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Electrical Stimulation in Multiple Sclerosis
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Abbate A.D., Cook A.W., and
Atallah M. (1977) Effect of electrical stimulation of the thoracic spinal cord
on the function of the bladder in multiple sclerosis. J. Urol. 117, 285-288.
Abstract: We treated 40 patients who had multiple sclerosis and bladder symptoms
with thoracic spinal cord electrical stimulation. Bladder and sphincter
dysfunction was evaluated by cystometry and electromyography. Subjective
improvement was noted in 77.5 per cent of the patients and documented
improvement was found on cystometry and electromyography in 42.5 per cent. By
electrical stimulation of the spinal cord we have demonstrated varying degrees
of restoration of voluntary and reflex control of the bladder and sphincter
Barker A.T., Freeston I.L.,
Jalinous R., and Jarratt J.A. (1987) Magnetic stimulation of the human brain and
peripheral nervous system: an introduction and the results of an initial
clinical evaluation. Neurosurgery 20, 100-109.
Abstract: This report describes a novel method of stimulating the motor cortex
and deep peripheral nerves in humans. The technique, developed in the Department
of Medical Physics of Sheffield University, uses a large pulse of magnetic field
to induce currents within the body and is painless. The basic principles of
magnetic stimulation are described, and the technique is compared with
conventional electrical stimulation. Safety aspects are discussed with reference
to established clinical electrical and magnetic procedures. The results of the
first clinical study using magnetic stimulation are described and show clear
central motor pathway slowing in multiple sclerosis patients
Berardelli A., Inghilleri M.,
Cruccu G., Fornarelli M., Accornero N., and Manfredi M. (1988) Stimulation of
motor tracts in multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 51,
677-683.
Abstract: Percutaneous electrical stimulation of the motor cortex was used to
evaluate corticospinal conduction to upper-limb motoneurons in 29 patients with
multiple sclerosis. Central motor conduction abnormalities were correlated with
clinical signs and somatosensory evoked potentials. Muscle responses to cortical
stimulation were altered in 20 patients. The most common abnormality was
increased central motor conduction time; in two cases the responses to cortical
stimulation were absent. Abnormalities were also present in patients with no
clinical evidence of corticomotoneuron deficit. Alterations of muscle responses
and of somatosensory evoked potentials were usually correlated, but may appear
independently. Both testing methods are useful in the study of patients with
multiple sclerosis
Berg V., Bergmann S., Hovdal
H., Hunstad N., Johnsen H.J., Levin L., and Sjaastad O. (1982) The value of
dorsal column stimulation in multiple sclerosis. Scand. J. Rehabil. Med. 14,
183-191.
Abstract: Ten patients with definite and one with probable MS, all markedly
inflicted, but with a varying degree of motor and bladder dysfunction were
subjected to spinal cord stimulation in a controlled study. None of the patients
exhibited appreciable fluctuation in symptoms in the pre-study period. Bladder
symptoms were most markedly influenced by electrical stimulation. The reduction
in hesitancy and urgency was of great importance to the patients. In 9 of 10
patients reduction in voiding frequency took place, the all over reduction being
8%. Maximum extension torque increased by 9% and flexion torque by 29% during
the stimulation when compared to the first placebo period. In selected MS
patients, i.e. patients with bladder dysfunction and with a certain muscular
reserve, electrical spinal cord stimulation may have an indication
Campos R.J., Dimitrijevic M.M.,
Faganel J., and Sharkey P.C. (1981) Clinical evaluation of the effect of spinal
cord stimulation on motor performance in patients with upper motor neuron
lesions. Appl. Neurophysiol. 44, 141-151.
Abstract: The effect of chronic electrical stimulation of the spinal cord was
evaluated in a group of 24 patients with multiple sclerosis, spinal cord injury,
and degenerative disorders of the central nervous system. The systems for
stimulation had been implanted from 12 to 30 months prior to completion of
evaluation. At the time of completion of evaluation, 23 of the 24 patients still
had implanted systems, although 6 of them had not used spinal cord stimulation
because of no noticeable effect. In 3 patients stimulation had been disconnected
because of technical failure of the system. In 1 patient the system had been
removed 8 weeks after implantation because of inflammation in the under- skin
receiver pocket. The effects on motor performance of the remaining 14 patients
who had continuously active systems were improved bladder control, diminished
spasticity, improved movement coordination, and increased endurance
Cook A.W., Taylor J.K., and
Nidzgorski F. (1979) Functional stimulation of the spinal cord in multiple
sclerosis. J. Med. Eng Technol. 3, 18-23.
Abstract: The authors describe the effect of electrical stimulation of the
spinal cord in multiple sclerosis. After considering the nature of multiple
sclerosis, the authors describe the background, character, mode and method of
delivering electrical fields to the spinal cord. The results of this form of
treatment and the implications of these observations in terms of physiologic
mechanisms are discussed
Cook A.W. (1976) Electrical
stimulation in multiple sclerosis. Hosp. Pract. 11, 51-58.
Abstract: When electrodes were implanted in the spinal cord of a patient with
MS-- for dorsal column stimulation to relieve intractable pain--she regained
considerable movement in her legs. Subsequently such stimulation has been
employed in more than 70 other patients, and many have regained voluntary
control over their arms, legs, and sphincters. The procedure is detailed and its
implications are explored
Cook A.W. (1974) Letter:
Electrical stimulation of the spinal cord. Lancet 1, 869-870.
DeLisa J.A., Hammond M.C.,
Mikulic M.A., Miller R.M. (1985) Multiple Sclerosis: Part 1. Common physical
disabilities and rehabilitation. AFP 32:157-163.
Duquette P., Duquette J., and
Bouvier G. (1980) [Electrical stimulation of the spinal cord in multiple
sclerosis]. Union Med. Can. 109, 890-894.
Fredriksen T.A., Bergmann S.,
Hesselberg J.P., Stolt-Nielsen A., Ringkjob R., and Sjaastad O. (1986)
Electrical stimulation in multiple sclerosis. Comparison of transcutaneous
electrical stimulation and epidural spinal cord stimulation. Appl. Neurophysiol.
49, 4-24.
Abstract: Forty-nine multiple sclerosis patients with bladder symptoms and/or
walking disability were subjected to a therapeutic trial with electrical spinal
cord stimulation and transcutaneous electrical stimulation, a second aim being
to compare these two treatments. A clear subjective improvement in bladder
symptoms was achieved in the majority of the cases, and this was substantiated
by objective parameters. In a proportion of cases a more moderate improvement
seems to have been achieved in a variety of symptoms. Transcutaneous electrical
stimulation seems to be a useful selection procedure for later electrical spinal
cord stimulation
Gross R.E. and Lozano A.M.
(2000) Advances in neurostimulation for movement disorders. Neurol. Res. 22,
247-258.
Abstract: In just 12 years since its introduction, deep brain stimulation (DBS)
has become well established as a safe and effective therapy in the treatment of
medically refractory movement disorders. Ventralis intermedius (Vim) DBS has
virtually replaced thalamotomy in the routine clinical treatment of essential
tremor, affording relief to thousands of patients who previously would not have
undergone surgery, and there is increasing usage of Vim DBS in other tremors of
intention (e.g., multiple sclerosis). Subthalamic nucleus (STN) and globus
pallidus internus (GPi) DBS have revolutionized the treatment of advanced stage
Parkinson's disease, improving all cardinal disease features and increasing 'on'
time without dyskinesias. Finally, DBS of various sub- cortical structures is
being developed and tested in other less prevalent movement disorders such as
dystonia. Future developments in this rapidly advancing area will no doubt
include widening indications for this relatively safe surgical procedure,
elucidation of the mechanisms of action of electrical stimulation, and
technological advancements improving effectiveness and convenience
Haher J.N., Haher T.R., Devlin
V.J., Schwartz J. (1983) The release of flexion contractures as a prerequisite
for the treatment of pressure sores in multiple sclerosis: a report of 10 cases.
Ann Plast Surg 11:246-249.
Hess C.W., Mills K.R., Murray
N.M., and Schriefer T.N. (1987) Magnetic brain stimulation: central motor
conduction studies in multiple sclerosis. Ann. Neurol. 22, 744-752.
Abstract: Central motor conduction (CMC) was evaluated in 32 normal subjects and
83 patients with multiple sclerosis, and the findings were correlated with
clinical signs and evoked potential data. CMC time was obtained from the latency
difference in responses from the abductor muscle of the little finger to
magnetic stimulation of the motor cortex and electrical stimulation at the
C-7/T-1 interspace. Mean CMC time in normal subjects was 6.2 msec (SD 0.86 msec),
and amplitudes of responses to cortical stimuli were at least 18% of those
obtained with stimuli at the wrist. CMC was abnormal in 60 patients with
multiple sclerosis (72%); this correlated well with brisk finger flexor jerks (p
less than 0.005). CMC was abnormal in 79% of patients with weakness of the
abductor muscle of the little finger and in 54% with a normal muscle.
Neurological examination was normal in 7 arms with abnormal CMC. Visual evoked
potentials were abnormal in 67%, somatosensory evoked potentials in 59%, and
brainstem auditory evoked potentials in 39% of those tested. For each procedure
more subjects had abnormal CMC and normal evoked potentials than the reverse.
The technique is of value for demonstrating and documenting central motor
pathway lesions in multiple sclerosis, especially when physical signs are
equivocal
Javidan M., Elek J., and
Prochazka A. (1992) Attenuation of pathological tremors by functional electrical
stimulation. II: Clinical evaluation. Ann. Biomed. Eng 20, 225-236.
Abstract: In this study we evaluated a technique for tremor suppression with
functional electrical stimulation (FES), the technical details of which were
described in the previous paper. Three groups of patients were investigated:
those with essential tremor, parkinsonian tremor, and cerebellar tremor
associated with multiple sclerosis. In each group, tremor was attenuated by
significant amounts (essential tremor: 73%; parkinsonian tremor: 62%; cerebellar
tremor: 38%). These attenuations were in good accord with predictions based on
the dynamic analyses and filter designs derived in the previous paper. With
filters "tuned" to the lower mean tremor frequency encountered in the cerebellar
patients, more attenuation was possible in this group as well. We identified
some practical limitations in the clinical application of the technique in its
present form. The most important was that in daily use, only one antagonist pair
of muscles can realistically be controlled. At first sight, this restricts the
usefulness of the system to patients with single-joint tremors. However, the
concomitant use of mechanical orthoses may broaden the scope of application
Lenman A.J., Tulley F.M.,
Vrbova G., Dimitrijevic M.R., and Towle J.A. (1989) Muscle fatigue in some
neurological disorders. Muscle Nerve 12, 938-942.
Abstract: Fatigue of tibialis anterior (TA) was induced by repetitive electrical
stimulation. Using this test, patients with upper motor neuron muscle weakness
owing to multiple sclerosis (MS) and injuries to the spinal cord showed greater
fatigability of their TA muscles, suggesting that the muscle fiber population
changed toward that typical of fatigable motor units. During repetitive
stimulation, in addition to the decrement in tension there was an increase in
half-relaxation time of tetanic contractions at 40 Hz in both subjects and
patients. The increase in half relaxation during repeated activity was greater
in patients with MS and spinal cord injury than in healthy subjects, suggesting
that the long-term inactivity affected the efficiency of the Ca2+ uptake
mechanism of their muscle fibers. Thus long-term inactivity of patients with
upper motoneuron dysfunction leads to increased fatigability of their muscles
and exaggerates the slowing of muscle relaxation after prolonged exercise
Mathers S.E., Ingram D.A., and
Swash M. (1990) Electrophysiology of motor pathways for sphincter control in
multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 53, 955-960.
Abstract: The central and peripheral motor pathways serving striated sphincter
muscle function were studied using cortical and lumbar transcutaneous electrical
stimulation, pudendal nerve stimulation and sphincter electromyography in 23
patients with multiple sclerosis (MS), and sphincter disturbance, including
incontinence of urine or faeces, urinary voiding dysfunction, or constipation.
The central motor conduction time was significantly increased in the MS group
compared to controls (p less than 0.05). Damage to both the upper and lower
motor neuron pathways can contribute to sphincter disturbance in MS. The latter
may be due to coexisting pathology or to involvement of the conus medullaris by
MS
Montgomery E.B., Jr. (1999)
Deep brain stimulation reduces symptoms of Parkinson disease. Cleve. Clin. J.
Med. 66, 9-11.
Abstract: Surgical ablation or continuous electrical stimulation of specific
areas deep in the brain may help patients with Parkinson disease or other
movement disorders for whom medications have failed or who experience
dose-limiting side effects from medications
Perry J., Gronley J.K.,
Lunsford T. (1981) Rocker Shoe as Walking Aid in Multiple Sclerosis. Arch Phys
Med Rehabil 62:59-65.
Primus G. and Kramer G. (1996)
Maximal external electrical stimulation for treatment of neurogenic or non-neurogenic
urgency and/or urge incontinence. Neurourol. Urodyn. 15, 187-194.
Abstract: Maximal electrical stimulation by intravaginal or intra-anal
electrodes was used for treatment of 75 patients with complaints of urgency
and/or urge incontinence. The patient group consisted of 51 women and 24 men. A
neurogenic background was present in 30 of the women who had a diagnosis of
multiple sclerosis, in the other 45 patients the pathology was idiopathic in
nature. After 3 weeks of maximal electrical stimulation treatment, composed of
15 sessions of 20 minutes duration, 59% of the patients had urodynamic and
subjective improvement and an additional 40% only subjective improvement. One
patient found no benefit after this treatment. The effect lasted for at least 2
years in 64% of the idiopathic group. In the multiple sclerosis group relapse
occurred within about 2 months. Re-treatment of the failures was successful
again immediately; the multiple sclerosis patients do need daily home
stimulation treatments
Primus G. (1992) Maximal
electrical stimulation in neurogenic detrusor hyperactivity: experiences in
multiple sclerosis. Eur. J. Med. 1, 80-82.
Abstract: OBJECTIVES: We report our experiences with maximal tolerable
electrical stimulation in neurogenic bladder dysfunction due to multiple
sclerosis. METHODS: 27 female patients were treated with an intravaginal
electrode carrier and an external pulse generator. The devices were individually
adjustable with respect to electrode positioning and stimulation parameters. The
frequency was 20 Hz. The threshold for sensation of the electrical stimulus was
determined by slowly increasing the current and care was taken to stimulate with
maximal tolerable stimuli. Urodynamic evaluation was done before and after
cessation of treatment. RESULTS: During stimulation, 85% of the patients were
free of symptoms. Three months after cessation of treatment only 18% remained
free of symptoms, but the symptoms were not as pronounced as before treatment.
CONCLUSION: Electrical stimulation using intravaginal electrodes represents a
practical technical choice to treat motor urge incontinence in multiple
sclerosis patients, although chronic stimulation is needed to retain improvement
Ruud Bosch J.L. and Groen J.
(1996) Treatment of refractory urge urinary incontinence with sacral spinal
nerve stimulation in multiple sclerosis patients. Lancet 348, 717-719.
Abstract: BACKGROUND: Urge urinary incontinence in multiple sclerosis patients
is usually due to detrusor hyperreflexia. Patients who do not respond to
conservative measures such as anticholinergics, with or without clean
intermittent catheterisation, are difficult to manage. METHODS: We applied
electrical stimulation to the S3 sacral spinal nerves with the aim of activating
afferent somatic nerve fibres. Stimulation of these fibres can inhibit the
micturition reflex. An S3 electrode coupled to a subcutaneously placed pulse
generator was implanted in four women who had shown a good response during
temporary stimulation via a percutaneously placed wire electrode. All patients
were followed for at least 2 years. FINDINGS: The number of leakage episodes
decreased from a mean of 4 to 0.3 per 24 h. Two patients were completely dry.
The hyperreflexia disappeared in one, improved in two, and got worse in one
patient. The urodynamic result in the last patient may be explained by clinical
progression of the multiple sclerosis. INTERPRETATION: Chronic stimulation of
the S3 sacral spinal nerve by an implantable neuroprosthesis is a promising
treatment option for selected multiple sclerosis patients with refractory urge
incontinence.
Schriefer T.N., Hess C.W.,
Mills K.R., and Murray N.M. (1989) Central motor conduction studies in motor
neurone disease using magnetic brain stimulation. Electroencephalogr. Clin.
Neurophysiol. 74, 431-437.
Abstract: Central motor conduction (CMC) to abductor digiti minimi (ADM) was
evaluated in 22 patients with motor neurone disease (MND) using magnetic
stimulation of the motor cortex and electrical stimulation at the C7/T1
interspace. CMC was abnormal in 14 patients; prolonged CMC time and absence of
response to brain stimulation were more frequent abnormalities than low
amplitude responses without prolonged CMC time. The technique can reveal
subclinical upper motor neurone involvement and document central motor pathway
dysfunction in MND. The patterns of abnormality are not specific to MND; all may
occur in other neurological disorders including multiple sclerosis
Siegfried J. and Lippitz
B. (1994) Chronic electrical stimulation of the VL-VPL complex and of the
pallidum in the treatment of movement disorders: personal experience since 1982.
Stereotact. Funct. Neurosurg. 62, 71-75.
Abstract: Since 1982, we have been able to control involuntary movements
associated with deaf-ferentation by means of chronic electrical stimulation of
the thalamic sensory nucleus through implanted programmable neuropacemakers.
Since 1987, we have been using the same system with electrodes chronically
implanted in the VL for treating selected cases of tremor due to Parkinson's
disease, multiple sclerosis and in cases of essential tremor. In our series of
60 patients, suppression of tremor was achieved in almost all cases; however,
due to dysarthria in 30% of the cases (cases after previous thalamotomy in the
other side or with bilateral stimulation), the amplitude of stimulation was
corrected and thus some tremor was still observed. The rigidity of parkinsonism
was in all cases improved. One case of hemiballism was perfectly controlled with
the same technique. Finally, 3 cases of Parkinson's disease with severe
hypokinesia, speech and gait disturbances, and on-off phenomenon have been
globally improved by a bilateral chronic stimulation of the pallidum
Siegfried J., Lazorthes Y., and
Broggi G. (1981) Electrical spinal cord stimulation for spastic movement
disorders. Appl. Neurophysiol. 44, 77-92.
Abstract: Clinical results of electrical stimulation of the spinal cord at three
different clinics are reported for 53 patients suffering from different spastic
movement disorders out of a series of 164 cases tested transitorily. Two-thirds
of the cases were multiple sclerosis patients. The difficulty of objective
assessment is emphasized. Motor function was principally evaluated and
surprisingly showed a marked improvement 1-5 years after the implantation of an
electrical device. Other criteria are analyzed and compared with literature.
Dorsal cord stimulation seems to be a valuable method for improving the quality
of life in a limited percentage of cases of neurological motor disorders
Siegfried J. (1980) Treatment
of spasticity by dorsal cord stimulation. Int. Rehabil. Med. 2, 31-34.
Abstract: Two types of operations can be proposed today in the neurosurgical
treatment of spasticity; the destruction of a brain target, a medullary pathway
or a nerve root, and electrical stimulation of nervous structures. Striking
improvements in voluntary motor control and sensory appreciation were first
reported by Cook and Weinstein (1) in 1973, after implantation of a dorsal cord
stimulator for intractable back pain in a case of muiltiple scleroris. The
favourable effect on spasticity was confirmed later by other groups. Our own
experience, with 26 cases tested for a few days with floating electrodes and 11
cases operated on and followed up for more than 3 years, shows that the best
results are obtained in cases of medullary spasticity, without complete section
of the cord, occurring mainly in multiple sclerosis. Cerebral spasticity did not
respond as well. The objective data, measurement of stretch and H-reflexes,
support the clinical results. The physiological mechanisms of dorsal cord
stimulation on spasticity have not yet been elucidated
Smeltzer S.C., Skurnick J.H.,
Troiano R., Cook S.D., Duran W., Laviates M.H. (1992) Respiratory function in
multiple sclerosis. Utility of clinical assessment of respiratory muscle
function. Chest 101:479-484.
Swain I.D., Burridge J.H.,
Johnson C.A., Mann G.E., Taylor P.N., Wright P.A. (2000) The efficacy of
Functional Electrical Stimulation in improving walking ability for people with
multiple sclerosis. Proc 5th Annual Conf of the IFESS Society,
Aalborg, Denmark, pp 55-58.
Tani S., Shimizu H., Ishijima
B., and Hanakago R. (1984) [Our experiences of PISCES (percutaneously inserted
spinal cord electrical stimulation) in SMON and other neurologic disorders]. No
To Shinkei 36, 383-388.
Abstract: Percutaneously inserted spinal cord electrical stimulation (PISCES)
was carried out in eleven intractable pain cases and in one spastic paraplegic
case. The causes of intractable pain constitute subacute myelo-optic neuropathy
(SMON) 6 cases, cerebrovascular disease 2 cases, multiple sclerosis (MS) 1 case,
Charcot-Marie-Tooth (CMT) 1 case and transverse myelitis (TM) 1 case. The cause
of spastic paraplegia was due to the ossification of posterior longitudinal
ligament (OPLL). A trial stimulation was performed about two weeks before
planning a permanent implantation of PISCES system. For the trial stimulation,
epidural electrodes were percutaneously inserted with a guide of fluoroscopy in
a X-ray room. The conditions of stimulation were adjusted to give an optimal
electric dysesthesia. We employed pulse width 0.1-1.0 msec, pulse rate 1-120 Hz
and pulse amplitude 0-10 Volt. If an excellent effect was obtained by trial
study, we proceeded to the chronic implantation of PISCES system which were
composed of epidural electrodes, a subcutaneous receiver and a surface antenna.
The procedure of implantation was carried out in an operating room under local
anesthesia. In our series, seven subjects (58%) experienced a rewarding effect
by the trial stimulation and three underwent the permanent implantation of
PISCES. We summarized the clinical courses of these three cases which were OPLL,
CMT and SMON. Compared with the other methods for pain relief, PISCES is most
characteristic in its safety and simplicity. To date, PISCES has been applied to
various disorders; such as ataxia, spasticity, intractable pain, neurogenic
bladder and peripheral vascular disease. But its efficacy has not been
established in all these disorders.(ABSTRACT TRUNCATED AT 250 WORDS)
Taylor P.N., Burridge J.H.,
Dunkerley A.L., Wood D.E., Norton J.A., Singleton C., and Swain I.D. (1999)
Clinical use of the Odstock dropped foot stimulator: its effect on the speed and
effort of walking. Arch. Phys. Med. Rehabil. 80, 1577-1583.
Abstract: OBJECTIVE: To assess the clinical effectiveness of the Odstock dropped
foot stimulator by analysis of its effect on physiological cost index (PCI) and
speed of walking. This functional electrical stimulation (FES) device stimulates
the common peroneal nerve during the swing phase of gait. DESIGN: A
retrospective study of patients who had used the device for 4 1/2 months.
SUBJECTS: One hundred fifty-one patients with a dropped foot resulting from an
upper motor neuron lesion. SETTING: A medical physics and biomedical engineering
department of a district general hospital specializing in the clinical
application of FES and a neurophysiotherapy department at a separate hospital.
MAIN OUTCOME MEASURES: Changes in walking speed and effort of walking, as
measured by PCI over a 10-meter course. RESULTS: There was a 92.7% compliance
with treatment. Stroke patients showed a mean increase in walking speed of 27%
(p<.01) and reduction in PCI of 31% (p`.01) with stimulation, and changes of 14%
(p<.01) and 19% (p<.01), respectively, while not using the stimulator. Multiple
sclerosis patients gained similar orthotic benefit but no "carry-over."
CONCLUSIONS: The measured differences in walking with and without stimulation
were statistically significant in the stroke and multiple sclerosis groups. In
this study use of the stimulator improved walking. Those with stroke
demonstrated a short-term "carry-over" effect
Taylor P.N., Burridge J.H.,
Dunkerley A.L., Lamb A., Wood D.E., Norton J.A., and Swain I.D. (1999) Patients'
perceptions of the Odstock Dropped Foot Stimulator (ODFS). Clin. Rehabil. 13,
439-446.
Abstract: OBJECTIVE: To determine the perceived benefit, pattern and problems of
use of the Odstock Dropped Foot Stimulator (ODFS) and the users' opinion of the
service provided. DESIGN: Questionnaire sent in a single mailshot to current and
past users of the ODFS. Returns were sent anonymously. SETTING: Outpatient-based
clinical service. SUBJECTS: One hundred and sixty-eight current and 123 past
users with diagnoses of stroke (CVA), multiple sclerosis (MS), incomplete spinal
cord injury (SCI), traumatic brain injury (TBI) and cerebral palsy (CP).
INTERVENTION: Functional electrical stimulation (FES) to correct dropped foot in
subjects with an upper motor neuron lesion, using the ODFS. MAIN OUTCOME
MEASURES: Purpose-designed questionnaire. RESULTS: Return rate 64% current users
(mean duration of use 19.5 months) and 43% past users (mean duration of use 10.7
months). Principal reason cited for using equipment was a reduction in the
effort of walking. Principal reasons identified for discontinuing were an
improvement in mobility, electrode positioning difficulties and deteriorating
mobility. There were some problems with reliability of equipment. Level of
service provided was thought to be good. CONCLUSION: The ODFS was perceived by
the users to be of considerable benefit. A comprehensive clinical follow-up
service is essential to achieve the maximum continuing benefit from FES-based
orthoses
Vahtera T., Haaranen M.,
Viramo-Koskela A.L., and Ruutiainen J. (1997) Pelvic floor rehabilitation is
effective in patients with multiple sclerosis. Clin. Rehabil. 11, 211-219.
Abstract: OBJECTIVE: To determine the effect of pelvic floor muscle exercises
combined with electrical stimulation of pelvic floor on lower urinary tract
dysfunction in multiple sclerosis (MS) patients with near normal (# 100 ml)
postvoid residual volumes. DESIGN: Open, controlled, randomized study in two
parallel groups. SETTING: Rehabilitation centre for MS patients. SUBJECTS: Fifty
women and 30 men with definite MS and current symptoms of lower urinary tract
dysfunction. OUTCOME: The muscle activity of the pelvic floor muscles was tested
using surface EMG. Subjective urinary symptoms were assessed using a
questionnaire. INTERVENTIONS: Pelvic floor muscles were stimulated using
electrical stimulation at six sessions. During and after the final session the
patients were taught to exercise their pelvic floor muscles and advised to
continue these exercises regularly for at least six months. The control group
was not treated. RESULTS: The maximal contraction power and endurance of the
pelvic floor muscles increased after six sessions of electrical stimulation with
interferential currents. Symptoms of urinary urgency, frequency and incontinence
were significantly less frequent in the treated group than in the untreated
subjects. Male patients appeared to respond better to the treatment than female
patients. Compliance with the pelvic floor exercises was over 60% at the end of
a follow-up for six months. Most drop-outs were due to the disappearance of
urinary tract symptoms or to severe relapses in MS. CONCLUSIONS: The present
study indicates that pelvic floor muscle exercises combined with electrical
stimulation of the pelvic floor constitute an effective treatment for lower
urinary tract dysfunction at least in male patients with MS
Vodovnik L., Rebersek S.,
Stefanovska A., Zidar J., Acimovic R., and Gros N. (1988) Electrical stimulation
for control of paralysis and therapy of abnormal movements. Scand. J. Rehabil.
Med. Suppl 17, 91-97.
Abstract: After a short review of the functional aspects of electrical
stimulation in rehabilitating paralysed patients, the article describes its
effects on spasticity. Three different studies are briefly described. In the
first one paraplegic patients' knee extensors and flexors were stimulated with
four channel stimulator. In the second one two channel stimulation was applied
to the ankle joint flexors and extensors in hemiplegic patients, while in the
third, the effects of spinal cord stimulation were studied in multiple sclerosis
patients. Although the parameters and sites of stimulation were different in
each study, the effects were similar. In approximately 50% of paraplegic and
hemiplegic patients stimulation caused decrease of reflex activity which lasted
more than half an hour. In M.S. patients measurements were performed only in
intervals of day and therefore short term effects were not documented. Two days
after interruption of continuous spinal cord stimulation the reflex activity
significantly increased in the majority of patients. In addition to this
increase the volitional force decreased considerably
Winter A. (1976) The use
of transcutaneous electrical stimulation (TNS) in the treatment of multiple
sclerosis. J. Neurosurg. Nurs. 8, 125-131.
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