BackgroundThis study sought to examine the effect of targeted physical therapy with and without cranial nerve non-invasive neuromodulation (CN-NINM), on the walking ability of people with MS who exhibited a dysfunctional gait. We hypothesized that subjects who received electrical stimulation would have greater improvement than those who had a control device after a 14-week intervention. Gait disturbance is a common problem for people with multiple sclerosis (MS). Current management may include exercise, pharmacology, functional electrical stimulation, compensatory strategies, use of assistive devices, and implanted electrical devices. We have developed an effective rehabilitative strategy using neuromodulation of the cranial nerves via electrical stimulation of the tongue to enhance the plasticity of the brain.MethodsThe study is a within-subject blinded randomized control design. Twenty chronic MS subjects with an identified gait disturbance were assigned to either an active or control group. Both groups completed a 14-week intervention program using a standardized combination of exercise and a device that provided electrical stimulation to the tongue. Those in the active group received electrical stimulation on the tongue that they could perceive. Those in the control group used a device that did not provide a physiologically significant stimulus and was not perceivable. Subjects were assessed with the Dynamic Gait Index (DGI).ResultsThe DGI scores improved for both groups. There were significant between-group differences, with the active group showing statistically greater improvement than the control group mean.ConclusionPeople with MS demonstrated improved gait with CN-NINM training in a pilot randomized controlled trial. This study suggests that tongue-based neurostimulation may amplify the benefits of exercise for improving gait in people with chronic MS.

This article examines the scoring of assistive technology (AT) in health and rehabilitation outcome scales and delineates implications. Searches of MEDLINE, CINAHL, and PsychINFO databases and relevant functional assessment textbooks provided the basis for this investigation of 100 widely used health and rehabilitation outcomes instruments. Each of the 100 instruments was assessed to the nature and degree in which AT was included in the instrument scales, content, and scoring procedures. We classified instruments into categories according to the methods used to consider AT in the scoring. We found that 30% of the instruments ignored AT. When instruments included AT, 44% of the instruments lowered the score, 22% of the instruments allowed AT use for the highest score, and 4% of the instruments provided a mix. Analysis also revealed whether the 100 instruments isolated the effect of AT as a contribution to outcome. The results indicate that rehabilitation and health outcomes instruments inconsistently consider AT as an intervention for people with disabilities. This inconsistency in scoring leads to muddled and potentially invalid assessments of rehabilitation outcomes. Due to the common concurrent use of AT in rehabilitation intervention, if AT use is not documented or controlled within outcomes study research designs or by the instrumentation, the outcomes of any targeted intervention may be confounded by the contribution of AT in the overall assessment of the person's function, participation, or quality of life.

We know that work is recognized as a central component of life for individuals with and without disabilities. It yields many physical and psychological benefits to the individual while simultaneously contributing numerous benefits to society. Lawmakers have enacted a plethora of laws designed to prevent discrimination, provide incentives for employers to hire individuals with disabilities, and facilitate job training/career preparation. Assistive technology figures prominently in disability employment law as a critical strategy for gaining access and supporting employment and upward mobility in the workplace. However, little systematic effort has been devoted to examining assistive technology use and outcomes as they relate to the employment of individuals with disabilities. The purpose of this article is to articulate a series of issues that permeate assistive technology outcome measurement in employment settings and subsequently affect the use of research knowledge for federal and state policy makers. For each issue, the authors pose three questions for critical analysis: Does the law compel the provision of assistive technology? Does outcome data play any part in the operation of the law? When it does, what kind of data would be useful to collect and where could it be found? Finally, the authors provide a brief glimpse of the current and future research efforts concerning the RSA-911 database. The recent database summaries exemplify the importance of such a national data collection system for informing federal policy, particularly concerning the contributions of assistive technology device use and services on improving the employment of individuals with disabilities.

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