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Aout T, Begon M, Jegou B, Peyrot N, Caderby T. Effects of Functional Electrical Stimulation on Gait Characteristics in Healthy Individuals: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:8684. [PMID: 37960383 PMCID: PMC10648660 DOI: 10.3390/s23218684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND This systematic review aimed to provide a comprehensive overview of the effects of functional electrical stimulation (FES) on gait characteristics in healthy individuals. METHODS Six electronic databases (PubMed, Embase, Epistemonikos, PEDro, COCHRANE Library, and Scopus) were searched for studies evaluating the effects of FES on spatiotemporal, kinematic, and kinetic gait parameters in healthy individuals. Two examiners evaluated the eligibility and quality of the included studies using the PEDro scale. RESULTS A total of 15 studies met the inclusion criteria. The findings from the literature reveal that FES can be used to modify lower-limb joint kinematics, i.e., to increase or reduce the range of motion of the hip, knee, and ankle joints. In addition, FES can be used to alter kinetics parameters, including ground reaction forces, center of pressure trajectory, or knee joint reaction force. As a consequence of these kinetics and kinematics changes, FES can lead to changes in spatiotemporal gait parameters, such as gait speed, step cadence, and stance duration. CONCLUSIONS The findings of this review improve our understanding of the effects of FES on gait biomechanics in healthy individuals and highlight the potential of this technology as a training or assistive solution for improving gait performance in this population.
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Affiliation(s)
- Thomas Aout
- Laboratoire IRISSE, EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, 97430 Le Tampon, France; (B.J.); (N.P.); (T.C.)
| | - Mickael Begon
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l’Activité Physique, Université de Montréal, Montreal, QC H3T 1J4, Canada;
- Centre de Recherche du CHU Sainte-Justine, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Baptiste Jegou
- Laboratoire IRISSE, EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, 97430 Le Tampon, France; (B.J.); (N.P.); (T.C.)
| | - Nicolas Peyrot
- Laboratoire IRISSE, EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, 97430 Le Tampon, France; (B.J.); (N.P.); (T.C.)
- Mouvement-Interactions-Performance (MIP), Le Mans Université, EA 4334, 72000 Le Mans, France
| | - Teddy Caderby
- Laboratoire IRISSE, EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, 97430 Le Tampon, France; (B.J.); (N.P.); (T.C.)
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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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Rooney S, McWilliam G, Wood L, Moffat F, Paul L. Oxygen Cost of Walking in People With Multiple Sclerosis and Its Association With Fatigue: A Systematic Review and Meta-analysis. Int J MS Care 2022; 24:74-80. [PMID: 35462868 PMCID: PMC9017655 DOI: 10.7224/1537-2073.2020-128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to compare the oxygen cost of walking in individuals with multiple sclerosis (MS) and controls and to assess the relationship between oxygen cost of walking and fatigue in individuals with MS. METHODS Four databases (CINAHL, MEDLINE, ProQuest, Web of Science) were searched up to September 2020. Studies were included if they recruited adults with MS and either compared oxygen cost of walking in those with MS and a control population or determined the relationship between oxygen cost of walking and fatigue. Meta-analysis of the standardized mean difference in oxygen cost of walking between individuals with MS and controls was performed. RESULTS Nine studies were included in this review, of which 7 compared oxygen cost of walking in individuals with MS (n = 176) and controls (n = 142) and 4 investigated the relationship between oxygen cost of walking and fatigue. Meta-analysis revealed that individuals with MS (with predominantly mild-to-moderate disability) had a significantly higher oxygen cost of walking compared with controls (standardized mean difference = 2.21, 95% CI = 0.88 to 3.54, P = .001). In addition, 3 studies found a significant yet weak positive association between oxygen cost of walking and fatigue. CONCLUSIONS Individuals with MS expend more energy when walking compared with controls. This increase in energy expenditure may contribute to the development of fatigue, as some studies found that higher oxygen costs of walking were associated with greater fatigue. Future studies should investigate whether reducing energy expenditure during movement improves fatigue.
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Affiliation(s)
- Scott Rooney
- From the School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK (SR, GM, LW, LP)
| | - Gavin McWilliam
- From the School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK (SR, GM, LW, LP)
| | - Leslie Wood
- From the School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK (SR, GM, LW, LP)
| | | | - Lorna Paul
- From the School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK (SR, GM, LW, LP)
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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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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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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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Miller Renfrew L, Lord AC, Warren J, Hunter R. Evaluating the Effect of Functional Electrical Stimulation Used for Foot Drop on Aspects of Health-Related Quality of Life in People with Multiple Sclerosis: A Systematic Review. Int J MS Care 2019; 21:173-182. [PMID: 31474810 PMCID: PMC6709571 DOI: 10.7224/1537-2073.2018-015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a common degenerative neurologic condition resulting in walking difficulties. Foot drop is a common walking impairment in MS that can affect health-related quality of life (HRQOL). Functional electrical stimulation (FES) can improve walking in people with MS, but its effect on HRQOL is not well established. This review investigated the effect of FES used for foot drop on HRQOL in adults with MS. METHODS A systematic search was performed using CINAHL, MEDLINE, Cochrane Library, PubMed, and PEDro online databases. Inclusion and exclusion criteria were applied to select eligible studies. Data were extracted, and two reviewers independently rated the quality of the studies using the Effective Public Health Practice Project assessment tool. RESULTS Eight studies were eligible for review; seven were of moderate-to-strong methodological quality and one was weak. Seven studies demonstrated significant positive effects of FES on different aspects of HRQOL as measured by the 29-item Multiple Sclerosis Impact Scale, 36-item Short Form Health Status Survey, Canadian Occupational Performance Measure, and Psychosocial Impact of Assistive Devices Scale. CONCLUSIONS This review provides preliminary evidence that FES has a positive effect on aspects of HRQOL in people with MS; however, the variety of HRQOL outcomes used makes it difficult to determine definitive conclusions. Future larger-scale randomized studies with long-term follow-up are recommended to better understand the effect of FES on HRQOL. This will inform prescribing decisions and support compliance with FES over the longer-term.
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Comparative Randomized, Single‐Dose, Two‐Way Crossover Open‐Label Study to Determine the Bioequivalence of Two Formulations of Dalfampridine Tablets. Clin Pharmacol Drug Dev 2019; 8:355-360. [DOI: 10.1002/cpdd.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/06/2018] [Indexed: 11/07/2022]
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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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Sternowski K, Perone K. Uses of Electrical Stimulation for the Rehabilitation of People with Multiple Sclerosis: A Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0157-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bettecken K, Bernhard F, Sartor J, Hobert MA, Hofmann M, Gladow T, van Uem JMT, Liepelt-Scarfone I, Maetzler W. No relevant association of kinematic gait parameters with Health-related Quality of Life in Parkinson's disease. PLoS One 2017; 12:e0176816. [PMID: 28531171 PMCID: PMC5439666 DOI: 10.1371/journal.pone.0176816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 04/18/2017] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Health-related Quality of Life (HrQoL) is probably the most important outcome parameter for the evaluation and management of chronic diseases. As this parameter is subjective and prone to bias, there is an urgent need to identify objective surrogate markers. Gait velocity has been shown to be associated with HrQoL in numerous chronic diseases, such as Parkinson's disease (PD). With the development and wide availability of simple-to-use wearable sensors and sophisticated gait algorithms, kinematic gait parameters may soon be implemented in clinical routine management. However, the association of such kinematic gait parameters with HrQoL in PD has not been assessed to date. METHODS Kinematic gait parameters from a 20-meter walk from 43 PD patients were extracted using a validated wearable sensor system. They were compared with the Visual Analogue Scale of the Euro-Qol-5D (EQ-5D VAS) by performing a multiple regression analysis, with the International Classification of Functioning, Disability and Health (ICF) model as a framework. RESULTS Use of assistive gait equipment, but no kinematic gait parameter, was significantly associated with HrQoL. CONCLUSION The widely accepted concept of a positive association between gait velocity and HrQoL may, at least in PD, be driven by relatively independent parameters, such as assistive gait equipment.
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Affiliation(s)
- Kristina Bettecken
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Felix Bernhard
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Jennifer Sartor
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Markus A. Hobert
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | | | - Till Gladow
- Hasomed, Magdeburg, Germany
- Institute for Physiotherapy, Department of Clinical Research, Jena University Hospital, Jena, Germany
| | - Janet M. T. van Uem
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Inga Liepelt-Scarfone
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Walter Maetzler
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
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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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