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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Van der Linden ML, Van Schie PEM, Hjalmarsson E, Andreopoulou G, Verheul MHG, Von Walden F. Frame running to confidence: the athlete-perceived impact of an adapted physical activity on aspects of physical fitness, functional mobility and psychosocial outcomes. J Rehabil Med 2022; 54:jrm00273. [PMID: 35019994 PMCID: PMC8902585 DOI: 10.2340/jrm.v53.1393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Frame Running (RaceRunning) allows people with moderate-to-severe mobility impairments to participate in physical activity using a 3-wheeled frame with a saddle and handlebars. The aim of this study was to investigate athlete-perceived impact of Frame Running on aspects of physical fitness, functional mobility and psychosocial outcomes. Design Survey. Participants Frame Running athletes aged 5 years and over. Methods A survey was distributed to athletes through their club or sports organization. Results The survey was completed by 115 athletes (53 females). Median age was 17 years (range 5–62 years) and 64 (57%) used a wheelchair or walker for distances over 50 m. Many felt that Frame Running stretched their muscles (n = 93, 87%) and increased their self-confidence (n = 63, 93%). Four (4%) reported extreme fatigue or sore muscles after training (n = 17, 15%). Of the 110 athletes who had been participating in Frame Running for over 3 months, 46 (47%) reported being less out of breath during mobility tasks and 66 (66%) felt they had improved their functional mobility. However, 7 (7%) reported increased muscle tightness and 4 (4%) reported a Frame Running-related injury lasting more than 4 weeks. Conclusion Frame Running is a safe physical activity with athlete-perceived benefits on physical fitness, functional mobility and psychosocial outcomes.
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Affiliation(s)
- Marietta L Van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, EH21 6UU, UK.
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Andreopoulou G, Mercer TH, Enriquez JG, Justin M, MacLeod N, Harrison E, Mahad DJ, van der Linden ML. Exercise-induced changes in gait kinematics in multiple sclerosis with minimal neurological disability. Mult Scler Relat Disord 2020; 47:102630. [PMID: 33232909 DOI: 10.1016/j.msard.2020.102630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exercise-induced gait deterioration is a frequently encountered symptom that limits ambulation throughout the clinical course, becoming more prominent with increasing neurological disability in people with MS (pwMS). OBJECTIVE We attempted to objectively document exercise-induced gait changes in pwMS with minimal neurological disability and stable disease. METHODS Gait kinematics and spatio-temporal parameters were recorded using 3D motion analysis before and after a 20-minute treadmill walk (Group A, n=15)/run (Group B, n=15) at a self-selected speed in pwMS and compared with healthy controls (n=15). RESULTS Gait analysis revealed a significant decrease in peak ankle dorsiflexion in swing of the most affected leg, post-exercise task, in both Group A (EDSS 2.5-3.5) and Group B (EDSS 1-2.5) and not in healthy controls. Fourteen out of 30 MS participants showed an exercise-induced gait deterioration, based on minimal detectable change. Pre-exercise gait parameters in Group A showed a significantly higher peak dorsiflexion in swing with shorter step length and higher cadence, whereas Group B was comparable to healthy controls. CONCLUSION The detection of exercise-induced gait deterioration (foot drop) in pwMS with minimal neurological disability and stable disease indicates the potential of gait kinematics, before and after an exercise task, to monitor subtle neurological deficits from an early stage of MS.
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Affiliation(s)
- Georgia Andreopoulou
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Musselburgh, UK
| | - Thomas H Mercer
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Musselburgh, UK
| | | | - Matthew Justin
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, UK
| | - Nicola MacLeod
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, UK
| | - Emily Harrison
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, UK
| | - Don J Mahad
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, UK.
| | - Marietta L van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Musselburgh, UK.
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Ryan J, Theis N, Koufaki P, Phillips S, Anokye N, Andreopoulou G, Kennedy F, Jagadamma KC, vanSchie P, Dines H, van der Linden ML. Effect of RaceRunning on cardiometabolic disease risk factors and functional mobility in young people with moderate-to-severe cerebral palsy: protocol for a feasibility study. BMJ Open 2020; 10:e036469. [PMID: 32611743 PMCID: PMC7332180 DOI: 10.1136/bmjopen-2019-036469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION There is consistent evidence that people with cerebral palsy (CP) do not engage in the recommended physical activity guidelines for the general population from a young age. Participation in moderate-to-vigorous physical activity is particularly reduced in people with CP who have a moderate-to-severe disability. RaceRunning is a growing disability sport that provides an opportunity for people with moderate-to-severe disability to participate in physical activity in the community. It allows those who are unable to walk independently to propel themselves using a RaceRunning bike, which has a breastplate for support but no pedals. The aim of this study is to examine the feasibility and acceptability of RaceRunning for young people with moderate-to-severe CP and the feasibility of conducting a definitive study of the effect of RaceRunning on cardiometabolic disease risk factors and functional mobility. METHODS AND ANALYSIS Twenty-five young people (age 5-21 years) with CP or acquired brain injury affecting coordination will be included in this single-arm intervention study. Participants will take part in one RaceRunning session each week for 24 weeks. Outcomes assessed at baseline, 12 and 24 weeks include body mass index, waist circumference, blood pressure, muscle strength, cardiorespiratory fitness, physical activity and sedentary behaviour, functional mobility, activity competence and psychosocial impact. Adverse events will be systematically recorded throughout the 24 weeks. Focus groups will be conducted with participants and/or parents to explore their views and experiences of taking part in RaceRunning. ETHICS AND DISSEMINATION Approval has been granted by Queen Margaret University Research Ethics Committee (REC) and the South East of Scotland REC. Results will be disseminated through peer-reviewed journals and distributed to people with CP and their families through RaceRunning and Athletic Clubs, National Health Service trusts and organisations for people with disabilities. TRIAL REGISTRATION NUMBER NCT04034342; pre-results.
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Affiliation(s)
- Jennifer Ryan
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Cheltenham, Gloucestershire, UK
| | - Pelagia Koufaki
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Shaun Phillips
- Institute for Sport, Physical Education and Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Nana Anokye
- Health Economics Research Group, Brunel University, London, Middlesex, UK
| | - Georgia Andreopoulou
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Fiona Kennedy
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Kavi C Jagadamma
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Petra vanSchie
- Department of Rehabilitation Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Hannah Dines
- Department of Exercise and Sports Science, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Marietta L van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
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Andreopoulou G, Mercer TH, van der Linden ML. Walking measures to evaluate assistive technology for foot drop in multiple sclerosis: A systematic review of psychometric properties. Gait Posture 2018; 61:55-66. [PMID: 29304511 DOI: 10.1016/j.gaitpost.2017.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Foot drop in people with multiple sclerosis (pwMS) often managed with assistive technologies, such as functional electrical stimulation and ankle foot orthoses. No evidence synthesis exists for the psychometric properties of outcomes used to evaluate the efficacy of these interventions. OBJECTIVE This systematic review aimed to identify the outcome measures reported to assess the benefits of assistive technology for pwMS and then synthesize the psychometric evidence in pwMS for a subset of these measures. METHODS Two searches in eight databases were conducted up to May 2017. Methodological quality was rated using the COSMIN guidelines. Overall level of evidence was scored according to the Cochrane criteria. RESULTS The first search identified 27 measures, with the 10 m walk test, gait kinematics and Physiological Cost Index (PCI) most frequently used. The second search resulted in 41 studies evaluating 10 measures related to walking performance. Strong levels of evidence were found for the internal consistency and test-retest reliability of the Multiple Sclerosis Walking Scale-12 and for the construct validity for Timed 25 Foot Walk. No psychometric studies were identified for gait kinematics and PCI in pwMS. There was a lack of evidence for measurement error and responsiveness. CONCLUSION Although a strong level of evidence exists for some measures included in this review, there was an absence of psychometric studies on commonly used measures such as gait kinematics. Future psychometric studies should evaluate a wider range of walking related measures used to assess the efficacy of interventions to treat foot drop in pwMS.
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Affiliation(s)
- Georgia Andreopoulou
- Centre for Health Activity and Rehabilitation Research,Queen Margaret University, Edinburgh, EH21 6UU, Scotland, UK.
| | - Thomas H Mercer
- Centre for Health Activity and Rehabilitation Research,Queen Margaret University, Edinburgh, EH21 6UU, Scotland, UK.
| | - Marietta L van der Linden
- Centre for Health Activity and Rehabilitation Research,Queen Margaret University, Edinburgh, EH21 6UU, Scotland, UK.
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Andreopoulou G, Maaswinkel E, Cofré Lizama LE, van Dieën JH. Effects of support surface stability on feedback control of trunk posture. Exp Brain Res 2014; 233:1079-87. [PMID: 25537472 DOI: 10.1007/s00221-014-4185-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Abstract
This study aimed to examine the interactions of visual, vestibular, proprioceptive, and tactile sensory manipulations and sitting on either a stable or an unstable surface on mediolateral (ML) trunk sway. Fifteen individuals were measured. In each trial, subjects sat as quiet as possible, on a stable or unstable surface, with or without each of four sensory manipulations: visual (eyes open/closed), vestibular (left and right galvanic vestibular stimulation alternating at 0.25 Hz), proprioceptive (left and right paraspinal muscle vibration alternating at 0.25 Hz), and tactile (minimal finger contact with object moving in the frontal plane at 0.25 Hz). The root mean square (RMS) and the power at 0.25 Hz (P25) of the ML trunk acceleration were the dependent variables. The latter was analyzed only for the rhythmic sensory manipulations and the reference condition. RMS was always significantly larger on the unstable than the stable surface. Closing the eyes caused a significant increase in RMS, more so on the unstable surface. Vestibular stimulation significantly increased RMS and P25 and more so on the unstable surface. Main effects of the proprioceptive manipulation were significant, but the interactions with surface condition were not. Finally, also tactile manipulation increased RMS and P25, but did not interact with surface condition. Sensory information in feedback control of trunk posture appears to be reweighted depending on stability of the environment. The absolute effects of visual and vestibular manipulations increase on an unstable surface, suggesting a relative decrease in the weights of proprioceptive and tactile information.
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Affiliation(s)
- Georgia Andreopoulou
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands
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