Mr Ben Patritti and team have recently published work that was made possible through the 2011 ISPO Australia research grant. The manuscript was published at Disability and Rehabilitation: Assistive Technology. The primary author and a clinical expert share their learning from the paper below.
From the author
In this study, we assessed the gait of people with MS before and after a fatiguing walk, both with and without the Bioness L300 FES device. We then let the participants use the L300 for 8 weeks, before repeating the testing. This is the only study to assess the effects of such a device after a fatiguing walk, which is closer to the real-life scenario where FES may be most needed to assist with fatigue related deterioration in gait pattern. Clinicians should be aware that orthotic effects of using the device are more pronounced after 8 weeks of use, including improvements in neuromuscular control. Some of the therapeutic benefits that carried over from prolonged FES use included increases in power generation at the hip and ankle, contributing to increased walking speed. Some of these benefits could not be maintained however after a fatiguing walk. Therefore, FES may be considered as a gait retraining device as well as an orthotic intervention for people with MS. Further research combining FES with training protocols is needed to determine the if FES can provide further therapeutic effects to gait during a fatiguing walk
Commentary from Hannah Keane (orthotist/prosthetist), the clinical expert
“With an increased use of outcome measures to support funding for Orthotic and Prosthetic devices, a recent publication by Barr et al ( 2016) examines the benefits of Functional Electrical stimulation(FES) in the MS population.
The study focused on the therapeutic benefits of FES on fatigue induced gait patterns in the MS population. It reports minimal orthotic effect after first use of FES, however after 8 weeks the results where described as generally positive with a reported increase in walking speed and improved neuromuscular control of the lower limb.
The results of this study highlight the need for prolonged trailing of FES to determine it is success with patients. This is an important factor to consider when measuring outcomes in this population of patients to support funding for FES devices.
Furthermore the authors found only some benefits of FES are maintained in fatigued patients and there may be some residual gait deficits. Clinically it reinforces that FES alone may not satisfy all the desired outcomes of treatment and suggests future research to determine its effects when used in conjunction with traditional therapies and interventions. As always the importance for patient centered care remains at the forefront when prescribing a FES device.”