intervention for improving locomotion in non-ambulatory stroke patients.

CLINICAL REHABILITATION IMPACT

This study might help to better understand the role of robot-assisted gait training in early phase stroke rehabilitation.

Walking adaptability after a stroke and its assessment in clinical settings

Control of walking has been described by a tripartite model consisting of stepping, equilibrium, and adaptability. This review focuses on walking adaptability, which is defined as the ability to modify walking to meet task goals and environmental demands. Walking adaptability is crucial to safe ambulation in the home and community environments and is often severely compromised after a stroke. Yet quantification of walking adaptability after stroke has received relatively little attention in the clinical setting. The objectives of this review were to examine the conceptual challenges for clinical measurement of walking adaptability and summarize the current state of clinical assessment for walking adaptability. We created nine domains of walking adaptability from dimensions of community mobility to address the conceptual challenges in measurement and reviewed performance-based clinical assessments of walking to determine if the assessments measure walking adaptability in these domains. Our literature review suggests the lack of a comprehensive well-tested clinical assessment tool for measuring walking adaptability. Accordingly, recommendations for the development of a comprehensive clinical assessment of walking adaptability after stroke have been presented. Such a clinical assessment will be essential for gauging recovery of walking adaptability with rehabilitation and for motivating novel strategies to enhance recovery of walking adaptability after stroke.

Contralaterally controlled neuromuscular electrical stimulation for recovery of ankle dorsiflexion: a pilot randomized controlled trial in patients with chronic post-stroke hemiplegia

OBJECTIVE

The aim of this study was to compare the effects of contralaterally controlled neuromuscular electrical stimulation (CCNMES) vs. cyclic neuromuscular electrical stimulation (NMES) on lower extremity impairment, functional ambulation, and gait characteristics.

DESIGN

Twenty-six survivors of stroke with chronic (≥6 mos) foot drop during ambulation were randomly assigned to 6 wks of CCNMES or cyclic NMES. Both groups had ten sessions per week of self-administered home application of either CCNMES or cyclic NMES plus two sessions per week of gait training with a physical therapist. Primary outcomes included lower extremity Fugl-Meyer score, modified Emory Functional Ambulation Profile, and gait velocity. Assessments were made at pretreatment and posttreatment and at 1 and 3 mos after treatment.

RESULTS

There were no significant differences between the groups in the outcome trajectories for any of the measures. With data from both groups pooled, there were significant but modest and sustained improvements in the Fugl-Meyer score and the modified Emory Functional Ambulation Profile but not in gait velocity.

CONCLUSIONS

The results support the hypothesis that gait training combined with either CCNMES or cyclic NMES reduces lower extremity impairment and functional ambulation but do not support the hypothesis that CCNMES is more effective than cyclic NMES in patients with chronic post-stroke hemiplegia.

Measuring ambulation in adults with central neurologic disorders

This review discusses challenges faced by clinicians and researchers when measuring ambulation in individuals with central neurologic disorders within 3 distinct environments: clinical, laboratory, and community. Even the most robust measure of ambulation is affected by the environment in which it is implemented and by the clinical or research question and the specificity of the hypothesis being investigated. The ability to accurately measure ambulation (one of the most important metrics used to show transition into a community environment) is essential to measure treatment effectiveness and rehabilitation outcomes in populations with central neurologic disorders.

Randomized controlled trial of surface peroneal nerve stimulation for motor relearning in lower limb hemiparesis

OBJECTIVE

To compare the motor relearning effect of a surface peroneal nerve stimulator (PNS) versus usual care on lower limb motor impairment, activity limitation, and quality of life among chronic stroke survivors.

DESIGN

Single-blinded randomized controlled trial.

SETTING

Teaching hospital of academic medical center.

PARTICIPANTS

Chronic stroke survivors (N=110; >12wk poststroke) with unilateral hemiparesis and dorsiflexion strength of ≤4/5 on the Medical Research Council scale.

INTERVENTIONS

Subjects were stratified by motor impairment level and then randomly assigned to ambulation training with either a surface PNS device or usual care (ankle-foot orthosis or no device) intervention. Subjects were treated for 12 weeks and followed up for 6 months posttreatment.

MAIN OUTCOME MEASURES

Lower limb portion of the Fugl-Meyer (FM) Assessment (motor impairment), the modified Emory Functional Ambulation Profile (mEFAP) performed without a device (functional ambulation), and the Stroke Specific Quality of Life (SSQOL) scale.

RESULTS

There was no significant treatment group main effect or treatment group by time interaction effect on FM, mEFAP, or SSQOL raw scores (P>.05). The time effect was significant for the 3 raw scores (P<.05). However, when comparing average change scores from baseline (t1) to end of treatment (t2, 12wk), and at 12 weeks (t3) and 24 weeks (t4) after end of treatment, significant differences were noted only for the mEFAP and SSQOL scores. The change in the average scores for both mEFAP and SSQOL occurred between t1 and t2, followed by relative stability thereafter.

CONCLUSIONS

There was no evidence of a motor relearning effect on lower limb motor impairment in either the PNS or usual-care groups. However, both the PNS and usual-care groups demonstrated significant improvements in functional mobility and quality of life during the treatment period, which were maintained at 6-month follow-up.

You've heard about outcome measures, so how do you use them? Integrating clinically relevant outcome measures in orthotic management of stroke

In today's healthcare environment it is increasingly important to be able to quantify the amount of change associated with a given intervention; this can be accomplished using one or more appropriate outcome measures. However, the selection and integration of outcome measures within clinical practice requires careful consideration. This includes identification of the measure construct which can be assisted by the International Classification of Functioning, Disability, and Health; selection of outcome measures based on need, appropriateness and feasibility; and careful use in regular clinical practice including data collection, analysis and re-assessment of the process. We describe this process, focusing on orthotic management of stroke, in particular the improvement of mobility as a common goal. Clinical relevance The growing emphasis on improved documentation of patient care and outcomes requires that clinicians integrate clinically relevant outcome measures into their practice. We suggest a process to assist clinicians integrate outcome measures into clinical practice with a particular emphasis on the orthotic management of stroke.

A systematic review of the responsiveness of lower limb physical performance measures in inpatient care after stroke

Background

Responsiveness refers to a measurement tool’s ability to detect change in performance over time. The aim of the review was to summarise studies of responsiveness of lower limb physical performance measures during inpatient care after stroke.

Methods

A systematic literature review was conducted. Prospective studies that included participants with a diagnosis of stroke, were commenced in the acute or subacute phase of inpatient care and included a measure of a lower limb physical performance were included in this review.

Results

Twenty-one studies met these inclusion criteria. A variety of measures were investigated including the Berg Balance Scale, various timed walking tests and the Rivermead Mobility Index. Ten of the included studies had small sample sizes (50 participants or less), 2 studies used a convenience sample rather than consecutive recruitment and 5 studies excluded potential participants with poor physical abilities at baseline. Responsiveness varied between and within studies but was generally large, Effect Size (ES) or Standardised Response Mean (SRM) > 0.8. Measures displaying large responsiveness included the twelve-minute walk test (SRM 1.90) and the Modified Rivermead Mobility Index (SRM 1.31) when re-measured at four weeks after stroke, and the Berg Balance Scale (ES 1.11) and Postural Assessment Scale for Stroke Patients (ES 1.12) when re-measured at approximately six months after stroke.

Conclusion

Studies conducted to date have generally found physical performance measures after stroke to have large responsiveness i.e., to be able to detect changes. Further investigation of the responsiveness of measurement tools after stroke in larger prospective cohort studies is required.

Relationship between body mass index and rehabilitation outcomes in chronic stroke

OBJECTIVE

The aim of this study was to evaluate the relationship between body mass index (BMI) and change in motor impairment and functional mobility after a gait rehabilitation intervention in chronic stroke subjects.

DESIGN

Correlation and linear regression analyses of pretreatment and end-of-treatment Fugl-Meyer scores and modified Emory Functional Ambulation Profile scores from hemiparetic subjects (n = 108, >3 mos post stroke) who participated in a randomized controlled trial comparing two 12-wk ambulation training treatments were generated.

RESULTS

A series of linear regression models that controlled for age, sex, stroke type, interval post-stroke, and training device found the change in the Fugl-Meyer score to be significantly negatively associated with pretreatment BMI (β = -0.207, P = 0.036) and the change in the "up and go" modified Emory Functional Ambulation Profile score to be significantly positively associated with BMI (β = 0.216, P = 0.03). Changes in modified Emory Functional Ambulation Profile scores in floor, carpet, obstacles, or stair climbing were not significantly associated with BMI.

CONCLUSIONS

Chronic stroke subjects with a higher BMI were less likely to demonstrate improvement in motor impairment and up and go functional mobility performance in response to ambulation training, irrespective of treatment intervention. Stroke rehabilitation clinicians should consider BMI when formulating rehabilitation goals. Further studies are necessary to determine whether obesity is a predictor of longer-term post-stroke motor and functional recovery.

A wearable robotic knee orthosis for gait training: a case-series of hemiparetic stroke survivors

BACKGROUND AND AIM

Until recently, robotic devices for stroke rehabilitation had multi-joint designs that were often tethered to a treadmill for gait training. A new single-joint wearable robotic knee orthosis (RKO) has been designed that provides patient-initiated powered-assistance in untethered functional mobility. This case-series documents application of the wearable RKO in untethered functional training with stroke survivors.

TECHNIQUE

Three ambulatory adult stroke survivors used a wearable RKO during 18 one-hour sessions within a six-week physical therapy programme. Subjects were assessed with a variety of balance, gait and functional tests including the Berg Balance Scale (BBS); six-minute walk test (6MWT); and Emory Functional Ambulation Profile (EFAP) at pre-treatment, post-treatment, one-month and three-month follow-up.

DISCUSSION

All subjects improved balance, gait and functional performances with mean individual improvements of 12.6% for BBS, 12.0% for 6MWT and 16.7% for EFAP post-treatment. No adverse events occurred. These three stroke survivors may have benefited from the task-specific functional training programme augmented by RKO use.

Using robot-applied resistance to augment body-weight-supported treadmill training in an individual with incomplete spinal cord injury

BACKGROUND AND PURPOSE

The efficacy of task-specific gait training for people with spinal cord injury (SCI) is premised on evidence that the provision of gait-related afferent feedback is key for the recovery of stepping movements. Recent findings have shown that sensory feedback from flexor muscle afferents can facilitate flexor muscle activity during the swing phase of walking. This case report was undertaken to determine the feasibility of using robot-applied forces to resist leg movements during body-weight-supported treadmill training (BWSTT) and to measure its effect on gait and other health-related outcomes.

CASE DESCRIPTION

The patient described in this case report was a 43-year-old man with a T11 incomplete chronic SCI. He underwent 36 sessions of BWSTT using a robotic gait orthosis to provide forces that resist hip and knee flexion.

OUTCOMES

Tolerance to the training program was monitored using the Borg CR10 scale and heart rate and blood pressure changes during each training session. Outcome measures (ie, 10-Meter Walk Test, Six-Minute Walk Test, modified Emory Functional Ambulation Profile [mEFAP], Activities-specific Balance Confidence Scale, and Canadian Occupational Performance Measure) were completed and kinematic parameters of gait, lower-extremity muscle strength (force-generating capacity), lower-limb girth, and tolerance to orthostatic stress were measured before and after the training program.

DISCUSSION

The patient could tolerate the training. Overground walking speed, endurance, and performance on all subtasks of the mEFAP improved and were accompanied by increased lower-limb joint flexion and toe clearance during gait. The patient's ambulatory self-confidence and self-perceived performance in walking also improved. These findings suggest that this new approach to BWSTT is a feasible and potentially effective therapy for improving skilled overground walking performance.

Turning capacity in ambulatory individuals poststroke

OBJECTIVE

To compare turning capacity in ambulatory individuals poststroke with controls and to determine the relationship between turning capacity, functional ambulation, motor recovery, and gait asymmetry.

DESIGN

This was a cross-sectional experimental study using community-dwelling, ambulatory chronic stroke survivors (n = 13) and age-matched able-bodied controls (n = 10). Neural impairment resulting from stroke was assessed by the Chedoke-McMaster Stroke Assessment for the leg and foot. Turning capacity was measured by the number of steps and time required to complete 45-, 90-, and 180-degree turns. Functional ambulation and balance were assessed by the 10-m walk test, Timed Up and Go test, Emory Functional Ambulation Profile, and the Berg Balance Scale. Gait asymmetry was measured by single-support gait asymmetry.

RESULTS

Participants with stroke required a significantly greater number of steps and longer time to complete the 45-, 90-, and 180-degree turns compared with controls. The average number of steps or time required to turn 45, 90, or 180 degrees was not different whether the turns were made to the paretic side or to the nonparetic side in the participants with stroke or whether turns were made toward the dominant or nondominant side in the controls. In the participants with stroke, turning capacity for 180-degree turns to both the paretic and nonparetic side was significantly correlated to the 10-m walk test, Timed Up and Go test, Emory Functional Ambulation Profile, and Berg Balance Scale. Single-support gait asymmetry was also significantly correlated to 180-degree turning capacity.

CONCLUSIONS

The results of this study demonstrate that turning capacity poststroke is compromised, as exemplified by the greater number of steps and time required to complete turns at each angle tested. Turning capacity was related to the degree of gait asymmetry and the level of functional ambulation. Further work is needed to elucidate the contribution of biomechanical and neurologic parameters of hemiplegic gait impairments to turning capacity.

Treadmill-based locomotor training with leg weights to enhance functional ambulation in people with chronic stroke: a pilot study

BACKGROUND AND PURPOSE

Novel locomotor training strategies for individuals with disorders of the central nervous system have been associated with improved locomotor function. The purpose of this study was to investigate the effects of treadmill-based locomotor training combined with leg weights on functional ambulation in individuals with chronic stroke. We assessed functional ambulation and muscle activity in ambulatory individuals with chronic stroke.

METHODS

We used a pre/posttest design. Six individuals with chronic stroke who were community ambulators were recruited. Participants underwent a 30-minute treadmill-based locomotor training sessions three times per week for four to 12 weeks. The training program involved treadmill walking for 30 minutes with partial body weight support as needed. Leg weights, equivalent to 5% of body weight, were affixed around the paretic leg. Outcome measures consisted of the 10-m walk test, the modified Emory Functional Ambulation Profile, and temporal gait parameters.

RESULTS

Improvements were observed in functional ambulation measures, particularly the stairs subscore of the modified Emory Functional Ambulation Profile. Participants also exhibited an increase in the proportion of time the paretic leg spent in swing. No significant improvements were observed in the 10-m walk test.

CONCLUSIONS

This pilot study demonstrates that the combination of leg weights and treadmill training is a feasible approach, that is well tolerated by participants. This approach may have the potential to improve some aspects of functional ambulation and the performance of activities requiring hip and knee flexion.

The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: a systematic review

Objective: To identify psychometrically robust and clinically feasible measures of walking and mobility in people with neurological conditions

Data sources: MEDLINE, CINAHL, EMBASE, PEDro and AMED.

Review methods: Independent reviewers selected and extracted data from articles that assessed the reliability, validity, sensitivity to change or clinical utility of measures of walking and mobility in adult neurological conditions. Measures with ‘good’ psychometrics and 9/10 clinical utility scores were recommended.

Results: Seventeen measures were selected. Of these, the 5-m and 10-m walk tests, six-minute walk test, High Level Mobility Assessment Tool (HiMAT) and the Rivermead Mobility Index (RMI) reached the required standards and are usable in clinical practice. None of the recommended measures assessed wheelchair mobility. The least frequently assessed property was sensitivity to change. Further measures could be recommended if the minimal detectable change were demonstrated.

Conclusion: The 5-m, 10-m and six-minute walk test, High Level Mobility Assessment Tool and the Rivermead Mobility Index are psychometrically robust measures of walking and mobility and are feasible for use in clinical practice.

Neuroprosthetic effect of peroneal nerve stimulation in multiple sclerosis: a preliminary study

OBJECTIVE

To determine the neuroprosthetic effect of a peroneal nerve stimulator on tasks of functional ambulation in multiple sclerosis (MS).

DESIGN

A single point-in-time assessment of functional ambulation tasks under the conditions of no device and peroneal nerve stimulator.

SETTING

Outpatient academic medical center.

PARTICIPANTS

Participants (N=11) with diagnosis of MS (>6mo), dorsiflexion weakness, and prior usage of an ankle-foot orthosis.

INTERVENTION

Surface peroneal nerve stimulator for ambulation.

MAIN OUTCOME MEASURES

Timed 25-foot Walk portion of the MS Functional Composite; Floor, Carpet, Up and Go, Obstacle, and Stair components of the Modified Emory Functional Ambulation Profile.

RESULTS

Peroneal nerve stimulator-Stair performance was significantly enhanced (P=.05) versus no device, and statistical significance was approached for peroneal nerve stimulator-Obstacles (P=.09) versus no device. There were no significant differences between peroneal nerve stimulator and no device conditions in the remaining outcome measures.

CONCLUSIONS

The neuroprosthetic effect of the peroneal nerve stimulator is modest relative to no device in the performance of specific functional tasks of ambulation in MS gait. A longitudinal, controlled trial is needed to show effectiveness.