Combining Telerehabilitation with Functional Electrical Stimulation for Walking for People with Multiple Sclerosis: A Pilot Study

Background: Research suggests that people with multiple sclerosis (MS) have improved outcomes when receiving physical therapy remotely and receiving functional electrical stimulation (FES) during walking. However, there has been little research investigating the combination of these two treatments.

Objectives: This study investigated the benefits and challenges of combining telerehabilitation with FES for walking for people with MS.

Methods: Nine patients diagnosed with MS received an EvoWalk device (Evolution Devices, Inc.) by mail and remote physical therapy for once a week (1 hour per session) for 9 weeks. Two of the nine patients did not complete treatment due to discomfort caused by electrical stimulation. Patients were instructed to wear the EvoWalk to assist them with walking throughout their daily life. The EvoWalk measures walking metrics and applies electrical stimulation during walking. Patients were administered a MS walking scale and activity specific balance scale at the beginning and conclusion of the treatment. In addition, the EvoWalk tracked the walking speed of each patient throughout the treatment.

Results: We found that patients were able to set up the FES device with remote guidance after 1-2 sessions. At the conclusion of the study, patients improved in MS walking scale (from 61% to 53%, p = 0.052), suggesting the impact of MS on their symptoms was reduced. They did not, however, improve in the activity- specific balance scale (69% to 68%, p=0.79). Patients demonstrated a moderate improvement in walking speed (0.69 m/s to 0.75 m/s, p = 0.29).

Conclusions: Overall, we found combining FES with remote therapy and monitoring is not only feasible but likely improves outcomes and FES adherence in patients with MS and should be investigated further.