title: Dorsiflexion assist orthosis reduces the physiological cost and mitigates deterioration in strength and balance associated with walking in people with multiple sclerosis.
abstract: OBJECTIVE
  To evaluate the effect of wearing a dorsiflexion assist orthosis (DAO) on walking distance, physiological cost, fatigue, and strength and balance measures after a modified 6-minute walk test (6MWT) in people with multiple sclerosis (MS).
  
  
  METHODS
  Randomized crossover trial.
  
  
  METHODS
  Hospital Movement Laboratory.
  
  
  METHODS
  People with moderate MS and Expanded Disability Status Scale score of 3.7±0.7 (N=34; 26 women).
  
  
  METHODS
  Modified 6MWT with and without a DAO worn on the weaker leg.
  
  
  METHODS
  Distance walked, perceived fatigue, and the physiological cost of walking were compared between walking conditions. Pre- and postwalk changes in knee extensor and ankle dorsiflexor isometric strength and standing postural sway with eyes open and closed were compared between walking conditions.
  
  
  RESULTS
  There were no differences in distance walked or perceived fatigue between the 2 walking conditions. However, there was a reduced physiological cost of walking (P<.05), a smaller reduction in knee extensor strength (P<.05), and a smaller increase in standing postural sway with eyes open (P<.01) after walking while wearing the DAO compared with walking without wearing the DAO.
  
  
  CONCLUSIONS
  Despite not increasing walking distance or reducing perceived fatigue, the DAO reduced the physiological cost of walking and maintained knee strength and standing balance, which may have important implications for physical rehabilitation in people with MS. Further trials are required to determine whether the beneficial effects of wearing a DAO found here are maintained for longer periods.
authors.affiliation: Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia; University of New South Wales, Sydney, New South Wales, Australia. Electronic address: james.mcloughlin@flinders.edu.au.
authors.forename: James V
authors.initials: JV
authors.lastname: McLoughlin
authors.affiliation: University of New South Wales, Sydney, New South Wales, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
authors.affiliation: Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Barr
authors.affiliation: Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: Crotty
authors.affiliation: University of New South Wales, Sydney, New South Wales, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia.
authors.forename: Daina L
authors.initials: DL
authors.lastname: Sturnieks
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000502:physiology; D018592:Cross-Over Studies; D005080:Exercise Test; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation*; D053580:Muscle Strength / Q000502:physiology; D018908:Muscle Weakness / Q000209:etiology / Q000534:rehabilitation; D018482:Muscle, Skeletal / Q000503:physiopathology; D009989:Orthotic Devices; D005082:Physical Exertion / Q000502:physiology*; D004856:Postural Balance / Q000502:physiology; D016138:Walking / Q000502:physiology*
keywords: Fatigue; Multiple sclerosis; Muscle strength; Orthotic devices; Postural balance; Rehabilitation