Functional electrical stimulation for foot drop in people with multiple sclerosis: The relevance and importance of addressing quality of movement

Abstract

Impaired mobility is common in people with multiple sclerosis (MS). Changes in gait have different causes and require individualised gait rehabilitation. A common and often early cause of mobility impairment is footdrop, inability to lift the foot during the swing phase of gait, with increased risk of falls, effortful walking and fatigue. Using literature review, we have characterised published data on footdrop treatment in MS, specifically functional electrical stimulation (FES) to better understand the reported outcomes relevant to the user. We discuss the strengths and weaknesses of FES and how far it meets the needs of people with footdrop. Physiotherapy combined with FES may further enhance the benefits of FES. MS studies emphasise the value of maintaining activity levels in early MS but discussion on how to achieve this is lacking. We emphasise the value of qualitative measures to broaden our understanding and improve treatment and adherence and identify areas for further research. Supplementary video material illustrates key features of MS gait and its correction using FES and physiotherapy.

Is functional electrical stimulation effective in improving walking in adults with lower limb impairment due to an upper motor neuron lesion? An umbrella review

“…A recent narrative review of the use of FES, by Smith et al 56 also concluded that future studies should investigate the impact of FES on a wider range of Patient Reported Outcomes (PROMS) but also use qualitative approaches to capture users' opinions and observed changes in addition to changes in quantitative outcomes. A qualitative study by Wilkinson et al 57 of 20 people less than 6 months post‐stroke explored ‘valued personal’ benefits of FES not measured by walking speed and identified factors such as spontaneity, freedom, automaticity (ability to walk without thinking about it), and self‐determination as important benefits.…”

The assistive potential of functional electrical stimulation to support object manipulation in functional upper extremity movements after stroke: A randomized cross-over study

“…Preliminary results of the application of an assistive robotic glove at home indicated that both the orthotic and the therapeutic use of the glove resulted in comparable gains in UL function. 13 Furthermore, it has been suggested that the orthotic application of FES might play a role in patients’ motivation, 21 which could positively influence motor learning. 22 …”

Effects of brain-computer interface with functional electrical stimulation for gait rehabilitation in multiple sclerosis patients: preliminary findings in gait speed and event-related desynchronization onset latency

“…The functional impairment of major clinical relevance for people with multiple sclerosis (pwMS) is gait disturbance, which is one of the principal reasons for a slow walking speed and it is characterized by muscle weakness, fatigue and an altered gait biomechanics [2,3]. Among the altered biomechanics parameters, there is a limited ankle dorsiflexion during the swing phase of gait due to weakness in the tibialis anterior that leads to foot drop [2,4]. Foot drop has important clinical effects since it is accompanied by an increased risk of falls, decreased level of activity, and constraints on quality of life [4].…”

“…Among the altered biomechanics parameters, there is a limited ankle dorsiflexion during the swing phase of gait due to weakness in the tibialis anterior that leads to foot drop [2,4]. Foot drop has important clinical effects since it is accompanied by an increased risk of falls, decreased level of activity, and constraints on quality of life [4].…”

“…Functional electrical stimulation (FES) has been proposed to manage foot drop in pwMS [5,6]. In this context, FES is usually used to assist foot drop when walking freely by electrically stimulating the common peroneal nerve that elicits the dorsiflexor muscle contraction and lifts the foot during the gait [4]. FES could be considered as a bottom-up rehabilitation approach [7,8].…”