Habitual functional electrical stimulation therapy improves gait kinematics and walking performance, but not patient-reported functional outcomes, of people with multiple sclerosis who present with foot-drop

Marietta L van der Linden, Julie E Hooper, Paula Cowan, Belinda B Weller, Thomas H Mercer, Marietta L van der Linden, Julie E Hooper, Paula Cowan, Belinda B Weller, Thomas H Mercer

Abstract

Background: People with Multiple Sclerosis (pwMS) often experience a disturbed gait function such as foot-drop. The objective of this pilot study was to investigate the medium term effects of using Functional Electrical Stimulation (FES) to treat foot-drop over a period 12 weeks on gait and patient reported outcomes of pwMS.

Methods and findings: Nine pwMS aged 35 to 64 (2 males, 7 females) were assessed on four occasions; four weeks before baseline, at baseline and after six weeks and twelve weeks of FES use. Joint kinematics and performance on the 10 meter and 2 minute walk tests (10WT, 2 minWT) were assessed with and without FES. Participants also completed the MS walking Scale (MSWS), MS impact scale (MSIS29), Fatigue Severity Score (FSS) and wore an activity monitor for seven days after each assessment. Compared to unassisted walking, FES resulted in statistically significant improvements in peak dorsiflexion in swing (p = 0.006), 10MWT (p = 0.006) and 2 minWT (p = 0.002). Effect sizes for the training effect, defined as the change from unassisted walking at baseline to that at 12 weeks, indicated improved ankle angle at initial contact (2.6°, 95% CI -1° to 4°, d = 0.78), and a decrease in perceived exertion over the 2 min walking tests (-1.2 points, 95% CI -5.7 to 3.4, d = -0.86). Five participants exceeded the Minimally Detectable Change (MDC) for a training effect on the 10mWT, but only two did so for the 2 minWT. No effects of the use of FES for 12 weeks were found for MSWS, MSIS29, FSS or step count.

Conclusion: Although FES to treat foot-drop appears to offer the potential for a medium term training effect on ankle kinematics and walking speed, this was not reflected in the patient reported outcomes. This observed lack of relationship between objective walking performance and patient reported outcomes warrants further investigation.

Trial registration: ClinicalTrials.gov NCT01977287.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. CONSORT diagram.
Figure 1. CONSORT diagram.
Figure 2. Individual change scores from baseline…
Figure 2. Individual change scores from baseline for MSWS at 6 and 12 weeks.
Broken line: Levels of Minimally Detectable Change (MDC) for negative change (indicates improvement) and positive change (indicates deterioration).

References

    1. Freal JE, Kraft GH, Coryell JK (1984) Symptomatic fatigue in multiple sclerosis. Arch Phys Med Rehabil 65: 135–8.
    1. Crayton HJ, Rossman HS (2006) Managing the symptoms of multiple sclerosis: A multimodal approach. Clin Ther 28: 445–460.
    1. Heesen C, Böhm J, Reich C, Kasper J, Goebel M, Gold SM (2008) Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable. Mult Scler 14: 988–91.
    1. Benedetti MG, Piperno R, Simoncini L, Bonato P, Tonini A, et al. (1999) Gait abnormalities in minimally impaired multiple sclerosis patients. Mult Scler 5: 363–8.
    1. Martin CL, Phillips BA, Kilpatrick TJ, Butzkueven H, Tubridy N, et al. (2006) Gait and balance impairment in early multiple sclerosis in the absence of clinical disability. Mult Scler 12 620–8.
    1. Scott SM, van der Linden ML, Hooper JE, Cowan P, Mercer TH (2013) Quantification of gait kinematics and walking ability of people with multiple sclerosis who are new users of functional electrical stimulation. J Rehabil Med 45: 364–9.
    1. Gunn H, Creanor S, Haas B, Marsden J, Freeman J (1984) Frequency, characteristics, and consequences of falls in multiple sclerosis: findings from a cohort study. Arch Phys Med Rehabil 95: 538–45.
    1. Horsley W (2012) Orthotic functional electrical stimulation for drop foot of neurological origin. NHS North East Treatment Advisory Group. Available: Accessed 2013 September 1.
    1. Stein RB, Everaert DG, Thompson AK, Su LC, Whittaker M, et al. (2010) Long-term therapeutic and orthotic effects of a foot drop stimulator on walking performance in progressive and nonprogressive neurological disorders. Neurorehabil Neural Repair 24: 152–167.
    1. Paul L, Rafferty D, Young S, Miller L, Mattison P, et al. (2008) The effect of functional electrical stimulation on the physiological cost of gait in people with multiple sclerosis. Mult Scler 14: 954–961.
    1. Taylor PN, Burridge JH, Dunkerley AL, Wood DE, Norton JA, et al. (1999) Clinical use of the odstock dropped foot stimulator: Its effect on the speed and effort of walking. Arch Phys Med Rehabil 80: 1577–1583.
    1. Taylor P, Humphreys L, Swain I (2013) The long-term cost-effectiveness of the use of Functional Electrical Stimulation for the correction of dropped foot due to upper motor neuron lesion. J Rehabil Med. 45: 154–60.
    1. Taylor P, Barrett C, Mann G, Wareham W, Swain I (2014) A feasibility study to investigate the effect of functional electrical stimulation and physiotherapy exercise on the quality of gait of people with Multiple Sclerosis. Neuromodulation 17: 75–84.
    1. Sheffler LR, Hennessey MT, Knutson JS, Chae J (2009) Neuroprosthetic effect of peroneal nerve stimulation in multiple sclerosis: a preliminary study. Arch Phys Med Rehabil 90: 362–5.
    1. Bulley C, Shiels J, Wilkie K, Salisbury L (2011) User experiences, preferences and choices relating to functional electrical stimulation and ankle foot orthoses for foot-drop after stroke. Physiotherapy 97: 226–233.
    1. Barrett CL, Mann GE, Taylor PN, Strike P (2009) A randomized trial to investigate the effects of functional electrical stimulation and therapeutic exercise on walking performance for people with multiple sclerosis. Mult Scler 15: 493–504.
    1. Esnouf JE, Taylor PN, Mann GE, Barrett CL (2010) Impact on activities of daily living using a functional electrical stimulation device to improve dropped foot in people with multiple sclerosis, measured by the Canadian Occupational Performance Measure. Mult Scler 16: 1141–7.
    1. Polman CH, Reingold SC, Edan G, Filippi M, Hartung HP, et al. (2005) “Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Ann Neurol 58: 840–6.
    1. Rossier P, Wade DT (2001) Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment. Arch Phys Med Rehabil 82: 9–13.
    1. Gijbels D, Eijnde B, Feys P (2011) Comparison of the 2- and 6-minute walk test in multiple sclerosis. Mult Scler 17: 1269–1272.
    1. Feys P, Bibby B, Romberg A, Santoyo C, Gebara B, et al. (2014) Within-day variability on short and long walking tests in persons with multiple sclerosis. J Neurol Sci 338: 183–7.
    1. Borg G (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exer 14: 377–81.
    1. Kadaba MP, Ramakrishnan HK, Wootten ME (1990) Measurement of lower extremity kinematics during level walking. J Orthop Res 8: 383–392.
    1. Dahlgren G, Carlsson D, Moorhead A, Häger-Ross C, McDonough SM (2010) Test-retest reliability of step counts with the ActivPAL device in common daily activities. Gait Posture 32: 386–90.
    1. Hobart J, Lamping D, Fitzpatrick R, Riazi A, Thompson A (2000) The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure. Brain 124: 962–973.
    1. Krupp LB, Muir-Nash LN, Steinberg AD (1989) The Fatigue Severity Scale. Arch Neurol 46: 1121–1123.
    1. Hobart JC, Riazi A, Lamping DL, Fitzpatrick R, Thompson AJ (2003) Measuring the impact of MS on walking ability: the 12-item MS Walking Scale (MSWS-12). Neurology 60: 31–6.
    1. Learmonth YC, Dlugonski D, Pilutti LA, Sandroff BM, Klaren R, et al. (2013) Psychometric properties of the Fatigue Severity Scale and the Modified Fatigue Impact Scale. J Neurol Sci 331: 102–7.
    1. Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates 567.
    1. van der Linden ML, Hazlewood ME, Hillman SJ, Robb JE (2008) Functional electrical stimulation to the dorsiflexors and quadriceps in children with cerebral palsy. Pediatr Phys Ther 20: 23–9.
    1. Winter DA (1992) Foot trajectory in human gait: a precise and multifactorial motor control task. Phys Ther 72: 45–66.
    1. Perry J, Garrett M, Gronley JK, Mulroy SJ (1995) Classification of walking handicap in the stroke population. Stroke 26: 982–989.
    1. Barrett C, Taylor P (2010) The effects of the Odstock drop foot stimulator on perceived quality of life for people with stroke and multiple sclerosis. Neuromodulation 13: 58–64.
    1. McGinley JL, Baker R, Wolfe R, Morris ME (2009) The reliability of three-dimensional kinematic gait measurements: a systematic review. Gait Posture 29: 360–9.

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