A systematic literature review of ankle-foot orthosis and functional electrical stimulation foot-drop treatments for persons with multiple sclerosis

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.

Materials and Manufacturing for Ankle–Foot Orthoses: A Review

“…[70,71] On the other hand, functional electrostimulation (FES) is an effective approach that is occasionally classified as an active AFO due to its role in addressing similar functional impairments and its application as a wearable device. [72] FES is a potential treatment method for foot drop in clinical settings which involves the use of electrical stimulation to activate the muscles responsible for foot dorsiflexion, thus aiding individuals with foot drop in achieving a more natural gait pattern. [73,74] In general, an active AFO is flexible in the sagittal plane, which allows for some dorsiflexion and plantarflexion movement.…”