Effects of Functional Electrical Stimulation on Reducing Falls and Improving Gait Parameters in Multiple Sclerosis and Stroke.
BACKGROUND
Loss of neuromuscular control of the ankle joint is a common impairment in neurologic conditions, leading to abnormal gait and a greater risk of falling. Limited information, however, is available on the effectiveness of functional electrical stimulation (FES) on reducing falls, and no studies have investigated its usefulness in improving lower limbs kinematics related to foot clearance and energy recovery.


METHODS
Clinical setting.


METHODS
Prospective longitudinal study.


METHODS
Twenty-four subjects, 14 people with multiple sclerosis (mean age ± standard deviation 50.93 ± 8.72 years) and 10 people with stroke (55.38 ± 14.55 years).


METHODS
The number of falls was assessed at baseline and after 8 weeks, and a clinical assessment was performed at the baseline, 4-week, and 8-week time points. A subsample of the 24 subjects comprising 5 people with multiple sclerosis and 5 people with stroke performed a gait analysis assessment at baseline and after 4 weeks. After receiving the equipment and the training schedule, subjects performed daily home walking training using FES for 8 weeks.


METHODS
The main outcomes were (1) the number of falls, (2) foot clearance, and (3) energy recovery.


RESULTS
A reduction in the number of falls was observed from baseline (n = 10) to the 8-week assessment (n = 2), P = .02. Foot clearance increased (+5.26 mm, P = .04) between the baseline without FES and at 4 weeks with FES (total effect). No statistically significant differences were found in energy recovery between baseline and 4 weeks.


CONCLUSIONS
The use of FES had an impact on gait, specifically reducing the number of falls and improving walking. A specific effect at the ankle joint was observed, increasing foot clearance during the swing phase of gait. This effect was not accompanied with a reduction in the energetic expenditure during walking in subjects with multiple sclerosis and stroke.
LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(∗).
Elisa
E
Gervasoni
LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(†).
Riccardo
R
Parelli
Multiple Sclerosis of Ireland, Western Regional Office, Galway, Ireland(‡).
Marcin
M
Uszynski
LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, and SaFLo: Gait Analysis Laboratory, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(§).
Alessandro
A
Crippa
SaFLo: Gait Analysis Laboratory, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(¶).
Alberto
A
Marzegan
LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(#).
Angelo
A
Montesano
LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Capecelatro 66 - 20148 Milano, Italy(∗∗). Electronic address: dcattaneo@dongnocchi.it.
Davide
D
Cattaneo
D000058:Accidental Falls / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation*; D004856:Postural Balance / Q000502:physiology; D011379:Prognosis; D011446:Prospective Studies; D011597:Psychomotor Performance; D016059:Range of Motion, Articular / Q000502:physiology; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology; D000071939:Stroke Rehabilitation / Q000379:methods; D016896:Treatment Outcome