Functional intermuscular reduction in spasticity for people with multiple sclerosis

Abstract

Background Eighty-five percent of people with multiple sclerosis (MS) incur gait impairments debilitating enough to significantly impact their function. Objectives The aim of this study was to determine if a novel combination of intermuscular electrical stimulation, followed by functional electrical stimulation combined with supported bodyweight treadmill training, would improve gait, decrease spasticity and fatigue, and improve muscle strength. Methods Using a pre-post experimental design, we implemented this combination six-week protocol in 16 individuals with MS. We completed summary statistics and longitudinal pre-post results using Wilcoxon sign rank tests with Bonferroni adjustment. Results Participants responded with median increases of 29.4 feet ( p < 0.0001) during the Six Minute Walk Test, median decreases of 0.7 s ( p = 0.0011) in the 25-Foot Walk Test, median increases of 3.8 toe taps to fatigue ( p = 0.0306) and median increases of 5.0 heel raises ( p = 0.0093). Significant changes were noted in the Modified Ashworth Scale, both after intermuscular electrical stimulation (median change = −0.5 p = 0.0039) and after treadmill walking (median change = −0.5, p < 0.0005). Conclusions Results of this novel protocol suggest this intervention combination has the potential to decrease spasticity, and improve gait speed and endurance in individuals with MS. Observed changes in mobility occurred without accompanying increases in fatigue.

Effectiveness of dry needling on the treatment of patients with multiple sclerosis: systematic review

“…In total, 33 individuals were included in this review, 22 of whom were women. Four studies specified the MS type of the patients [24][25][26][27], while the other studies did not specify MS type. The results of the studies are summarized in Table 1 (study purpose, design and subjects) and Table 2…”

“…The dry needling techniques applied in the studies varied. Two studies used the "fast in-fast out" technique [26,29,30], one study used the "sparrow pecking" technique [28], one study used the intramuscular electrical stimulation technique [27], one study used the neuromodulation technique [25], and in one study no detailed information was given about the dry needling technique [24].…”

“…Pain was evaluated in three studies. Luque-Moreno et al [26] evaluated pain with VAS before, after and during treatment and also evaluated pressure pain threshold with algometer before and after treatment. After treatment, there was a 2 point decrease in pain in the rectus femoris muscle according to VAS, an increase in pain tolerance in the gastrocnemius medialis muscle and a decrease in the rectus femoris muscle in algometer measurements.…”

“…ROM was evaluated in two studies. Luque-Moreno et al [26] evaluated passive ROM of ankle dorsiflexion, knee flexion, hip flexion and extension using a goniometer before and after treatment and found no change except an eight-degree increase in hip extension. McDowell et al [28] reported that the patient's lumbar spine ROM was 25% less before treatment.…”

“…Quality of life was evaluated in two studies. Luque-Moreno et al [26] assessed quality of life with MusiQoL before and after treatment and showed improvement in quality of life. Del Pilar Pérez-Trujillo et al [24] assessed quality of life with the MSQoL-54 before and after treatment and found improvements in quality of life.…”