Journal Club April 2017: Effects of Functional Electrical Stimulation on Reducing Falls and Improving Gait Parameters in Multiple Sclerosis and Stroke

Article: Effects of Functional Electrical Stimulation on Reducing Falls and Improving Gait Parameters in Multiple Sclerosis and Stroke

Authors: Elisa Gervasoni, Riccardo Parelli, Marcin Uszynski, Alessandro Crippa, Alberto Marzegan, Angelo Montesano, Davide Cattaneo

Journal: PM&R Nov 2016. doi: http://dx.doi.org/10.1016/j.pmrj.2016.10.019

Discussion:

Multiple sclerosis and stroke have detrimental effects on patients’ health. In particular neuromuscular control may be impaired from potential damage to the motor cortex or corticospinal tract. These conditions often result in decreased motor control, such as significant weakness at the ankle joint. This results in an inefficient gait pattern and increases the likelihood of falling. Falls in these patients have been associated with fractures, increased care utilization, decreased capacity to perform activities of daily living, and diminished overall quality of life. Ankle foot orthotics have been used to support the ankle joint during the swing phase of the gait cycle, however, functional electrical stimulation (FES) have been developed as an alternative treatment modality to decrease foot drop and improve the gait pattern in these patients.

FES devices utilize low-energy electrical pulses to artificially generate contractions in paralyzed muscles. Prior studies related to FES have demonstrated improved dorsiflexion at the ankle and reduced foot drop, which subsequently improves the quality of the gait; however, little data is available on FES effects on reducing falls, and resultant kinematic changes in the lower extremities related to foot clearance and energy recovery.

This prospective longitudinal study by Gervasoni, et al. investigated the effectiveness of functional electrical stimulation in 24 subjects with known upper motor neuron lesions. The subjects, 10 with multiple sclerosis and 10 with stroke, were followed for 8 weeks and measurements were made via instrumental gait analysis and clinical assessment at baseline, 4 weeks, and at 8 weeks. The main outcomes of this study were to assess: the effectiveness of FES on reducing falls, the effectiveness of FES on improving foot clearance and lower limbs kinematics, and the effectiveness of FES on promoting energy recovery.

The researchers determined that there is indeed an improvement in gait mechanics in the study subjects via increased foot clearance, and a resultant decrease in number of falls after 8 weeks of FES use. In conclusion, FES should be considered by a consulting rehabilitation team in mitigating falls, and their negative sequelae, in multiple sclerosis and stroke patients with motor control impairment in their lower extremities.

Discussion Author: Juan R. Querubin, OMS-III (Lincoln Memorial University – DeBusk College of Osteopathic Medicine)

Discussion Points:

  1. Was the sample size adequate? What are the study’s strengths/weakness?
  2. What are the different disease patterns of progression in multiple sclerosis?
  3. What role does a physiatrist play in the care of patients with multiple sclerosis/ stroke?
  4. What other medical conditions would the application of FES be appropriate for?
  5. Under what circumstance(s) would an ankle foot orthotic (AFO) be a better treatment choice for foot drop as opposed to FES, and vice versa?

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Journal Club Discussion April 2017

Journal Club Article April 2017