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WalkAide: experiences with a multidisciplinary model for testing, adjustment and follow-up
K.Ø. Jones, T. Smedal (Bergen, NO)
Background: WalkAide (WA) is an electrical device designed to improve walking for people with drop-foot caused by central nervous lesions e.g multiple sclerosis (MS). WA uses functional electric stimulation (Peroneal nerve) to activate lift of the foot in the swing-phase.
Goals: To evaluate a multidisciplinary systematic way of testing and adjusting WA, and to examine whether WA seemed suitable for our patients with MS.
Methods: Patients with MS who were considered relevant for WA were referred by a neurologist (2010-2012) for two short day-hospital stays at the Department of Neurology. During the first stay, a physiotherapist (PT) and an orthotist (CPO) cooperated to ensure best combination of walking analysis and knowledge in technical opportunities. PT evaluated gait, motor and sensory functions and core stability. Cognitive function related to handling the WA was considered. Based on the evaluation and the patients` goals and motivation, it was decided whether WA seemed suitable. During the first hospital stay patients were given advice and instructions in specific exercises when needed. Eligible patients returned after one month to get and adjust WA together with the PT and CPO. Patients completed Timed Up and Go (TUG), 10-metre timed walk (10MTW) and 2-min walk test (2MWT) without and with WA. Patient Global Impression of Change (PGIC) after using WA was reported. Patients were followed up by the CPO after one and 3 months, and thereafter every 6 month. PT was involved when necessary.
Results: Forty-four patients were evaluated, and 15 were not found relevant due to e.g contractures, hip instability, severe spasticity and hypersensitivity. Twenty-nine were considered relevant (12 female and 17 male). Mean age: 55 years (range 41-72), duration of disease: 12 years (range 1-28). Twelve had RRMS, 8 SPMS and 9 PPMS. Results of tests without and with WA: TUG (n=23): 12.07 and 11.27 sec. respectively (p=0.028). 2MWT (n=21): 123 and 132m respectively (p=0.010). 10MTW (n=23): 11.27 and 10.16 sec. respectively (p=0.020). PGIC (n=25): 6 reported minimal, 18 much, and 1 very much improved. We find the multidisciplinary model appropriate.
Conclusions: Patients who received WA seemed to benefit. In future we aim to follow up the patients according to the model, and will also include a standard of PT follow-up at three-month. When implementing the model in further clinical practice, we have limited the test battery to either 2MWT or 6MWT, Borg Scale and PGIC.
K.Ø. Jones, T. Smedal (Bergen, NO)
Background: WalkAide (WA) is an electrical device designed to improve walking for people with drop-foot caused by central nervous lesions e.g multiple sclerosis (MS). WA uses functional electric stimulation (Peroneal nerve) to activate lift of the foot in the swing-phase.
Goals: To evaluate a multidisciplinary systematic way of testing and adjusting WA, and to examine whether WA seemed suitable for our patients with MS.
Methods: Patients with MS who were considered relevant for WA were referred by a neurologist (2010-2012) for two short day-hospital stays at the Department of Neurology. During the first stay, a physiotherapist (PT) and an orthotist (CPO) cooperated to ensure best combination of walking analysis and knowledge in technical opportunities. PT evaluated gait, motor and sensory functions and core stability. Cognitive function related to handling the WA was considered. Based on the evaluation and the patients` goals and motivation, it was decided whether WA seemed suitable. During the first hospital stay patients were given advice and instructions in specific exercises when needed. Eligible patients returned after one month to get and adjust WA together with the PT and CPO. Patients completed Timed Up and Go (TUG), 10-metre timed walk (10MTW) and 2-min walk test (2MWT) without and with WA. Patient Global Impression of Change (PGIC) after using WA was reported. Patients were followed up by the CPO after one and 3 months, and thereafter every 6 month. PT was involved when necessary.
Results: Forty-four patients were evaluated, and 15 were not found relevant due to e.g contractures, hip instability, severe spasticity and hypersensitivity. Twenty-nine were considered relevant (12 female and 17 male). Mean age: 55 years (range 41-72), duration of disease: 12 years (range 1-28). Twelve had RRMS, 8 SPMS and 9 PPMS. Results of tests without and with WA: TUG (n=23): 12.07 and 11.27 sec. respectively (p=0.028). 2MWT (n=21): 123 and 132m respectively (p=0.010). 10MTW (n=23): 11.27 and 10.16 sec. respectively (p=0.020). PGIC (n=25): 6 reported minimal, 18 much, and 1 very much improved. We find the multidisciplinary model appropriate.
Conclusions: Patients who received WA seemed to benefit. In future we aim to follow up the patients according to the model, and will also include a standard of PT follow-up at three-month. When implementing the model in further clinical practice, we have limited the test battery to either 2MWT or 6MWT, Borg Scale and PGIC.