The effects of adding a neuromuscular electrical stimulation device to a progressive resistance training programme in people with multiple sclerosis

Background: Multiple Scelrosis (MS) is a progressive demyelinating disease of the central nervous system. It is recognised that people with MS (PwMS) who require a mobility aid, experience higher levels of disability, compared to those without mobility impairment. Decreased strength of the lower limbs is a primary problem, which is clinically associated with functional limitations in MS. Progressive resistance training (PRT) and neuromuscular electrical stimulation (NMES), to a lesser degree, are effective rehabilitation strategies to improve strength and function in PwMS. Presently, there is limited literature to support superimposing NMES on PRT in PwMS, particularly in the home-setting. The clinical profile literature of PwMS who use a walking aid, is also limited. Aims: The primary aim of this thesis was to investigate the effects of adding an NMES device (Kneehab) to a home-based PRT in PwMS who use a walking aid. Secondary aims included, evaluating the clinical profile of this population and determining participant satisfaction with the Kneehab device. Methods: The study used a randomised design to compare 12 weeks of homebased PRT to the same with superimposed NMES. The Kneehab device is designed for the quadriceps. The study assessor was blinded to group allocation. Participants were evaluated at week 0, 6 and 12 for a number of important clinical problems that were identified in the literature review. These included quadriceps strength (primary outcome), quadriceps thickness and endurance, spasticity, balance, mobility, health-related quality of life (HRQoL) and fatigue. Participants in the Kneehab group completed a device satisfaction questionnaire. Results: Thirty-seven PwMS participated in the study. The baseline data for this group showed that muscle weakness, balance and mobility limitations were severe problems. Moderate correlations between quadriceps endurance and balance (r=0.692), and quadriceps endurance and mobility (r=-0.583) were shown. Twenty-five participants completed the study (PRT n=10; Kneehab n=15). Two-drop-outs in the Kneehab group were due to muscle spasm induced by the device. In both groups, quadriceps strength increased non-significantly while balance and gluteal strength improved significantly (p<0.05). The Kneehab group improved significantly on plantar-flexion strength, rectus femoris thickness, quadriceps endurance, perceived spasticity, HRQoL ad fatigue (all p<0.05). The plantar-flexion strength, spasticity, HRQoL and fatigue improvements in the Kneehab group were significantly greater than the PRT group (all p<0.05). The Kneehab group also completed significantly more sessions, and total and quadriceps work (all p<0.05). Participants were satisfied with the usability and value of having the Kneehab device. Conclusion: This preliminary research indicates that adding an NMES device to a PRT programme for PwMS who use a walking aid results in better outcomes than PRT alone. This may be due to a placebo type effect, whereby participants were motivated to complete a more exercise due to having the device. Recommendations for future research to determine the effects of this superimposing NMES on PRT are made.