Elevated C-reactive protein associated with decreased high-density lipoprotein cholesterol in men with spinal cord injury

Liang H, Mojtahedi MC, Chen D, Braunschweig CL. Elevated C-reactive protein associated with decreased high-density lipoprotein cholesterol in men with spinal cord injury.

Objectives

To determine if people with spinal cord injury (SCI) have elevated C-reactive protein (CRP), to examine the association of CRP with high-density lipoprotein cholesterol (HDL-C), and to assess the influence of completeness and level of injury on these parameters.

Design

Cross-sectional.

Setting

Urban university.

Participants

Men with SCI (n=129) who were free of infection and/or recent anti-inflammatory medication use as well as their 1:1 age- and race-matched able-bodied counterparts from the 1999-2002 National Health and Nutrition Examination Surveys.

Interventions

Not applicable.

Main Outcome Measures

High CRP was defined as 3mg/L or higher and low HDL-C as less than 1.04mmol/L.

Results

Men with SCI were more likely to have high CRP (odds ratio [OR]=2.29; 95% confidence interval [CI], 1.33-3.95) and low HDL-C (OR=1.81; 95% CI, 1.01-3.27). The OR for low HDL-C in SCI was no longer significant when high CRP was controlled. CRP was higher in complete versus incomplete injury (median, 3.7mg/L vs 1.2mg/L; P=.005), and this elevation was independent of age, smoking, physical activity, waist circumference, and weight. No conclusion can be made on the association of injury level and CRP because of a lack of power.

Conclusions

The elevated CRP, possibly the major risk factor, together with decreased HDL-C may contribute to greater incidence for cardiovascular disease in the SCI population.     

Do smokers with chronic obstructive pulmonary disease report their smoking status reliably? A comparison of self-report and bio-chemical validation

Background

Chronic obstructive pulmonary disease (COPD) is predominantly caused by cigarette smoking and is considered a worldwide preventable chronic illness. Smoking cessation is considered the primary intervention for disease management and nurses should play a major role in assisting patients to stop smoking. Currently there is a lack of professional consensus on how cessation interventions should be evaluated. The vast array of biochemical markers reported in the literature can be confusing and can make the comparisons of results difficult.

Objective

To validate self-report data on smoking with exhaled carbon monoxide in patients with chronic obstructive pulmonary disease over twelve months.

Design

We performed a secondary analysis of a previously published randomized controlled trial evaluating nursing interventions to assist respiratory patients to stop smoking.

Setting

Northern Ireland's Regional Respiratory Centre.

Participants

A total of 91 cigarette smokers attending secondary care for the treatment for COPD participated in the study.

Method

Self-reported smoking status and cigarettes smoked per day were compared to exhaled carbon monoxide readings at baseline, 2, 3, 6, 9 and 12 months. The cut-off value of ≤10 ppm was used to identify non-smokers. The p-values are based on Pearson's correlation coefficient and Kappa Coefficient as appropriate.

Results

Findings suggest self-reported smoking status and cigarette consumption amongst patients with chronic obstructive pulmonary disease was highly consistent with exhaled carbon monoxide results (p = 0.001-0.003).

Conclusion

The majority of patients with chronic obstructive pulmonary disease reliably report their cigarette consumption.     

Exercise and Quality of Life Among People With Multiple Sclerosis: Looking Beyond Physical Functioning to Mental Health and Participation in Life

Turner AP, Kivlahan DR, Haselkorn JK. Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life.

Objective

To describe the prevalence of exercise in a national sample of veterans with multiple sclerosis (MS) and the association of exercise with quality of life, including physical health, mental health, and participation restriction.

Design

Cross-sectional cohort study linking computerized medical records to mailed survey data from 1999.

Setting

Veterans Health Administration.

Participants

Veterans with MS (N=2995; 86.5% men) who received services in the Veterans Health Administration and returned survey questionnaires.

Interventions

Not applicable.

Main Outcome Measures

Demographic information, Veteran RAND 36-Item Health Survey (VR-36), self-reported exercise frequency.

Results

Among all survey respondents with MS, only 28.6% (95% confidence interval, 26.9-30.2) endorsed any exercise. In adjusted logistic regression, exercise was associated with younger age, more education, living alone, lower levels of bodily pain, and higher body mass index. After adjusting for demographic variables and medical comorbidities, exercise was associated with better physical and mental health. People who exercised reported they had better social functioning and better role functioning (participation in life despite physical and emotional difficulties).

Conclusions

Exercise in veterans with MS is uncommon. In the context of chronic illness care, the identification of exercise patterns and promotion of physical activity may represent an important opportunity to improve mental health and quality of life among people with MS. Intervention should address factors associated with lower rates of exercise including age, education, and pain.     

Prevalence and Impact of Pain in Multiple Sclerosis: Physical and Psychologic Contributors

Hirsh AT, Turner AP, Ehde DM, Haselkorn JK. Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors.

Objective

To characterize the prevalence and impact of pain in veterans with multiple sclerosis (MS) and to assess their association with demographic, biologic, and psychologic variables.

Design

Cross-sectional cohort study linking computerized medical record information to mailed survey data.

Setting

Veterans Health Administration (VHA).

Participants

Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires.

Interventions

Not applicable.

Main Outcome Measures

Items assessing pain intensity, pain interference, and physical and mental health functioning.

Results

Ninety-two percent of participants reported bodily pain within the prior 4 weeks, with 69% of the total sample indicating pain of moderate or higher intensity. Eighty-five percent indicated that pain caused functional interference during the past 4 weeks, with 71% of the total sample reporting pain-related interference that was moderate or greater. No significant sex or race differences emerged for the pain indices. A significant but modest relationship between increasing age and pain interference emerged (r=.05, P<.01); however, age was not significantly related to pain intensity. Multivariate regression analyses identified pain intensity (β=.73), physical health functioning (β=-.07), and mental health functioning (β=-.13) variables as significant, unique contributors to the prediction of pain interference. The interaction of pain intensity and physical functioning was also significant but of minimal effect size (β=-.03).

Conclusions

Pain is highly prevalent and causes substantial interference in the lives of veterans with MS. The functional impact of pain in veterans with MS is influenced by pain intensity, physical health, and emotional functioning. Clinical practice should take each of these domains into consideration and reflect a biopsychosocial conceptualization.     

Effect of Respiration on the Static Rear Stability of Wheelchairs

Kirby RL, Heimrath O, Stewart A, Smith C, MacLeod DA. Effect of respiration on the static rear stability of wheelchairs.

Objective

To test the hypothesis that the static rear stability of an occupied wheelchair is greater during full inspiration than expiration.

Design

Within-subject comparisons.

Setting

Rehabilitation center.

Participants

Able-bodied participants (N=10).

Intervention

None.

Main Outcome Measures

We measured the static rear stability (brakes unlocked) of an occupied wheelchair on a test platform according to International Organization for Standardization standards. We also used the Exhalation Threshold Test. The Exhalation Threshold Test was positive if, having been positioned at the maximum degree of platform tilt needed to maintain stability during full inspiration, the wheelchair tipped backward when the participant exhaled.

Results

The mean static rear stability values at full inspiration and expiration ± SD were 16.5°±2.3° and 16.1°±2.4°, with a mean difference of .46°±.24° (3%; P=.002). The Exhalation Threshold Test was positive in 19 (95%) of 20 trials.

Conclusions

Respiration has a slight but statistically significant effect on the rear stability of occupied wheelchairs, with greater stability at full inspiration. This has potential clinical implications for stability testing and the training of wheelchair skills, but further study is needed.     

Perceived Need and Unmet Need for Vocational, Mental Health, and Other Support Services After Severe Lower-Extremity Trauma

Archer KR, Castillo RC, MacKenzie EJ, Bosse MJ, and the LEAP Study Group. Perceived need and unmet need for vocational, mental health, and other support services following severe lower-extremity trauma.

Objectives

To examine the perceived need and unmet need for support services, the reasons for not obtaining services, and the factors contributing to unmet need for vocational and mental health services in patients with traumatic lower-extremity injury.

Design

Multicenter, prospective observational study.

Setting

Eight level I trauma centers.

Participants

Patients (N=545) undergoing lower-extremity reconstruction or amputation from March 1994 to June 1997.

Interventions

Not applicable.

Main Outcome Measures

Perceived need and unmet need for support services at 3, 6, and 12 months after hospitalization.

Results

Eighty-five percent of patients reported a need for at least 1 support service, and 32% reported an unmet need over the 12 months. The highest perceived need was for home nursing and legal, and for unmet need was vocational and mental health services. The main reason for patients not trying to obtain mental health assistance was thinking they would get better on their own, and for other support services was not knowing where to go. Patients treated by reconstruction compared with amputation, and being nonwhite were statistically associated with unmet needs for vocational and mental health services.

Conclusions

The results suggest a significant amount of unmet need for vocational and mental health services during the first year after hospitalization in the severe lower-extremity trauma population with perceived need. Areas for future research are to objectively measure need and unmet need, and further investigate the disparities in unmet need by race and treatment type in this patient population. Recommendations for trauma centers include education and screening for mental health conditions and the need for support services during hospitalization and clinic visits, and increasing communication between surgeons and providers specializing in vocational, psychological, and socioeconomic issues.     

A Comparison of Balance Performance: Computerized Dynamic Posturography and a Random Motion Platform

Broglio SP, Sosnoff JJ, Rosengren KS, McShane K. A comparison of balance performance: computerized dynamic posturography and a random motion platform.

Objective

To establish the clinical utility of the PROPRIO 5000 as a balance assessment device by establishing convergent validity with the NeuroCom sensory organization test (SOT).

Design

Cross-sectional.

Setting

Balance research laboratory.

Participants

Young adults (N=40; 21.1±1.4y).

Interventions

Not applicable.

Main Outcome Measures

Performance on each of the 6 NeuroCom SOT testing conditions and PROPRIO 5000 dynamic motion analysis score.

Results

Correlational analyses between output variables yielded significant relationships between the dynamic motion analysis score from the 0 to 10 second (r=−.38), 10 to 20 second (r=−.34), and 20 to 30 second (r=−.35) intervals and the SOT composite balance score.

Conclusions

The initial stages of the PROPRIO 5000 and the NeuroCom SOT battery may evaluate similar aspects of postural control. However, as the magnitude of PROPRIO perturbations increased, the relationship between the devices diverged and the complete PROPRIO assessment is not thought to pair with the SOT assessment. Differences between the 2 devices may be associated with varying degrees of test difficulty and the necessary postural control strategies involved in responding to continual balance perturbations (PROPRIO 5000) or to different sensory inputs (SOT).     

Managing activity difficulties at home: a survey of Medicare beneficiaries

Dudgeon BJ, Hoffman JM, Ciol MA, Shumway-Cook A, Yorkston KM, Chan L. Managing activity difficulties at home: a survey of Medicare beneficiaries.

Objective

To describe assistance from helpers and use of assistive technology and environmental modification by community-dwelling people with difficulties in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Design

Cross-sectional study using the 2004 Medicare Current Beneficiary Survey.

Setting

Community.

Participants

Nationally representative sample of 14,500 Medicare beneficiaries (mean age, 71.5y; 55% female; 49% currently married; 68% living with others; 84% white).

Interventions

Not applicable.

Main Outcome Measures

Self-reported difficulty with ADLs and IADLs; uses of help, assistive technology, and/or environmental modification.

Results

Difficulties were reported most frequently for heavy housework, walking, and shopping; money management, shopping, and light housework were reported as activities most often needing a helper. Walking, bathing, and toileting were activities most often needing uses of assistive technology. Bathroom modifications were the most commonly reported environmental modification. Results from a logistic regression showed that advancing age was the primary factor associated with increasing use of helpers and assistive technology or both for difficult activities.

Conclusions

Uses of helpers, assistive technology, and environmental modification are common but vary by type of ADL and/or IADL and age. Focused studies regarding uses of help and access to assistive technology and environmental modification appear needed to support community living. Public education about methods and types of accommodations appears needed and may substitute for or augment guidance from care providers.     

A paramedic-staffed medical rehydration unit at a mass gathering

Introduction

Heat-related illness is reported to be a significant cause of morbidity at outdoor mass gatherings during warm weather. Paramedics are traditionally present at mass gatherings to provide prehospital care for people in need.

Objectives

To describe a paramedic-staffed medical rehydration unit and a new role for paramedics at a mass gathering attended by more than 450,000 people.

Methods

A 48-bed medical rehydration unit was deployed adjacent to the main field hospital. Paramedics admitted patients to the unit if they met predetermined criteria for mild to moderate heat-related illness. Each paramedic was responsible for four beds. Paramedics initiated oral and intravenous rehydration therapy by following medical directives. Emergency medical services (EMS) physicians reviewed patients before discharge.

Results

The medical rehydration unit managed 143 patients (3/10,000 attendees). The mean number of patients admitted per hour was nine. The average age was 24 years; 103 (72%) were female. The main presenting complaint was syncope, presyncope, or dizziness in 43 (30%). Forty-four (31%) patients received parenteral and oral fluids; the remainder received oral fluids alone. The average length of stay was 94 minutes (95% CI 82-106). One hundred seven (75%) patients were discharged, 17 (12%) were transferred to the main field hospital, four (3%) left against medical advice, and two (1%) required transfer to a hospital off site. In 13 (9%) cases, records of patient disposition were incomplete.

Conclusions

This article defines a new role for paramedics and describes the operation of a medical rehydration unit at a large, single-day mass gathering in summer.     

Examining the Relationship Between Cognition and Driving Performance in Multiple Sclerosis

Schultheis MT, Weisser V, Ang J, Elovic E, Nead R, Sestito N, Fleksher C, Millis SR. Examining the relationship between cognition and driving performance in multiple sclerosis.

Objective

To identify cognitive predictors of driving performance after multiple sclerosis (MS).

Design

Prospective design examining predictive value of cognitive measures on driving performance.

Setting

All data were collected in an outpatient research setting and an outpatient driver rehabilitation program.

Participants

Participants were community-dwelling persons (N=66) with clinically defined MS (86% relapsing-remitting, 14% progressive) with a mean age of 43.47 years. All were active drivers who met vision requirements established by their respective states, and none required adaptive driving equipment.

Intervention

Not applicable.

Main Outcome Measures

Participants were administered a comprehensive neuropsychologic assessment and a clinical behind-the-wheel (BTW) driving evaluation. Additional measures of driving performance included history of traffic violations and collisions (since MS onset).

Results

Logistic regression indicated that information processing speed (Symbol Digit Modality Test [SDMT]) was the strongest predictor of BTW performance. A logistic regression revealed that the strongest predictors of collision and violation frequency were visuospatial learning and recall (7/24 Spatial Recall Test [SPART 7/24]).

Conclusions

These findings indicate that information processing and visuospatial skills are predictive of driving performance among persons with MS. These measures (SDMT and SPART 7/24) may serve as screening methods for identifying the potential impact of cognitive impairment on driving. Furthermore, the findings raise questions regarding the appropriateness of the BTW evaluation to evaluate driving difficulties accurately among individuals with MS.     

Prevalence of deep tissue injuries in hospitals and nursing homes: Two cross-sectional studies

Background

Deep tissue injuries are severe damages underneath the intact skin caused by long-endured, unrelieved pressure or shear forces. Empirical evidence regarding the magnitude of this health problem is limited.

Objective

Investigation of the prevalence, characteristics of persons affected and identification of the most affected body locations.

Design

Two cross-sectional studies in 2008 and 2009.

Settings

Nursing homes and hospitals throughout Germany.

Participants

6919 (year 2008) and 8451 (year 2009) hospital patients and nursing home residents.

Methods

Trained nurses conducted full skin assessments and collected demographic data based on written data collection forms. The Braden scale was used to measure pressure ulcer risk.

Results

Pressure ulcer prevalence including grades 1-4 and deep tissue injuries ranged from 4.3% (95% CI 3.8-4.9) in nursing homes to 7.1% (95% CI 6.2-8.0) in hospitals. Point prevalence rates of deep tissue injuries were 0.4% (95% CI 0.2-0.5) in hospitals and less than 0.1% in nursing homes. In total, 30 persons were affected by 38 deep tissue injuries. The mean age was 73.4 and the mean Braden scale sum score was 12.8. The most frequently affected anatomic sites were heels (n = 24) and ischial tuberosities (n = 6).

Conclusions

Nurses must be aware that deep tissue injuries exist in clinical practice. Deep tissue injuries seem to be more common in hospitals than in nursing homes and heels are more prone to this kind of injuries than other body sites. Whenever such a lesion is suspected, optimal pressure relief is required to enable the affected tissue to heal.     

The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis

Johnson KL, Yorkston KM, Klasner ER, Kuehn CM, Johnson E, Amtmann D. The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis. Arch Phys Med Rehabil 2004;85:201-9.

Objective

To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace.

Design

Qualitative research methodology comprising a series of semistructured interviews.

Setting

Community-based setting.

Participants

Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews.

Interventions

Not applicable.

Main outcome measure

Accounts of personal experiences related to employment.

Results

Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working.

Conclusions

Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.     

Minimizing pre- and post-defibrillation pauses increases the likelihood of return of spontaneous circulation (ROSC)

Background

The three-phase model of ventricular fibrillation (VF) arrest suggests a period of compressions to “prime” the heart prior to defibrillation attempts. In addition, post-shock compressions may increase the likelihood of return of spontaneous circulation (ROSC). The optimal intervals for shock delivery following cessation of compressions (pre-shock interval) and resumption of compressions following a shock (post-shock interval) remain unclear.

Objective

To define optimal pre- and post-defibrillation compression pauses for out-of-hospital cardiac arrest (OOHCA).

Methods

All patients suffering OOHCA from VF were identified over a 1-month period. Defibrillator data were abstracted and analyzed using the combination of ECG, impedance, and audio recording. Receiver-operator curve (ROC) analysis was used to define the optimal pre- and post-shock compression intervals. Multiple logistic regression analysis was used to quantify the relationship between these intervals and ROSC. Covariates included cumulative number of defibrillation attempts, intubation status, and administration of epinephrine in the immediate pre-shock compression cycle. Cluster adjustment was performed due to the possibility of multiple defibrillation attempts for each patient.

Results

A total of 36 patients with 96 defibrillation attempts were included. The ROC analysis identified an optimal pre-shock interval of <3 s and an optimal post-shock interval of <6 s. Increased likelihood of ROSC was observed with a pre-shock interval <3 s (adjusted OR 6.7, 95% CI 2.0-22.3, p = 0.002) and a post-shock interval of <6 s (adjusted OR 10.7, 95% CI 2.8-41.4, p = 0.001). Likelihood of ROSC was substantially increased with the optimization of both pre- and post-shock intervals (adjusted OR 13.1, 95% CI 3.4-49.9, p < 0.001).

Conclusions

Decreasing pre- and post-shock compression intervals increases the likelihood of ROSC in OOHCA from VF.     

Determinants of utilization of physical rehabilitation services for persons with chronic and disabling conditions: an exploratory study

Elrod CS, DeJong G. Determinants of utilization of physical rehabilitation services for persons with chronic and disabling conditions: an exploratory study.

Objective

To determine which variables influence the receipt of physical rehabilitation services (ie, physical, occupational, speech therapy) for a population of people with chronic and disabling conditions.

Design

A convenience sample of 502 adults with cerebral palsy (CP), multiple sclerosis (MS), and spinal cord injury (SCI), drawn from diverse parts of the United States.

Setting

Respondents were surveyed in the general community.

Participants

Persons (91% under the age of 65y) with CP, MS, or SCI who responded to the 1999 component of a national longitudinal survey.

Interventions

Not applicable.

Main Outcome Measures

Self-reported need for physical rehabilitation services. Bivariate and multivariate analyses were used to examine variables that influenced utilization of services.

Results

Some 53% of respondents did not receive self-reported needed physical rehabilitation services. Respondents who had Medicaid were more likely than those with Medicare or private insurance to receive physical rehabilitation services. Respondents having a lower household income and poorer health were less likely to receive services.

Conclusions

Our findings indicate that health care funding sources provide widely disparate coverage for physical rehabilitation services to persons with 3 specific chronic and disabling conditions. Policy-makers and health plan administrators should re-evaluate their coverage of physical rehabilitation services designed to enhance quality of life and reduce the burden of lost independence.     

Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes

Haley SM, Gandek B, Siebens H, Black-Schaffer RM, Sinclair SJ, Tao W, Coster WJ, Ni P, Jette AM. Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes.

Objectives

To measure participation outcomes with a computerized adaptive test (CAT) and compare CAT and traditional fixed-length surveys in terms of score agreement, respondent burden, discriminant validity, and responsiveness.

Design

Longitudinal, prospective cohort study of patients interviewed approximately 2 weeks after discharge from inpatient rehabilitation and 3 months later.

Setting

Follow-up interviews conducted in patient’s home setting.

Participants

Adults (N=94) with diagnoses of neurologic, orthopedic, or medically complex conditions.

Interventions

Not applicable.

Main Outcome Measures

Participation domains of mobility, domestic life, and community, social, & civic life, measured using a CAT version of the Participation Measure for Postacute Care (PM-PAC-CAT) and a 53-item fixed-length survey (PM-PAC-53).

Results

The PM-PAC-CAT showed substantial agreement with PM-PAC-53 scores (intraclass correlation coefficient, model 3,1, .71-.81). On average, the PM-PAC-CAT was completed in 42% of the time and with only 48% of the items as compared with the PM-PAC-53. Both formats discriminated across functional severity groups. The PM-PAC-CAT had modest reductions in sensitivity and responsiveness to patient-reported change over a 3-month interval as compared with the PM-PAC-53.

Conclusions

Although continued evaluation is warranted, accurate estimates of participation status and responsiveness to change for group-level analyses can be obtained from CAT administrations, with a sizeable reduction in respondent burden.     

The contribution of cognition and spasticity to driving performance in multiple sclerosis

Marcotte TD, Rosenthal TJ, Roberts E, Lampinen S, Scott JC, Allen RW, Corey-Bloom J. The contribution of cognition and spasticity to driving performance in multiple sclerosis.

Objective

To examine the independent and combined impact of cognitive dysfunction and spasticity on driving tasks involving high cognitive workload and lower-limb mobility in persons with multiple sclerosis (MS).

Design

Single-visit cohort study.

Setting

Clinical research center.

Participants

Participants included 17 drivers with MS and 14 referent controls. The group with MS exhibited a broad range of cognitive functioning and disability. Of the 17 patients with MS, 8 had significant spasticity in the knee used to manipulate the accelerator and brake pedals (based on the Modified Ashworth Scale).

Interventions

Not applicable.

Main Outcome Measures

A brief neuropsychologic test battery and 2 driving simulations. Simulation 1 required participants to maintain a constant speed and lane position while attending to a secondary task. Simulation 2 required participants to adjust their speed to accelerations and decelerations of a lead car in front of them.

Results

Patients with MS showed greater variability in lane position (effect size, g=1.30), greater difficulty in maintaining a constant speed (g=1.25), and less ability to respond to lead car speed changes (g=1.85) compared with controls. Within the MS group, in a multivariate model that included neuropsychologic and spasticity measures, cognitive functioning was the strongest predictor of difficulty in maintaining lane position during the divided attention task and poor response time to lead car speed changes, whereas spasticity was associated with reductions in accuracy of tracking the lead car movements and speed maintenance.

Conclusions

In this preliminary study, cognitive and physical impairments associated with MS were related to deficits in specific components of simulated driving. Assessment of these factors may help guide the clinician regarding the types of driving behaviors that would put patients with MS at an increased risk for an automobile crash.     

Neuroprosthetic Effect of Peroneal Nerve Stimulation in Multiple Sclerosis: A Preliminary Study

Sheffler LR, Hennessey MT, Knutson JS, Chae J. Neuroprosthetic effect of peroneal nerve stimulation in multiple sclerosis: a preliminary study.

Objective

To determine the neuroprosthetic effect of a peroneal nerve stimulator on tasks of functional ambulation in multiple sclerosis (MS).

Design

A single point-in-time assessment of functional ambulation tasks under the conditions of no device and peroneal nerve stimulator.

Setting

Outpatient academic medical center.

Participants

Participants (N=11) with diagnosis of MS (>6mo), dorsiflexion weakness, and prior usage of an ankle-foot orthosis.

Intervention

Surface peroneal nerve stimulator for ambulation.

Main Outcome Measures

Timed 25-foot Walk portion of the MS Functional Composite; Floor, Carpet, Up and Go, Obstacle, and Stair components of the Modified Emory Functional Ambulation Profile.

Results

Peroneal nerve stimulator-Stair performance was significantly enhanced (P=.05) versus no device, and statistical significance was approached for peroneal nerve stimulator-Obstacles (P=.09) versus no device. There were no significant differences between peroneal nerve stimulator and no device conditions in the remaining outcome measures.

Conclusions

The neuroprosthetic effect of the peroneal nerve stimulator is modest relative to no device in the performance of specific functional tasks of ambulation in MS gait. A longitudinal, controlled trial is needed to show effectiveness.