Case Report Rehabilitation with Neuromuscular Electrical Stimulation Leads to Functional Gains in Ambulation in Patients with Secondary Progressive and Primary Progressive Multiple Sclerosis: A Case Series Report

Background: Gait disability in patients with secondary progressive multiple sclerosis (SPMS) or primary progressive multiple sclerosis (PPMS) rarely improves. Primary study objective: This article reports on a case series of patients with SPMS and PPMS who were treated using neuromuscular electrical stimulation (NMES), a well-tolerated physical therapy (PT) treatment modality used to aid musculoskeletal recovery, coupled with a home-exercise program (HEP) to treat MS-related gait disability. Setting: The setting for this trial was a PT private practice. Patients: This trial was conducted with patients who had SPMS or PPMS with MS-related gait disability. Case series description/intervention: Between June 2007 and June 2009, a licensed physical therapist (R.D.) used NMES coupled with a HEP to work with patients who had SPMS/PPMS and multiple sclerosis (MS)–related gait disability. All of the cases in which an NMES test session of NMES was conducted were included in the case series. Data regarding MS symptoms, treatment, gait, and function were abstracted from the PT clinic notes. Results of assessment with the expanded Kurtzke Disability Status Scale (EDSS) at presentation and at most recent visit were abstracted from the clinical record by the treating physical therapist (R.D.). Clinical outcome/results: Nine (9) patients (7 with SPMS and 2 with PPMS) met inclusion criteria for review. Mean of years of diagnosis was 10.4 (range, 4–15), and mean EDSS score at presentation was 5.9 (range, 4.5–6.5). Mean of days of NMES was 140 (range, 22–495). Mean EDSS scores improved by 0.78 (range, 0–2.0). Conclusions: NMES, an approved Food and Drug Administration treatment modality for muscle spasm, muscle pain, and disuse atrophy—all of which are commonly present in patients with gait disability associated with SPMS and PPMS—was associated with measurable gains in ambulatory function. Additional studies are warranted.