title: Effect of wearing a dorsiflexion assist orthosis on mobility, perceived fatigue and exertion during the six-minute walk test in people with multiple sclerosis: a randomised cross-over protocol.
abstract: BACKGROUND
  Fatigue in combination with gait and balance impairments can severely limit daily activities in people with multiple sclerosis (PWMS). Generalised fatigue has a major impact on walking ability, with moderately disabled PWMS experiencing difficulty in walking extended distances. Localised motor fatigue in the ankle dorsiflexors can lead to foot drop, further reducing functional ambulation. The aim of this study is to evaluate the effect of a simple dynamic dorsiflexion assist orthosis on walking-induced fatigue, gait, balance and functional mobility in PWMS.
  
  
  METHODS
  A randomised cross-over trial will be conducted with 40 community dwelling PWMS with mild to moderate mobility disability. Participants will initially be screened for disease severity, balance, strength, depression and fatigue at the South Australian Motion Analysis Centre. On two non-consecutive occasions, within two weeks, participants will undergo either the 6-minute walk test (6MWT) or the 6MWT while wearing a dorsiflexion ankle orthosis (with a randomised condition order). Distance walked, perceived exertion, perceived fatigue and the physiological cost of walking (the primary outcome measures) will be compared between the two walking conditions. Additional pre- and post-6MWT assessments for the two conditions will include tests of strength, reaction time, gait and balance.
  
  
  CONCLUSIONS
  This study will increase our understanding of motor fatigue on gait and balance control in PWMS and elucidate the effect of a Dynamic Ankle Orthosis on fatigue-related balance and gait in PWMS. It will also examine relationships between mobility and balance performance with perceived fatigue levels in this group.
  
  
  BACKGROUND
  ACTRN12612000218897.
authors.affiliation: Flinders University South Australia, GPO Box 2100, Adelaide 5001, Australia. james.mcloughlin@flinders.edu.au
authors.forename: James
authors.initials: J
authors.lastname: McLoughlin
authors.forename: Christopher
authors.initials: C
authors.lastname: Barr
authors.forename: Daina
authors.initials: D
authors.lastname: Sturnieks
authors.forename: Stephen
authors.initials: S
authors.lastname: Lord
authors.forename: Maria
authors.initials: M
authors.lastname: Crotty
mesh_terms: D000293:Adolescent; D000328:Adult; D018592:Cross-Over Studies; D059026:Diagnostic Self Evaluation; D005080:Exercise Test; D017079:Exercise Tolerance; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation*; D009989:Orthotic Devices; D016896:Treatment Outcome; D055815:Young Adult