Functional intermuscular reduction in spasticity for people with multiple sclerosis

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.

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Web-based physiotherapy for people affected by multiple sclerosis: a single blind, randomized controlled feasibility study

Clinical Rehabilitation ◽

10.1177/0269215518817080 ◽

2018 ◽

Vol 33 (3) ◽

pp. 473-484 ◽

Cited By ~ 10

Author(s):

Lorna Paul ◽

Linda Renfrew ◽

Jennifer Freeman ◽

Heather Murray ◽

Belinda Weller ◽

...

Keyword(s):

Multiple Sclerosis ◽

Outcome Measures ◽

Exercise Programme ◽

Home Exercise ◽

Walk Test ◽

Web Based ◽

Randomized Controlled ◽

Home Exercise Programme ◽

Minute Walk ◽

Over Time

Objective: To examine the feasibility of a trial to evaluate web-based physiotherapy compared to a standard home exercise programme in people with multiple sclerosis. Design: Multi-centre, randomized controlled, feasibility study. Setting: Three multiple sclerosis out-patient centres. Participants: A total of 90 people with multiple sclerosis (Expanded Disability Status Scale 4–6.5). Interventions: Participants were randomized to a six-month individualized, home exercise programme delivered via web-based physiotherapy ( n = 45; intervention) or a sheet of exercises ( n = 45; active comparator). Outcome measures: Outcome measures (0, three, six and nine months) included adherence, two-minute walk test, 25 foot walk, Berg Balance Scale, physical activity and healthcare resource use. Interviews were undertaken with 24 participants and 3 physiotherapists. Results: Almost 25% of people approached agreed to take part. No intervention-related adverse events were recorded. Adherence was 40%–63% and 53%–71% in the intervention and comparator groups. There was no difference in the two-minute walk test between groups at baseline (Intervention-80.4(33.91)m, Comparator-70.6(31.20)m) and no change over time (at six-month Intervention-81.6(32.75)m, Comparator-74.8(36.16)m. There were no significant changes over time in other outcome measures except the EuroQol-5 Dimension at six months which decreased in the active comparator group. For a difference of 8(17.4)m in two-minute walk test between groups, 76 participants/group would be required (80% power, P > 0.05) for a future randomized controlled trial. Conclusion: No changes were found in the majority of outcome measures over time. This study was acceptable and feasible by participants and physiotherapists. An adequately powered study needs 160 participants.

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Fatigue-induced alterations of gait in Multiple Sclerosis through an instrumented 6-Minute Walk Test: A pilot study

Gait & Posture ◽

10.1016/j.gaitpost.2018.07.113 ◽

2018 ◽

Vol 66 ◽

pp. S8-S9

Author(s):

I. Carpinella ◽

E. Gervasoni ◽

D. Anastasi ◽

M. Ferrarin ◽

D. Cattaneo

Keyword(s):

Multiple Sclerosis ◽

Pilot Study ◽

Walk Test ◽

6 Minute Walk Test ◽

Minute Walk

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Functional electrical stimulation for equine epaxial muscle spasms: retrospective study of 241 clinical cases

Comparative Exercise Physiology ◽

10.3920/cep13031 ◽

2014 ◽

Vol 10 (2) ◽

pp. 89-97 ◽

Cited By ~ 6

Author(s):

S.J. Schils ◽

T.A. Turner

Keyword(s):

Electrical Stimulation ◽

Retrospective Study ◽

Functional Electrical Stimulation ◽

Sustained Improvement ◽

Modified Ashworth Scale ◽

Muscle Spasms ◽

Ashworth Scale ◽

Epaxial Muscle ◽

Clinical Cases

A retrospective study of 241 clinical cases, utilising over 1,800 functional electrical stimulation (FES) treatments to alleviate epaxial muscle spasms, showed that almost 80% (191) of the horses had a 1-grade improvement in muscle spasms after 2 FES treatments, based on the Modified Ashworth Scale adapted to horses. In addition, 60% (142) of these horses showed a sustained improvement for a minimum of 2 months.

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Gait asymmetry, and bilateral coordination of gait during a six-minute walk test in persons with multiple sclerosis

Scientific Reports ◽

10.1038/s41598-020-68263-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Meir Plotnik ◽

Joanne M. Wagner ◽

Gautam Adusumilli ◽

Amihai Gottlieb ◽

Robert T. Naismith

Keyword(s):

Multiple Sclerosis ◽

Walk Test ◽

Bilateral Coordination ◽

Six Minute Walk Test ◽

Gait Asymmetry ◽

Minute Walk

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The Effects of Exercise and Copaxone on Six Minute Walk Test in Persons with Multiple Sclerosis: A Pilot Study (P01.148)

Neurology ◽

10.1212/wnl.78.1_meetingabstracts.p01.148 ◽

2012 ◽

Vol 78 (Meeting Abstracts 1) ◽

pp. P01.148-P01.148

Author(s):

S. Khurana ◽

L. Brooks ◽

A. Beranger ◽

A. Dominguez ◽

J. Moore

Keyword(s):

Multiple Sclerosis ◽

Pilot Study ◽

Walk Test ◽

Six Minute Walk Test ◽

Minute Walk

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The Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Multiple Sclerosis Patients: A Pilot Study

Neurorehabilitation and Neural Repair ◽

10.1177/0888439003017002001 ◽

2003 ◽

Vol 17 (2) ◽

pp. 79-82 ◽

Cited By ~ 30

Author(s):

Kadriye Armutlu ◽

Aydin Meriç ◽

Nuray Kirdi ◽

Edibe Yakut ◽

Rana Karabudak

Keyword(s):

Multiple Sclerosis ◽

Nerve Stimulation ◽

Transcutaneous Electrical Nerve Stimulation ◽

Muscle Relaxation ◽

Myoelectric Activity ◽

Electrical Nerve Stimulation ◽

Modified Ashworth Scale ◽

Before And After ◽

Multiple Sclerosis Patients ◽

Ashworth Scale

The aim of this study was to examine the effects of transcutaneous electrical nerve stimulation on spasticity in patients with multiple sclerosis. The study was carried out in the Hacettepe University School of Physical Therapy and Rehabilitation. The subjects in the study were 10 clinically definite, primary and secondary progressive type multiple sclerosis outpatients with mild to moderate spasticity in the plantar flexor muscles of the ankle. Stimuli of frequency 100 Hz and pulse width 0.3 msec were used 20 minutes per day for 4 weeks. Patients were assessed by electromyography, Modified Ashworth Scale, and Ambulation Index. Electromyography was performed before and after the daily treatment of spastic muscles with transcutaneous electrical nerve stimulation in order to assess the effect on muscle relaxation. The Modified Ashworth Scale and Ambulation Index were used before and after 4 weeks' treatment. After 4 weeks of treatment, there were statistically significant reductions in spasticity of both extremities as assessed by myoelectric activity and the Modified Ashworth Scale (P < 0.05). Ambulation Index level was not improved significantly)P > 0.05).

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Reliability and Validity of the 5-Minute Walk Test in Individuals with Multiple Sclerosis.

Neurology Report ◽

10.1097/01253086-199721050-00038 ◽

1997 ◽

Vol 21 (5) ◽

pp. 180-181

Author(s):

K Duey ◽

D Wynn ◽

D Fry-Welch ◽

C. Pfalzer

Keyword(s):

Multiple Sclerosis ◽

Reliability And Validity ◽

Walk Test ◽

Minute Walk

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Six-Minute Walk Test for Persons with Mild or Moderate Disability from Multiple Sclerosis: Performance and Explanatory Factors

Physiotherapy Canada ◽

10.3138/ptc.2009-62 ◽

2011 ◽

Vol 63 (2) ◽

pp. 166-180 ◽

Cited By ~ 38

Author(s):

Jane L. Wetzel ◽

Donna K. Fry ◽

Lucinda A. Pfalzer

Keyword(s):

Multiple Sclerosis ◽

Walk Test ◽

Six Minute Walk Test ◽

Explanatory Factors ◽

Minute Walk

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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

BMC Neurology ◽

10.1186/1471-2377-12-27 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 8

Author(s):

James McLoughlin ◽

Christopher Barr ◽

Daina Sturnieks ◽

Stephen Lord ◽

Maria Crotty

Keyword(s):

Multiple Sclerosis ◽

Walk Test ◽

Six Minute Walk Test ◽

Minute Walk

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Validation of the 2-Minute Walk Test with the 6-Minute Walk Test and Other Functional Measures in Persons with Multiple Sclerosis

International Journal of MS Care ◽

10.7224/1537-2073.2017-046 ◽

2018 ◽

Vol 20 (4) ◽

pp. 158-163 ◽

Cited By ~ 14

Author(s):

David A. Scalzitti ◽

Kenneth J. Harwood ◽

Joyce R. Maring ◽

Susan J. Leach ◽

Elizabeth A. Ruckert ◽

...

Keyword(s):

Multiple Sclerosis ◽

Gait Speed ◽

Discriminant Validity ◽

Alternative Measure ◽

Walk Test ◽

Timed Up And Go ◽

Cross Sectional ◽

Functional Measures ◽

6 Minute Walk Test ◽

Minute Walk

Abstract Background: Persons with multiple sclerosis (MS) commonly have difficulty walking. The 6-Minute Walk Test (6MWT) assesses functional capacity but may be considered burdensome for persons with MS, especially those with higher disability levels. The 2-Minute Walk Test (2MWT) may be an alternative measure to the 6MWT. The purpose of this study was to investigate the validity of the 2MWT in persons with MS. Methods: Twenty-eight ambulatory persons with MS aged 18 to 64 years participated in this cross-sectional study. Participants completed five measures of walking performance (2MWT, 6MWT, usual and fast gait speed, and Timed Up and Go test) and two functional measures (Berg Balance Scale and five-times sit-to-stand test) during a testing session. Participants were classified into two subgroups based on Disease Steps scale classification. Results: The 2MWT was significantly correlated with the 6MWT (r = 0.947), usual gait speed (r = 0.920), fast gait speed (r = 0.942), the Timed Up and Go test (r = −0.911), and other functional measures. The 2MWT explained 89% of the variance seen during the 6MWT. The distances completed on the 2MWT and 6MWT accurately distinguished the subgroups. Conclusions: This study demonstrated good construct and discriminant validity of the 2MWT in persons with MS, providing an efficient and practical alternative to the 6MWT. Validation of the 2MWT with other functional measures further supports these findings.

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