Advertisement

Six-Minute Walk Test Performance in Persons With Multiple Sclerosis While Using Passive or Powered Ankle-Foot Orthoses

Published:August 01, 2017DOI:https://doi.org/10.1016/j.apmr.2017.06.024

      Abstract

      Objective

      To determine whether a powered ankle-foot orthosis (AFO) that provides dorsiflexor and plantar flexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS).

      Design

      Short-term intervention.

      Setting

      University research laboratory.

      Participants

      Participants (N=16) with a neurologist-confirmed diagnosis of MS and daily use of a prescribed custom unilateral passive AFO.

      Interventions

      Three 6-minute walk tests (6MWTs), 1 per footwear condition: shoes (no AFO), prescribed passive AFO, and portable powered AFO (PPAFO). Assistive devices were worn on the impaired limb.

      Main Outcome Measures

      Distance walked and metabolic cost of transport were recorded during each 6MWT and compared between footwear conditions.

      Results

      Each participant completed all three 6MWTs within the experimental design. PPAFO use resulted in a shorter 6MWT distance than did a passive AFO or shoe use. No differences were observed in metabolic cost of transport between footwear conditions.

      Conclusions

      The current embodiment of this PPAFO did not improve endurance walking performance during the 6MWT in a sample of participants with gait impairment due to MS. Further research is required to determine whether expanded training or modified design of this powered orthosis can be effective in improving endurance walking performance in persons with gait impairment due to MS.

      Keywords

      List of abbreviations:

      6MWT (6-minute walk test), AFO (ankle-foot orthosis), ANOVA (analysis of variance), CoT (metabolic cost of transport), MS (multiple sclerosis), PPAFO (portable powered ankle-foot orthosis), V˙co2 (carbon dioxide consumption per unit time), V˙o2 (oxygen consumption per unit time)
      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

        • Noseworthy J.H.
        • Lucchinetti C.
        • Rodriguez M.
        • Weinshenker B.G.
        Multiple sclerosis.
        N Engl J Med. 2000; 343: 938-952
        • Motl R.W.
        Ambulation and multiple sclerosis.
        Phys Med Rehabil Clin North Am. 2013; 24: 325-336
        • Pike J.
        • Jones E.
        • Rajagopalan K.
        • Piercy J.
        • Anderson P.
        Social and economic burden of walking and mobility problems in multiple sclerosis.
        BMC Neurol. 2012; 12: 1-8
        • Wening J.
        • Ford J.
        • Jouett L.D.
        Orthotics and FES for maintenance of walking in patients with MS.
        Dis Mon. 2013; 59: 284-289
        • 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 J. 2006; 12: 219-226
        • 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.
        Am J Phys Med Rehabil. 2008; 87: 26-32
        • McLoughlin J.V.
        • Lord S.R.
        • Barr C.J.
        • Crotty M.
        • Sturnieks D.L.
        Dorsiflexion assist orthosis reduces the physiological cost and mitigates deterioration in strength and balance associated with walking in people with multiple sclerosis.
        Arch Phys Med Rehabil. 2015; 96: 226-232.e31
        • Bregman D.J.
        • de Groot V.
        • Van Diggele P.
        • Meulman H.
        • Houdijk H.
        • Harlaar J.
        Polypropylene ankle foot orthoses to overcome drop-foot gait in central neurological patients: a mechanical and functional evaluation.
        Prosthet Orthot Int. 2010; 34: 293-304
        • Bregman D.J.
        • Harlaar J.
        • Meskers C.G.
        • de Groot V.
        Spring-like ankle foot orthoses reduce the energy cost of walking by taking over ankle work.
        Gait Posture. 2012; 35: 148-153
        • Hwang Y.I.
        • Yoo W.G.
        • An D.H.
        • Heo H.J.
        The effect of an AFO-shaped elastic band on drop-foot gait in patients with central neurological lesions.
        NeuroRehabilitation. 2013; 32: 377-383
        • Hobart J.C.
        • Riazi A.
        • Lamping D.L.
        • Fitzpatrick R.
        • Thompson A.J.
        Measuring the impact of MS on walking ability—the 12-Item MS Walking Scale (MSWS-12).
        Neurology. 2003; 60: 31-36
        • Brehm M.A.
        • Nollet F.
        • Harlaar J.
        Energy demands of walking in persons with postpoliomyelitis syndrome: relationship with muscle strength and reproducibility.
        Arch Phys Med Rehabil. 2006; 87: 136-140
        • Shorter K.A.
        • Kogler G.F.
        • Loth E.
        • Durfee W.K.
        • Hsiao-Wecksler E.T.
        A portable-powered-ankle-foot-orthosis for rehabilitation.
        J Rehabil Res Dev. 2011; 48: 459-472
      1. Boes MK, Islam M, Li YD, Hsiao-Wecksler ET. Fuel efficiency of a portable powered ankle-foot orthosis. In: IEEE International Conference on Rehabilitation Robotics; 2013 Jun 24–26; Seattle (WA).

        • Shorter K.A.
        • Xia J.C.
        • Hsiao-Wecksler E.T.
        • Durfee W.K.
        • Kogler G.F.
        Technologies for powered ankle-foot orthotic systems: possibilities and challenges.
        IEEE/ASME Trans Mechatron. 2013; 18: 337-347
        • Li D.Y.
        • Becker A.
        • Shorter K.A.
        • Bretl T.
        • Hsiao-Wecksler E.T.
        Estimating system state during human walking with a powered ankle-foot orthosis.
        IEEE/ASME Trans Mechatron. 2011; 16: 835-844
        • Islam M.
        • Hagan M.T.
        • Hsiao-Wecksler E.T.
        Gait state estimation for a powered ankle orthosis using modified fractional timing and artificial neural network.
        J Med Devices. 2016; 10: 020920
        • Perry J.
        Gait analysis: normal and pathological function.
        Slack, Thorofare1992
        • Kirtley C.
        Introduction: clinical gait analysis.
        Churchill Livingstone, Edinburgh2006: 201-222
        • Shorter K.A.
        • Li Y.
        • Morris E.A.
        • Kogler G.F.
        • Hsiao-Wecksler E.T.
        Experimental evaluation of a portable powered ankle-foot orthosis.
        Conf Proc IEEE Eng Med Biol Soc. 2011; 2011: 624-627
        • Islam M.
        • Hsiao-Wecksler E.T.
        Detection of gait modes using an artificial neural network during walking with a powered ankle-foot orthosis.
        J Biophys. 2016; 2016: 7984157
        • Kurtzke J.F.
        Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS).
        Neurology. 1983; 33: 1444-1452
        • Goldman M.D.
        • Marrie R.A.
        • Cohen J.A.
        Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls.
        Mult Scler J. 2008; 14: 383-390
        • Sandroff B.M.
        • Motl R.W.
        • Pilutti L.A.
        • et al.
        Accuracy of StepWatch and ActiGraph accelerometers for measuring steps taken among persons with multiple sclerosis.
        PLoS One. 2014; 9: e93511
        • Motl R.W.
        • Snook E.M.
        • Agiovlasitis S.
        • Suh Y.
        Calibration of accelerometer output for ambulatory adults with multiple sclerosis.
        Arch Phys Med Rehabil. 2009; 90: 1778-1784
        • Donelan J.M.
        • Kramand R.
        • Kuo A.D.
        Mechanical and metabolic determinants of the preferred step width in human walking.
        Proc R Soc B Biol Sci. 2001; 268: 1985-1992
        • Brockway J.M.
        Derivation of formulae used to calculate energy expenditure in man.
        Hum Nutr Clin Nutr. 1987; 41: 463-471
        • Adamczyk P.G.
        • Collins S.H.
        • Kuo A.D.
        The advantages of a rolling foot in human walking.
        J Exp Biol. 2006; 209: 3953-3963
        • Tomassini V.
        • Matthews P.M.
        • Thompson A.J.
        • et al.
        Neuroplasticity and functional recovery in multiple sclerosis.
        Nat Rev Neurol. 2012; 8: 635-646
        • Ksiazek-Winiarek D.J.
        • Szpakowski P.
        • Glabinski A.
        Neural plasticity in multiple sclerosis: the functional and molecular background.
        Neural Plast. 2015; 2015: 307175
        • Barnett S.L.
        • Bagley A.M.
        • Skinner H.B.
        Ankle weight effect on gait: orthotic implications.
        Orthopedics. 1993; 16: 1127-1131
        • Browning R.C.
        • Modica J.R.
        • Kram R.
        • Goswami A.
        The effects of adding mass to the legs on the energetics and biomechanics of walking.
        Med Sci Sports Exer. 2007; 39: 515-525
        • Mooney L.M.
        • Rouse E.J.
        • Herr H.M.
        Autonomous exoskeleton reduces metabolic cost of human walking.
        J Neuroeng Rehabil. 2014; 11: 151
        • Mooney L.M.
        • Rouse E.J.
        • Herr H.M.
        Autonomous exoskeleton reduces metabolic cost of human walking during load carriage.
        J Neuroeng Rehabil. 2014; 11: 80
        • Malcolm P.
        • Derave W.
        • Galle S.
        • De Clercq D.
        A simple exoskeleton that assists plantarflexion can reduce the metabolic cost of human walking.
        PLoS One. 2013; 8: e56137
        • Sawicki G.S.
        • Ferris D.P.
        Powered ankle exoskeletons reveal the metabolic cost of plantar flexor mechanical work during walking with longer steps at constant step frequency.
        J Exp Biol. 2009; 212: 21-31
        • Walsh C.J.
        • Endo K.
        • Herr H.
        A quasi-passive leg exoskeleton for load-carrying augmentation.
        Int J Human Robot. 2007; 4: 487-506
        • Pilutti L.A.
        • Dlugonski D.
        • Sandroff B.M.
        • et al.
        Gait and six-minute walk performance in persons with multiple sclerosis.
        J Neurol Sci. 2013; 334: 72-76
        • Islam M.
        • Hsiao-Wecksler E.T.
        Developing a classification algorithm for plantarflexor actuation timing of a powered ankle-foot orthosis.
        J Med Devices. 2016; 10
        • Cain S.M.
        • Gordon K.E.
        • Ferris D.P.
        Locomotor adaptation to a powered ankle-foot orthosis depends on control method.
        J Neuroeng Rehabil. 2007; 4: 48
        • Gordon K.E.
        • Ferris D.P.
        Learning to walk with a robotic ankle exoskeleton.
        J Biomech. 2007; 40: 2636-2644
        • Sawicki G.S.
        • Ferris D.P.
        Mechanics and energetics of level walking with powered ankle exoskeletons.
        J Exp Biol. 2008; 211: 1402-1413
      2. Norris JA, Marsh AP, Granata KP, Ross SD. Positive feedback in powered exoskeletons: improved metabolic efficiency at the cost of reduced stability? In: ASME 2007 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference; 2007 Jan 1; Las Vegas (NV).

        • Hutchins S.
        • Bowker P.
        • Geary N.
        • Richards J.
        The biomechanics and clinical efficacy of footwear adapted with rocker profiles—evidence in the literature.
        Foot. 2009; 19: 165-170
        • Long J.T.
        • Klein J.P.
        • Sirota N.M.
        • Wertsch J.J.
        • Janisse D.
        • Harris G.F.
        Biomechanics of the double rocker sole shoe: gait kinematics and kinetics.
        J Biomech. 2007; 40: 2882-2890
        • Myers K.A.
        • Long J.T.
        • Klein J.P.
        • Wertsch J.J.
        • Janisse D.
        • Harris G.F.
        Biomechanical implications of the negative heel rocker sole shoe: gait kinematics and kinetics.
        Gait Posture. 2006; 24: 323-330