Quantification of gait kinematics and walking ability of people with multiple sclerosis who are new users of functional electrical stimulation

Abstract

The acute application of functional electrical stimulation resulted in an orthotic effect through a change in ankle and knee kinematics and increased walking speed over a short distance in people with multiple sclerosis who experience foot drop.

Orthotic and therapeutic effect of functional electrical stimulation on fatigue induced gait patterns in people with multiple sclerosis

“…When FES is used for the first time these effects have been termed an 'initial orthotic effect" of the stimulation [28]. Recent evidence shows the initial orthotic effects of FES on the gait of people with MS extend to improvements in the overall kinematic pattern of lower limbs during gait [27,29], including increased ankle dorsiflexion during swing [29,30], and at initial foot contact [29][30][31] leading to increases in stride length [29,32]. The maintenance of an orthotic effect with prolonged use of FES has been referred to as a 'continuing orthotic effect' [28].…”

“…Despite the increased interest in the effects of FES on gait in MS [29,30,32], no studies to date have investigated the initial orthotic effect of FES on fatigue induced changes in gait that occur in people with MS [18]. Additionally it remains unclear whether prolonged use of FES delivers continuing orthotic effects and therapeutic effects (i.e.…”

Functional Electrical Stimulation for Foot Drop in Multiple Sclerosis

“…They reduced the time to 3 minutes, but acknowledged that the validity and reliability of the 3-minute walk test were not established. 22 Recently, Scott et al 5 reported no benefit even on the 6MWT with acute application of FES in 12 pwMS who had no prior exposure to FES. Compared with prior research, the participants in this study were not habitual users of FES, postulating that an extended period of FES use might be needed to observe a clinically significant difference in mobility.…”

“…Compared with prior research, the participants in this study were not habitual users of FES, postulating that an extended period of FES use might be needed to observe a clinically significant difference in mobility. 5 Overall, a majority of the studies observing the effects on walking performance have reported orthotic effects, [4][5][6][7][8][9]13,14,16,20,22,24 and in some cases a total orthotic benefit after weeks of FES device use 8,24 with one study noticing this benefit only after 2 weeks. 16 Training effects have been consistently reproduced in nonprogressive neurologic conditions, such as stroke and spinal cord injury populations.…”

“…The orthotic benefit, or "on-off" effect of FES on gait, has been well-documented in the MS population. [3][4][5][6][7][8][9]13,14,16,[20][21][22][23][24] More recently, the term training, or therapeutic, effect has been applied to changes in walking performance after regular, prolonged FES use when gait is evaluated without the device. 14 We will refer to this type of effect as training effect throughout this article.…”