Physical Therapy & Rehabilitation Science
DPT (Doctor of Physical Therapy)
Session and Year of Graduation
Laura Frey Law
Background: Loss of mobility is commonly reported by people with multiple sclerosis and can dramatically affect quality of life. Foot drop is a manifestation of the disease that increases fall risk. The purpose of this case report is to describe the clinical decision-making process used in determining the best method to correct foot drop for improving gait quality in a patient with multiple sclerosis. Case Description: This case examines a 67-year-old male with a history of primary progressive multiple sclerosis. He presented to therapy for this episode of care with functional foot drop and gait disturbances. Intervention: The patient trialed two devices that are commonly prescribed to correct foot drop: the WalkAide functional electrical stimulation (FES) device and an ankle-foot orthosis (AFO). The patient began using the WalkAide device during therapy sessions focusing on gait training and also wore it when ambulating at home. Later in the episode of care, the patient switched to using an AFO during physical therapy and at home. Outcome Measures: The primary measures considered for this patient were the 6-minute walk test (6MWT), 10-meter walk test (10MWT), and the Berg balance score (BBS). The patient had a 120 feet improvement on the 6MWT at discharge. The patient showed an increase of 8 points on the BBS, signifying a noticeable improvement in balance. When directly comparing fast gait speeds with each device with the 10MWT, the patient was able to walk at 0.45 m/s with the AFO and 0.35 m/s with the WalkAide. Discussion: This report supports the use of one of these devices to assist with foot drop as an adjunct to traditional physical therapy interventions in some patients with MS. The clinical decision between the devices should take into consideration objective measures of gait speed and balance, the observable kinematic effect on the ankle and knee, and the patient’s preference. The patient in this case ultimately preferred the AFO due to the stability it provided at both his ankle and knee.
Multiple sclerosis; ankle-foot orthosis; AFO; foot drop; functional electrical stimulation; FES; gait training; neurology; physical therapy; rehabilitation
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