Campbell J.1
1California State University, Long Beach, Department of Physical Therapy, Long Beach, United States
Background: Urinary incontinence has been reported in 50 to 90% of individuals with multiple sclerosis [MS]. Prior investigators have employed percutaneous and cutaneous tibial nerve electrical stimulation [ES] and pelvic floor stimulation protocols with some success, but the protocols required clinical visits and invasive procedures. Prior investigators have not assessed changes in ankle range of motion [ROM], muscle performance or walking during lower limb ES for management of incontinence.
Purpose: The purpose of this pilot study was to determine if a 3 month home ES program with cutaneous electrodes on the leg would reduce incontinence and improve both function and mechanical characteristics of gait in a sample of people with MS.
Methods: Subjects completed a consent form, questionnaire and the MS Quality of Life Survey and then participated in a clinical assessment including ROM, manual muscle testing [MMT], spasticity assessment, Timed Up and Go [TUG], Berg Balance Scale [BBS], and 6 Minute Walk Test [6MWT]]. The GAITRite documented mechanical characteristics of gait. The ES home protocol included motor stimulation over the tibialis anterior [TA] combined with ankle dorsiflexion exercise for 30 minutes and ES over the calf at a sensory level for 1.5 hours daily. Daily logs, including frequency of urination and nocturia, were completed by the subject. All procedures were approved by the CSULB Research Committee. Descriptive statistics, Paired t-tests and Chi-Square [p .05] were used to analyze the data using the SPSS statistical software.
Results: 17 individuals with MS, 8 women and 9 men, 55.5 ±13.8 years of age and 13.3 ±11.9 years with MS, participated. Significant improvements occurred in ankle dorsiflexion ROM, TA MMT, single limb support time, BBS, and incontinence (p .05). Subjective reports on the daily logs were positive and reflected changes in spasticity, incontinence or function that began in week 1 through week 10. Selected subjects reported improved sleeping as a result of reduced nocturia and fewer episodes of spasticity during sleep.
Conclusion(s): The 12 week home ES protocol reduced daytime frequency of urination as well as nocturia in this sample of people with MS. Prior investigations in the effectiveness of ES in incontinence in MS have not assessed other clinical impairments. This study illustrates that improvement in ankle dorsiflexion ROM and improved TA MMT, along with modulation of spasticity at the ankle and knee were reflected in walking ability. Improvements in walking were observed in individuals who walked without and with ambulatory aids.
Implications: The immediate clinical significance is the improvement in incontinence and walking as a result of a practical, inexpensive, non-invasive ES protocol that can be done at home. Improvement in sleeping was among the improved quality of life measures. Further study is needed to document the effects in a larger sample size and to determine if a 3 times/week protocol would result in the same benefits as daily ES.
Funding acknowledgements: None
Topic: Neurology: multiple sclerosis
Ethics approval: This study has been and is currently approved by the Research Committee at California State University, Long Beach.
All authors, affiliations and abstracts have been published as submitted.
