Objectives; to investigate the effects of 12 weeks of Functional Electrical Stimulation (FES) on various outcome measures in a person with Multiple Sclerosis (PwMS) who uses a 4 wheel rollator for mobility.
Method; this was a single case study conducted in a community setting in Multiple Sclerosis of Ireland in Galway. Inclusion criteria: a PwMS with at least 90 degrees of passive dorsiflexion at the ankle, and the ability to walk at least 25 feet independently or with any type of physio aids (a stick or a rollator). Exclusion criteria: an episode of a relapse in the last 3 months, corticosteroid treatment within 28 days of the start of the study, Fampridine treatment, contra-indications for electrotherapy, recent fractures or ankle joint dislocation and skin sensitivity. Eight week exercise programme consisted of walking with FES for 30 minutes at various walking pace, distance and surfaces, stairs training, stepping over an aerobic step, kicking a football and sit to stand. A PwMS attended two (1-hour) sessions every week, one with a senior physiotherapist and the second with a trained physiotherapy assistant. Bioness L300 plus was used for electrical stimulation. Main Outcome Measures were: Six Minute Walk Test (6MWT) in meters (m), 25 foot walking test (25FWT) in seconds (s) and lower limb (LL) muscle strength using a Hand-held Dynamometer in pounds (Lb). PwMS was assessed at baseline (T1), at 4 weeks (T2) and at 8 weeks (T3). Additionally, follow up assessment at 12 weeks (T4); 4 weeks post FES training termination investigated long term therapeutic effect.
Results; Female, age 57, 18 years since diagnosis, initially relapsing-remitting, now secondary progressive type of MS with the majority of symptoms in the right side of body attended all training sessions and no side effects were reported. For 6MWT, there was a clinically meaningful change of 33.4 meters after 8 weeks of intervention (T1: 106.6m, T3: 140m). At follow up at T4, there was a decrease in distance by 2 meters (T4: 138m) in comparison to T3. For 25FWT there was a decrease in time (-11.98s) at T3 (T1: 25.94s, T3: 13.98s). At T4, there was an increase in time by 3.68s (T4: 17.56s) compared to T3. In comparison to baseline assessment, there were positive changes both in 6MWT and 25FWT at 12 week follow up (31.4 and -8.38 respectively). There was an increase in muscle strength at T3 in all tested joints of LL with the greatest change in right knee flexion, right ankle dorsiflexion and platarflexion (change of 14.05Lb, 12.4Lb and 12.85lb, respectively). At T4, there was a decrease in muscle strength throughout all tested joints however, apart from two tests (left ankle plantar flexion and left knee extension); there was still improvement in muscle strength in comparison to baseline values. It was a single case study, so no means and standard deviations were reported.
Conclusions; FES training was safe and resulted in clinically meaningful change in a long distance test (6MWT) post treatment that was maintained 4 weeks after stopping FES. Improvements in walking speed on short distance (25FWT) and in muscle strength were found after 8 week training and also at 12 week follow up. Additionally to current evidence about the orthotic effect of FES in MS, this case study provides further data about the therapeutic effect of FES.
Ethics Approval; Granted by the Faculty of Education and Health Science Research Ethics Committee, University of Limerick (2013_06_11_EHS).
