Advertisement

Dorsiflexion Assist Orthosis Reduces the Physiological Cost and Mitigates Deterioration in Strength and Balance Associated With Walking in People With Multiple Sclerosis

Published:September 25, 2014DOI:https://doi.org/10.1016/j.apmr.2014.09.005

      Abstract

      Objective

      To evaluate the effect of wearing a dorsiflexion assist orthosis (DAO) on walking distance, physiological cost, fatigue, and strength and balance measures after a modified 6-minute walk test (6MWT) in people with multiple sclerosis (MS).

      Design

      Randomized crossover trial.

      Setting

      Hospital Movement Laboratory.

      Participants

      People with moderate MS and Expanded Disability Status Scale score of 3.7±0.7 (N=34; 26 women).

      Interventions

      Modified 6MWT with and without a DAO worn on the weaker leg.

      Main Outcome Measures

      Distance walked, perceived fatigue, and the physiological cost of walking were compared between walking conditions. Pre- and postwalk changes in knee extensor and ankle dorsiflexor isometric strength and standing postural sway with eyes open and closed were compared between walking conditions.

      Results

      There were no differences in distance walked or perceived fatigue between the 2 walking conditions. However, there was a reduced physiological cost of walking (P<.05), a smaller reduction in knee extensor strength (P<.05), and a smaller increase in standing postural sway with eyes open (P<.01) after walking while wearing the DAO compared with walking without wearing the DAO.

      Conclusions

      Despite not increasing walking distance or reducing perceived fatigue, the DAO reduced the physiological cost of walking and maintained knee strength and standing balance, which may have important implications for physical rehabilitation in people with MS. Further trials are required to determine whether the beneficial effects of wearing a DAO found here are maintained for longer periods.

      Keywords

      List of abbreviations:

      6MWT (6-minute walk test), AFO (ankle foot orthosis), DAO (dorsiflexion assist orthosis), EDSS (Expanded Disability Status Scale), MS (multiple sclerosis), PCI (physiological cost index)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cameron M.H.
        • Lord S.
        Postural control in multiple sclerosis: implications for fall prevention.
        Curr Neurol Neurosci Rep. 2010; 10: 407-412
        • Cattaneo D.
        • Jonsdottir J.
        Sensory impairments in quiet standing in subjects with multiple sclerosis.
        Mult Scler. 2008; 15: 59-67
        • Nelson S.R.
        • Di Fabio R.P.
        • Anderson J.H.
        Vestibular and sensory interaction deficits assessed by dynamic platform posturography in patients with multiple sclerosis.
        Ann Otol Rhinol Laryngol. 1995; 104: 62-68
        • Peterson E.W.
        • Cho C.C.
        • von Koch L.
        • Finlayson M.L.
        Injurious falls among middle aged and older adults with multiple sclerosis.
        Arch Phys Med Rehabil. 2008; 89: 1031-1037
        • Yahia A.
        • Ghroubi S.
        • Mhiri C.
        • Elleuch M.H.
        Relationship between muscular strength, gait and postural parameters in multiple sclerosis.
        Ann Phys Rehabil Med. 2011; 54: 144-155
        • Nilsagard Y.
        • Denison E.
        • Gunnarsson L.G.
        • Bostrom K.
        Factors perceived as being related to accidental falls by persons with multiple sclerosis.
        Disabil Rehabil. 2009; 31: 1301-1310
        • Van Emmerik R.E.
        • Remelius J.G.
        • Johnson M.B.
        • Chung L.H.
        • Kent-Braun J.A.
        Postural control in women with multiple sclerosis: effects of task, vision and symptomatic fatigue.
        Gait Posture. 2010; 32: 608-614
        • Benedetti M.G.
        • Piperno R.
        • Simoncini L.
        • Bonato P.
        • Tonini A.
        • Giannini S.
        Gait abnormalities in minimally impaired multiple sclerosis patients.
        Mult Scler. 1999; 5: 363-368
        • Martin C.L.
        • Phillips B.A.
        • Kilpatrick T.J.
        • et al.
        Gait and balance impairment in early multiple sclerosis in the absence of clinical disability.
        Mult Scler. 2006; 12: 620-628
        • Feys P.
        • Severijns D.
        • Vantenderloo S.
        • et al.
        Spatio-temporal gait parameters change differently according to speed instructions and walking history in MS patients with different ambulatory dysfunction.
        Mult Scler Relat Disord. 2013; 2: 238-246
        • Schwid S.R.
        • Thornton C.A.
        • Pandya S.
        • et al.
        Quantitative assessment of motor fatigue and strength in MS.
        Neurology. 1999; 53: 743-750
        • Thickbroom G.W.
        • Sacco P.
        • Faulkner D.L.
        • Kermode A.G.
        • Mastaglia F.L.
        Enhanced corticomotor excitability with dynamic fatiguing exercise of the lower limb in multiple sclerosis.
        J Neurol. 2008; 255: 1001-1005
        • Ng A.V.
        • Miller R.G.
        • Gelinas D.
        • Kent-Braun J.A.
        Functional relationships of central and peripheral muscle alterations in multiple sclerosis.
        Muscle Nerve. 2004; 29: 843-852
        • Matsuda P.N.
        • Shumway-Cook A.
        • Bamer A.M.
        • Johnson S.L.
        • Amtmann D.
        • Kraft G.H.
        Falls in multiple sclerosis.
        PM R. 2011; 3: 624-632
        • Ramstrand N.
        • Ramstrand S.
        AAOP state-of-the-science evidence report: the effect of ankle-foot orthoses on balance—a systematic review.
        J Prosthet Orthot. 2010; 22: 4-23
        • Cattaneo D.
        • Marazzini F.
        • Crippa A.
        • Cardini R.
        Do static or dynamic AFOs improve balance?.
        Clin Rehabil. 2002; 16: 894-899
        • Sheffler L.R.
        • Hennessey M.T.
        • Knutson J.S.
        • Naples G.G.
        • Chae J.
        Functional effect of an ankle foot orthosis on gait in multiple sclerosis: a pilot study.
        PM R. 2008; 87: 26-32
      1. McLoughlin J, Barr C, Crotty M, Sturnieks D, Lord S. Six minutes of walking leads to reduced lower limb strength and increased postural sway in people with multiple sclerosis. Neurorehabilitation; in press. doi:10.3233/NRE-141143.

        • Karpatkin H.
        • Rzetelny A.
        Effect of a single bout of intermittent versus continuous walking on perceptions of fatigue in people with multiple sclerosis.
        Int J MS Care. 2012; 14: 124-131
        • Jackson K.
        • Bigelow K.E.
        Measures of balance performance are affected by a rested versus fatigued testing condition in people with multiple sclerosis.
        PM R. 2013; 11: 949-956
        • Sosnoff J.J.
        • Socie M.J.
        • Boes M.K.
        • et al.
        Mobility, balance and falls in persons with multiple sclerosis.
        PLoS One. 2011; 6: e28021
        • Wetzel J.L.
        • Fry D.K.
        • Pfalzer L.A.
        Six-minute walk test for persons with mild or moderate disability from multiple sclerosis: performance and explanatory factors.
        Physiother Can. 2011; 63: 166-180
        • Larson R.D.
        • McCully K.K.
        • Larson D.J.
        • Pryor W.M.
        • White L.J.
        Bilateral differences in lower-limb performance in individuals with multiple sclerosis.
        J Rehabil Res Dev. 2013; 50: 215-222
        • McLoughlin J.
        • Barr C.
        • Sturnieks D.
        • Lord S.
        • Crotty M.
        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 Neurol. 2012; 12: 27
        • Todd G.
        • Gandevia S.C.
        • Taylor J.L.
        Change in manipulation with muscle fatigue.
        Eur J Neurosci. 2010; 32: 1686-1694
        • ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories
        ATS statement: guidelines for the six-minute walk test.
        Am J Respir Crit Care Med. 2002; 166: 111-117
        • Goldman M.D.
        • Marrie R.A.
        • Cohen J.A.
        Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls.
        Mult Scler. 2008; 14: 383-390
        • Fredrickson E.
        • Ruff R.L.
        • Daly J.J.
        Physiological cost index as a proxy measure for the oxygen cost of gait in stroke patients.
        Neurorehabil Neural Repair. 2007; 21: 429-434
        • Motl R.W.
        • Suh Y.
        • Balantrapu S.
        • et al.
        Evidence for the different physiological significance of the 6- and 2-minute walk tests in multiple sclerosis.
        BMC Neurol. 2012; 12: 6
        • Lee K.A.
        • Hicks G.
        • Nino-Murcia G.
        Validity and reliability of a scale to assess fatigue.
        Psychiatry Res. 1991; 36: 291-298
        • Lord S.R.
        • Menz H.B.
        • Tiedemann A.
        A physiological profile approach to falls risk assessment and prevention.
        Phys Ther. 2003; 83: 237-252
        • Ramdharry G.M.
        • Marsden J.F.
        • Day B.L.
        • Thompson A.J.
        De-stabilizing and training effects of foot orthoses in multiple sclerosis.
        Mult Scler. 2006; 12: 219-226
      2. McLoughlin J, Barr C, Crotty M, Lord SR, Sturnieks DL. Postural sway is associated with disability status and cerebellar dysfunction in people with multiple sclerosis—a preliminary study. Int J MS Care; in press.

        • Sandroff B.M.
        • Pilutti L.A.
        • Dlugonski D.
        • Learmonth Y.C.
        • Pula J.H.
        • Motl R.W.
        Comparing two conditions of administering the six-minute walk test in people with multiple sclerosis.
        Int J MS Care. 2014; 16: 48-54
        • Motl R.W.
        • Dlugonski D.
        • Suh Y.
        • et al.
        Multiple Sclerosis Walking Scale-12 and oxygen cost of walking.
        Gait Posture. 2010; 31: 506-510
        • Motl R.W.
        • Sandroff B.M.
        • Suh Y.
        • Sosnoff J.J.
        Energy cost of walking and its association with gait parameters, daily activity, and fatigue in persons with mild multiple sclerosis.
        Neurorehabil Neural Repair. 2012; 26: 1015-1021
        • Olgiati R.
        • Burgunder J.M.
        • Mumenthaler M.
        Increased energy cost of walking in multiple sclerosis: effect of spasticity, ataxia, and weakness.
        Arch Phys Med Rehabil. 1988; 69: 846-849
        • Taylor P.N.
        • Burridge J.H.
        • Dunkerley A.L.
        • et al.
        Clinical use of the Odstock dropped foot stimulator: its effect on the speed and effort of walking.
        Arch Phys Med Rehabil. 1999; 80: 1577-1583
        • Paul L.
        • Rafferty D.
        • Young S.
        • Miller L.
        • Mattison P.
        • McFadyen A.
        The effect of functional electrical stimulation on the physiological cost of gait in people with multiple sclerosis.
        Mult Scler. 2008; 14: 954-961
        • Doern K.
        • Farrar M.F.
        • Macklin S.
        • Mojica M.
        • McCain K.J.
        The impact of an ankle foot orthosis on gait recovery in MS: pilot data. In: Proceedings of the 27th Annual Meeting of the CMSC and the 5th Cooperative Meeting of the CMSC-ACTRIMS: 2013 May 29 – June 1; Florida, Orlando, USA.
        Int J MS Care. 2013; 15: 112
        • Huisinga J.M.
        • Filipi M.L.
        • Schmid K.K.
        • Stergiou N.
        Is there a relationship between fatigue questionnaires and gait mechanics in persons with multiple sclerosis?.
        Arch Phys Med Rehabil. 2011; 92: 1594-1601
        • Dobkin B.H.
        Fatigue versus activity-dependent fatigability in patients with central or peripheral motor impairments.
        Neurorehabil Neural Repair. 2008; 22: 105-110
        • Gunn H.
        • Creanor S.
        • Haas B.
        • Marsden J.
        • Freeman J.
        Risk factors for falls in multiple sclerosis: an observational study.
        Mult Scler. 2013; 19: 1913-1922
        • Cameron M.H.
        • Horak F.B.
        • Herndon R.R.
        • Bourdette D.
        Imbalance in multiple sclerosis: a result of slowed spinal somatosensory conduction.
        Somatosens Mot Res. 2008; 25: 113-122
        • Butler A.A.
        • Lord S.R.
        • Rogers M.W.
        • Fitzpatrick R.C.
        Muscle weakness impairs the proprioceptive control of human standing.
        Brain Res. 2008; 1242: 244-251
        • Citaker S.
        • Gunduz A.G.
        • Guclu M.B.
        • Nazliel B.
        • Irkec C.
        • Kaya D.
        Relationship between foot sensation and standing balance in patients with multiple sclerosis.
        Gait Posture. 2011; 34: 275-278
        • Kelleher K.J.
        • Spence W.D.
        • Solomonidis S.
        • Apatsidis D.
        The effect of textured insoles on gait patterns of people with multiple sclerosis.
        Gait Posture. 2010; 32: 67-71
        • Dixon J.
        • Gamesby H.
        • Robinson J.
        • et al.
        The effect of textured insoles on gait in people with multiple sclerosis: an exploratory study.
        Physiother Res Int. 2011; 17: 121-122