Functional Electrical Stimulation (FES) braces improve gait

March 29, 2014 Angeli Mayadev, MD

Up to 80 percent of people with multiple sclerosis (MS) have problems with walking.  The combination of weakness of the muscles of the legs, spasticity, and core weakness contributes to this.  Often, it will present with problems lifting the foot, referred to as foot drop.  This is due to weakness of the muscles that lift the foot (dorsiflexors) and spasticity or over power of the muscles that push the foot down (plantar flexors).  Traditional ankle foot orthosis have advantages over functional electrical stimulation (FES) braces in that they help with ankle stability and reduce spasticity.  Advantages of FES braces include some evidence that there may be stimulation of the cortical neurons above the stimulation area, they are less cumbersome, and more discrete to wear.

A recent study looked at walking parameters in MS patients with and without an FES brace as well as healthy controls at self-selected speeds. Compared to healthy controls, MS patients walked slower and showed differences in nearly all aspects of walking. Examples are shorter stride length, reduced dorsiflexion at onset of walking, reduced plantar flexion at the end of foot down, and reduced knee flexion in swing of the leg.  Using an FES brace for foot drop resulted in more normal walking.  A limitation of FES braces are the cost - which is usually not covered by insurance in patients with MS.

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