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MS research update - Foot drop in MS: Experiences of using functional electrical stimulation (FES) or orthotic devices - 20 May 2014

Summary

Foot drop is a symptom experienced by some people with multiple sclerosis. It is caused by a disruption in the nerve pathway to and from the brain, which results in an inability to lift the foot and toes properly when walking. To improve walking and reduce the risk of trips or falls, foot drop can be treated using two types of device. Functional electrical stimulation (FES) uses small electrical charges to force the foot into a more natural position for walking. An ankle-foot orthoses (AFO) is a device made of plastic or carbon fibre that holds the foot and ankle in a correct position during walking.

This study aimed to explore the experiences and satisfaction with FES and AFO in people with MS who had foot drop.

10 participants took part in the study and were split into two groups, the first group was made up of people using FES (six participants) and the second used AFO (four participants). The groups were questioned and encouraged to discuss their experiences of using the devices.

A similar number of positive and negative aspects were described for FES and AFO. In both groups the participants said that their device had reduced their fatigue, improved their gait (the pattern of walking), reduced trips and falls and increased their confidence. The negative aspects mentioned by both groups included the implications for shoes and clothing, for example users had found it difficult to concealtheir device under their clothes for social occasions.

In conclusion both groups considered that the benefits to them from wearing the device were more important and outweighed any problems.

This study highlights the importance of a health professional taking the individual's experiences and preferences into account, when selecting and prescribing a device to manage foot drop.

Background

Foot drop is a symptom experienced by some people with multiple sclerosis. It is caused by a disruption in the nerve pathway to and from the brain, which results in an inability to lift the foot and toes properly when walking. To improve walking and reduce the risk of trips or falls, foot drop can be treated using two types of device. Functional electrical stimulation (FES) uses small electrical charges to the leg nerves and muscles to force the foot into a more natural position for walking. An ankle-foot orthoses (AFO) is a device made of plastic or carbon fibre that holds the foot and ankle in a correct position to prevent the foot from dropping down during walking.

Previous research has looked at the effect of FES and AFO on walking ability, but there has been little work done to compare FES with AFO in people with MS and to investigate user satisfaction with these devices

This study aimed to explore the experiences with FES and AFO in people with MS who had foot drop.

How this study was carried out

The researchers had performed two previous studies on the effectiveness of FES and AFO in people with MS, they invited people who had taken part in these studies to be part of this study and discuss their experiences.

10 participants took part in the study. Seven were female and three were male and all were aged between 36 and 59. The participants were split into two groups, the first group was made up of people using FES (six participants) and the second used AFO (four participants). The group discussions were conducted in a private meeting room at Queen Margaret University, Edinburgh.

The groups were questioned and encouraged to discuss their experiences of using the devices. This included the timeliness of receiving it, any changes in their life since they had starting to use the device that may have affected its use and their views on the impact that the device had.

The answers given during the discussion were examined and general themes and opinions were identified.

What was found

A similar number of positive and negative aspects were described for FES and AFO. In both groups the participants said that their device had reduced their fatigue, improved their gait (the pattern of walking), reduced trips and falls and increased their confidence. The group that used AFO also reported that the device had given them better balance and stability. The group using FES said they were able to walk further and had better levels of fitness and physical activity, since using the device.

The negative aspects mentioned by both groups included the implications for shoes and clothing, for example users had found it difficult to conceal their device under their clothes for social occasions. AFO users also described trouble walking normally while using their device, possibly due to the more rigid design. FES users described having difficulties in positioning the electrodes and also with the cost of the device and its replacement parts.

In conclusion both groups considered that the benefits outweighed the problems with each device. This was described as a trade-off, the participants were willing to put up with or get used to, some of the negatives, as the benefits to them from wearing the device were more important to them.

What does it mean?

This study highlights the importance of a health professional taking the individual's experiences and preferences into account, when selecting and prescribing a device to manage foot drop. It is suggested that greater understanding of user preferences may mean that the device is used and is effective for a long time, as the health professional can provide the most suitable device for that person.

As the group in this study was small and only focused on people who had continued to use their device, the authors conclude that further studies are needed. These studies should compare FES and AFO use and follow up those that do and do not choose to continue using their device for managing their foot drop.

Bulley C, Mercer TH, Hooper JE , et al.
Experiences of functional electrical stimulation (FES) and ankle foot orthoses (AFOs) for foot-drop in people with multiple sclerosis..
Disabil Rehabil Assist Technol. 2014 May 6. [Epub ahead of print]
abstract

More about foot drop

Foot drop is a symptom experienced by some people with multiple sclerosis. It is caused by a disruption in the nerve pathway to and from the brain, which causes an inability to lift the foot and toes properly when walking. As the foot drags along the ground or hangs down when walking, people with MS with foot drop are more vulnerable to tripping and falling. Walking also uses more energy and people may alter how they walk to try and compensate.

There are two types of devices which can be used to treat foot drop. Functional electrical stimulation uses two electrodes placed on the leg to deliver small electrical charges to the leg nerves and muscles to force the foot into a more natural position for walking. An ankle-foot orthoses is a device made of plastic or carbon fibre that is worn on the lower part of the leg, this can be a rigid splint or more flexible. This holds the foot and ankle in a correct position to prevent the foot from dropping down during walking.

If you are experiencing foot drop or other walking difficulties, you can speak to your MS nurse or GP who may refer you to physiotherapy services.

You can read more about FES in the Functional electrical stimulation (FES) A-Z of MS.

If you are concerned about falls, you might like to read Falls: managing the ups and downs of MS, which gives tips and suggestions for reducing the risks of falling.

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