Epub:
McLoughlin et al. Effect of wearing a dorsiflexion assist orthosis on mobility, perceived fatigue and exertion during the six-minute walk test in people with multiple sclerosis: a randomised cross-over protocol. BMC Neurol. 2012 May 25;12(1):27.
METHODS: A randomised cross-over trial will be conducted with 40 community dwelling
MSers with mild to moderate mobility disability. Participants will initially be screened for disease severity, balance, strength, depression and fatigue at the South Australian Motion Analysis Centre. On two non-consecutive occasions, within two weeks, participants will undergo either the 6-minute walk test (6MWT) or the 6MWT while wearing a dorsiflexion ankle orthosis (with a randomised condition order). Distance walked, perceived exertion, perceived fatigue and the physiological cost of walking (the primary outcome measures) will be compared between the two walking conditions. Additional pre- and post-6MWT assessments for the two conditions will include tests of strength, reaction time, gait and balance.
DISCUSSION: This study will increase our understanding of motor fatigue on gait and balance control in
MSers and elucidate the effect of a Dynamic Ankle Orthosis on fatigue-related balance and gait in PWMS. It will also examine relationships between mobility and balance performance with perceived fatigue levels in this group.
McLoughlin et al. Effect of wearing a dorsiflexion assist orthosis on mobility, perceived fatigue and exertion during the six-minute walk test in people with multiple sclerosis: a randomised cross-over protocol. BMC Neurol. 2012 May 25;12(1):27.
BACKGROUND: Fatigue in combination with gait and balance impairments can severely limit daily activities in MSers. Generalised fatigue has a major impact on walking ability, with moderately disabled
MSers experiencing difficulty in walking extended distances. Localised motor fatigue in the ankle dorsiflexors can lead to foot drop, further reducing functional ambulation. The aim of this study is to evaluate the effect of a simple dynamic dorsiflexion assist orthosis on walking-induced fatigue, gait, balance and functional mobility in
MSers.
METHODS: A randomised cross-over trial will be conducted with 40 community dwelling
MSers with mild to moderate mobility disability. Participants will initially be screened for disease severity, balance, strength, depression and fatigue at the South Australian Motion Analysis Centre. On two non-consecutive occasions, within two weeks, participants will undergo either the 6-minute walk test (6MWT) or the 6MWT while wearing a dorsiflexion ankle orthosis (with a randomised condition order). Distance walked, perceived exertion, perceived fatigue and the physiological cost of walking (the primary outcome measures) will be compared between the two walking conditions. Additional pre- and post-6MWT assessments for the two conditions will include tests of strength, reaction time, gait and balance.
DISCUSSION: This study will increase our understanding of motor fatigue on gait and balance control in
MSers and elucidate the effect of a Dynamic Ankle Orthosis on fatigue-related balance and gait in PWMS. It will also examine relationships between mobility and balance performance with perceived fatigue levels in this group.
“A publication about a planned study. Do you think it is well-designed? Would you change anything about the design? What about cost-effectiveness data? This study in the current form could not be used by NICE as it does not appear to include cost-effectiveness data. I would also want to know the impact on Dynamic Ankle Orthosis on falls and fractures. The latter is what our Commissioners’ have asked us about Fampridine.”
Prof G, in progressive MS, is excercise a ggod thing especially considering the stress one will be putting on already damged nerves? Is there a risk one is wearing out their nerves at a faster rate due to the fact they are stressing them out? I have PPMS and work out regularly, really pushing myself at times. Some folk tell me that that is why after seven years of living with the disease I am not yet in a wheelchair, but I'm wondering if one has anything to do with the other?
Prof G – I find the above comment interesting and as I also have PPMS (4 years), I have been thinking of organising my day around more exercise to try and maintain mobility. A comment would be welcomed.
Prof G, sorry to jump on the bandwagon, but I too want to know if excercising when having progressive MS puts undue stress on nerves and increases nerve fibre erossion? I like to push myself in the gym too, even though I'm on crutches.
Re: "… in progressive MS, is excercise a ggod thing especially considering the stress one will be putting on already damged nerves?"I really don't know; this is an evidence free zone and to say yes or no would be a guess. We have a "brain storming" session on this a few weeks ago an set out some experiments in our animal model that may give us an idea. This is an important issue and is relevant to fampridine treatment. Fampridine is may have the same effect as exercise, i.e. work vulnerable axons harder. Does this cause them to degenerate faster or does it protect them by affecting other pathways in the CNS that protects nerves. At the moment my advice to MSers is avoid exercise during an acute relapse and not to overdo it when you have a deficit in the relevant pathway. This is a thumb-suck!
Re: "Prof G, sorry to jump on the bandwagon, but I too want to know if excercising when having progressive MS puts undue stress on nerves and increases nerve fibre erossion? I like to push myself in the gym too, even though I'm on crutches."I suggest you lobby the MS Society to make a specific call to look into this with a randomised trial. It is clearly an important question that needs to be answered. Several International centres have exercise physiologists who could team up with a neurologist to do an appropriate clinical trial.
Re: "A comment would be welcomed."I don't have MS, but I try and exercise regularly (running 2-4x per week); if I miss out on exercise I get depressed. Exercise is a natural anti-depressant so it is difficult to disentangle the mood elevating effects from other symptoms. My advice therefore would be to exercise regularly, but try and not do it to exhaustion; i.e. leave enough energy in your battery to complete all your other activities. Don't make exercise the focus of your life; just a part of your life. I suspect this is easier to say than do.