#006- Articles on Stroke and Multiple Sclerosis.

ByAl-Jallad

Coverd Topics:

1. Ankle-Foot Orthosis Improve Walking Speed after Stroke.

2. Vestibular Training for Balance and Dizziness in People with Multiple Sclerosis.

Estimated reading time: 4 minutes, 38 seconds.

Articles

Ankle-Foot Orthosis and electrical stimulation Improve Walking Speed after Stroke.

This systematic review and meta analysis investigated the effect of AF orthosis and functional electrical stimulation (FES) on foot-drop after stroke and how they influence walking speed and balance, the authors examined each intervention vs sham or no treatment and and against each other.

Results

11 Trial including 1134 participant

AF Orthosis :

Using customized, dynamic or hinged orthosis for 8 to 12 weeks

  • Walking Speed: Compared to no treatment or sham, a moderate-quality evidence from 2 trials including 61 participant suggested that ankle-foot orthoses significantly increased walking speed by 0.24 m/s (baseline: 0.33 m/s to 0.74 m/s).
  • Balance: Data not enough for meta analysis, one trial reported an increase in Berg balance scale and one trial reported no improvement in Functional reach test.

Functional Electrical Stimulation:

Using sensor-trigged electrical stimulation to improve dorsiflexion, with a frequency between 15 and 50Hz for 8-12 weeks.

  • Walking speed: Compared to no treatment or sham,a moderate-quality evidence from 4 trials including 125 participant showed that FES significantly increased walking speed by 0.09 m/s (baseline: 0.33 m/s to 0.74 m/s).
  • Balance: No data.

AF Orthosis vs FES:

  • Walking speed: Moderate quality evidence from 4 trials involving 895 participants showed no difference between AF orthosis and Functional electrical stimulation on walking speed.
  • Balance: High quality evidence from 2 trials involving 692 participants showed no difference between AF orthosis and Functional electrical stimulation on balance.

So

When: To improve walking speed that was decreased due to foot-drop.

How: This article provided evidence for 2 methods to improve walking speed, AF orthosis and FES, which should you choose? Well, this you have to discuss with your patient, factors such as availability, cost and discomfort that comes from both methods will help you and your patient choose.

Vestibular Training for Balance and Dizziness in People with Multiple Sclerosis.

Dizziness is reported to affect 49% to 59% of people with MS (PwMS), while balance disorders in mild to moderate MS affect 75%-82% of PwMS, these symptoms arise from sensory impairments in visual, vestibular and proprioceptive pathways.

Vestibular Rehabilitation consists of exercises that train the sensory systems to provide the correct spatial cues for position as well as for head and body motion.

6 RCTs in systematic review and 5 RCTs in the meta analysis, 321 participant.

Vestibular training:

  • Consisted of head/eyes movement for a task in different positions and on different surfaces with open or closed eyes, used by 2 trials.
  • Cawthorne–Cooksey protocol (Original protocol here, 1946), used by 2 trial.
  • Balance and Eye-Movement Exercises for Persons with Multiple Sclerosis (BEEMS) (Full protocol), used by 2 trial (same author).

Results:

Balance:

  • Vestibular rehabilitation was more effective than no intervention for postural control improvements in an upright position.
  • Compared to usual care, vestibular rehabilitation obtained greater improvements in balance, Tandem Romberg and foam standing tests.
  • Compared to other exercises no significant difference was found.
  • 1 trial compared vestibular rehabilitation to standard exercise program and found significant difference in up right postural control in 4 conditions: eyes closed and firm surface, eyes open and compliant surface, eyes closed and compliant surface and sway referenced and compliant surface.

Dizziness:

  • Vestibular rehabilitation was more effective than no intervention as assessed using The Dizziness Handicap Inventory, 3 studies, while one study with a different program found no statistical difference between groups.

Secondary outcomes:

  • Fatigue: vestibular rehabilitation is more effective than no intervention for fatigue improvements (3 studies), compared to general exercise improvements in fatigue that were observed for vestibular rehabilitation, but not statistically significant.
  • Walking speed: Compared to no intervention, one trial found improvement and 1 trial did not, compared to general exercise, 1 trial found that vestibular rehabilitation had better results.
  • Depression: using Beck Depression Inventory by 2 trials, no significant difference between vestibular rehabilitation and exercise group.

Learned from this article:

  • Vestibular Rehabilitation can be as effective as other exercise programs targeting balance and dizziness and it is more effective than not exercise.
  • There are well described protocols that are affordable and easy to prescribe to PwMS as home programs.

Final Note

  • We have evidence for 2 treatment methods to increase walking speed after stroke.
  • Vestibular rehabilitation seems very promising to improve balance and dizziness after MS.

Trends

  • Functional electrical stimulation was most searched for by people in Germany and Austria, with the most related topic being cerebral palsy, where ankle orthosis was most searched in the Philippines. (Year 2020)
  • Vestibular Training was only searched by people in America during this year, where MS was most searched in Iran.

References

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