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Johnson KA, Bandera VM, Diehl M, Leach HJ, Fling BW. Walking performance differs between people with multiple sclerosis who perform distinct types of exercise. Neurodegener Dis Manag 2024; 14:75-85. [PMID: 39155765 PMCID: PMC11457625 DOI: 10.1080/17582024.2024.2389037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/31/2024] [Indexed: 08/20/2024] Open
Abstract
Aim: To determine whether walking performance differed between people with multiple sclerosis (MS) who performed distinct types, volumes and intensities of exercise.Materials & methods: Forty-five people with relapsing-remitting MS performed two trials of the 2-min walk test, one at a preferred speed and another at a fast speed. Gait metrics were measured by wireless inertial sensors. Participants reported the type (aerobic, resistance), volume and intensity of exercise performed.Results: Walking speed reserve and gait variability were better in participants who performed combined aerobic and resistance exercises compared with those who performed aerobic-only exercise.Conclusion: Walking performance differs in people with mild MS disability based on the type and volume of exercise performed.
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Affiliation(s)
- Kristin A Johnson
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO 80521, USA
| | - Victoria M Bandera
- Huntsman Cancer Institute, Salt Lake City, 84112, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, 84108, Utah
| | - Manfred Diehl
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80523, USA
| | - Heather J Leach
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO 80521, USA
| | - Brett W Fling
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO 80521, USA
- Molecular, Cellular & Integrative Neurosciences Program, Colorado State University, Fort Collins, CO80523, USA
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2
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Ozkan T, Unluer NO, Ates-Sari Y, Hangun SF, Vural G. Reliability and validity of the 4-meter walk test in patients with multiple sclerosis. Mult Scler Relat Disord 2024; 87:105679. [PMID: 38759422 DOI: 10.1016/j.msard.2024.105679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/29/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Walking speed is considered a vital sign of health and better functional outcomes. It is important to assess walking speed both for disease monitoring and before starting rehabilitation. The aim of this study was to examine the reliability, validity, minimal detectable change, and the ideal cutoff time for differentiating patients with multiple sclerosis (PwMS) who fall from PwMS who do not. METHODS This study included 43 PwMS (26 female and 17 male) and 36 healthy controls (23 female and 13 male). The 4-meter walk test (4-MWT) was conducted with the 10-meter walk test (10-MWT), timed up and go (TUG) test, dynamic gait index (DGI), timed 25-foot walk (T25-FW), multiple sclerosis walking scale-12 (MSWS-12), and the expanded disability status scale (EDSS). RESULTS Excellent test-retest reliability (ICC = 0.971) was found for the 4-MWT. The SEM value was 0.38 and MDC value was 1.05. The correlations with 4-MWT, 10-MWT, TUG, DGI, T25-FW, MSWS-12, and EDSS were found to be statistically significant (p < 0.001). PwMS had longer 4-MWT times than healthy controls, and PwMS fallers had longer 4-MWT times than non-fallers with PwMS (r between 0.668 and -0.858; p < 0.05 for all). In order to distinguish fallers from non-fallers with PwMS, a 4-MWT cutoff time of 4.14 s was shown to be optimal. CONCLUSION The 4-MWT was found to be valid and reliable for PwMS. It is concluded that the 4-MWT is a feasible assessment method for clinical and methodological studies of PwMS with mild to moderate disability.
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Affiliation(s)
- Taskin Ozkan
- Giresun University, Vocational School of Health Services, Therapy and Rehabilitation, Giresun, Turkey.
| | - Nezehat Ozgul Unluer
- Health Sciences University, Gülhane Faculty of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Yasemin Ates-Sari
- Ankara Yıldırım Beyazıt University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Ankara, Turkey
| | - Suleyman Furkan Hangun
- Health Sciences University, Gülhane Faculty of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Gonul Vural
- Ankara Yıldırım Beyazıt University, Faculty of Medicine, Neurology Department, Ankara, Turkey
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3
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Monaghan PG, VanNostrand M, Fritz NE. Backwards walking speed reserve in persons with multiple sclerosis. Mult Scler Relat Disord 2024; 85:105556. [PMID: 38520947 PMCID: PMC11070283 DOI: 10.1016/j.msard.2024.105556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/15/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Decreased gait speed is common in persons with Multiple Sclerosis (PwMS) and has been associated with elevated fall risk. The walking speed reserve (WSR) indicates the ability to increase gait speed on demand and has previously been examined in PwMS. Backward walking is a sensitive measure of fall risk in PwMS; however, no studies have reported on the utility of backward walking speed reserve (BW-WSR) as a clinical assessment tool of functional mobility or fall risk in PwMS, nor have they associated this measure with cognition. METHODS 23 PwMS completed walking trials at their preferred walking speed (PWS) and maximal walking speed (MWS). Participants performed these walking trials in both the forward (FW) and backward direction (BW). The forward walking speed reserve (FW-WSR) was calculated as the difference between MWS and PWS in the forward direction, while the backward walking speed reserve (BW-WSR) was calculated as the difference between MWS and PWS in the back backward direction. Correlation analyses examined the relationship between the FW- and BW-WSR with clinical assessments of functional mobility (the timed up-and-go) as well as cognitive functioning (the Symbol Digit Modalities Test, the Brief Visuospatial Memory Test-Revised, the California Verbal Learning Test, and the Trail Making Test A and B). Correlations also examined the relationship between FW- and BW-WSR with prospective falls. RESULTS A lower BW-WSR was associated with disease severity and poorer performance on clinical walking and balance assessment, as well as with decreased information processing speed and attentional performance. Interestingly, FW-WSR showed similar relations. Neither FW- or BW-WSR were associated with prospective risk in this small sample of PwMS. CONCLUSION The BW-WSR did not offer a distinct advantage over other measures, such as the FW-WSR, PWS, or MWS, in the forward or backward direction. The selection of the most sensitive clinical measures of functional mobility and fall risk is crucial; our study holds valuable clinical implications for PwMS by providing novel insights into functional mobility assessments in PwMS.
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Affiliation(s)
- Patrick G Monaghan
- Department of Health Care Sciences, Wayne State University, Detroit, MI, United States.
| | - Michael VanNostrand
- Department of Health Care Sciences, Wayne State University, Detroit, MI, United States
| | - Nora E Fritz
- Department of Health Care Sciences, Wayne State University, Detroit, MI, United States; Department of Neurology, Wayne State University, Detroit, MI, United States
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Fritz JM, Canseco K, Konop KA, Kruger KM, Tarima S, Long JT, Law BC, Kraus JC, King DM, Harris GF. Multi-segment foot kinematics during gait following ankle arthroplasty. J Orthop Res 2022; 40:685-694. [PMID: 33913547 DOI: 10.1002/jor.25062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/13/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023]
Abstract
Ankle arthritis is a debilitating disease marked by pain and limited function. Total ankle arthroplasty improves pain while preserving motion and offers an alternative to the traditional treatment of ankle fusion. Gait analysis and functional outcomes tools can provide an objective balanced analysis of ankle replacement for the treatment of ankle arthritis. Twenty-nine patients with end-stage ankle arthritis were evaluated before and after ankle arthroplasty. Multi-segment foot and ankle kinematics were assessed annually following surgery (average 3.5 years, range 1-6 years) using the Milwaukee Foot Model and a Vicon video motion analysis system. Functional outcomes (American Orthopedic Foot and Ankle Society [AOFAS] ankle/hindfoot scale, short form 36 [SF-36] questionnaire) and temporal-spatial parameters were also assessed. Kinematic results were compared to findings from a previously collected group of healthy ambulators. AOFAS and SF-36 mean scores improved postoperatively. Walking speed and stride length increased after surgery. There were significant improvements in tibial sagittal range of motion in terminal stance and hindfoot sagittal range of motion in preswing. Decreased external rotation of the tibia and increased external rotation of the hindfoot were noted throughout the gait cycle. Pain and function improved after ankle replacement as supported by better outcomes scores, increased temporal-spatial parameters, and significant improvement in tibial sagittal range of motion during terminal stance and hindfoot sagittal range of motion during preswing. While multi-segment foot kinematics were improved, they were not restored to control values. Statement of clinical significance: Total ankle arthroplasty does not fully normalize mutli-segment gait kinematics despite improved patient-reported outcomes and gait mechanics.
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Affiliation(s)
- Jessica M Fritz
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, WI, USA
| | - Karl Canseco
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine A Konop
- Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Karen M Kruger
- Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Motion Analysis Center, Shriners Hospitals for Children-Chicago, Chicago, Illinois, USA
| | - Sergey Tarima
- Department of Biostatistics, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason T Long
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brian C Law
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan C Kraus
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David M King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Gerald F Harris
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, WI, USA.,Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Motion Analysis Center, Shriners Hospitals for Children-Chicago, Chicago, Illinois, USA
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Musselman KE, Arora T, Chan K, Alavinia M, Bone M, Unger J, Lanovaz J, Oates A. Evaluating Intrinsic Fall Risk Factors After Incomplete Spinal Cord Injury: Distinguishing Fallers From Nonfallers. Arch Rehabil Res Clin Transl 2020; 3:100096. [PMID: 33778471 PMCID: PMC7984974 DOI: 10.1016/j.arrct.2020.100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine whether performance on measures of lower extremity muscle strength, sensory function, postural control, gait speed, and balance self-efficacy could distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury or disease (SCI/D). Design Prospective cohort study. Setting Community. Participants Individuals (N=26; 6 female, aged 58.9±18.2y) with motor incomplete SCI/D (American Spinal Injury Association Impairment Scale rating C [n=5] or D [n=21]) participated. Participants were 7.5±9.1 years post injury. Seventeen participants experienced traumatic causes of spinal cord injury. Main Outcome Measures Participants completed laboratory-based and clinical measures of postural control, gait speed, balance self-efficacy, and lower extremity strength, as well as proprioception and cutaneous pressure sensitivity. Participants were then followed for up to 1 year to track falls using a survey. The survey queried the circumstances and consequences of each fall. If a participant's number of falls equaled or exceeded the median number of falls experience by all participants, they were classified a faller. Results Median follow-up duration was 362 days and median time to first fall was 60.5 days. Fifteen participants were classified as fallers. Most falls occurred during the morning or afternoon (81%), at home (75%), and while walking (47%). The following laboratory-based and clinical measures distinguished fallers from nonfallers (P<.05): measures of lower extremity strength, cutaneous pressure sensitivity, walking speed, and center of pressure velocity in the mediolateral direction. Conclusions There are laboratory-based and clinical measures that can prospectively distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury. These findings may assist clinicians when evaluating their patients' fall risk.
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Affiliation(s)
- Kristin E Musselman
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Tarun Arora
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Katherine Chan
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Mohammad Alavinia
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Mackenzie Bone
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Janelle Unger
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joel Lanovaz
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alison Oates
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Soler B, Ramari C, Valet M, Dalgas U, Feys P. Clinical assessment, management, and rehabilitation of walking impairment in MS: an expert review. Expert Rev Neurother 2020; 20:875-886. [PMID: 32729742 DOI: 10.1080/14737175.2020.1801425] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION One of the most common and life-altering consequences of Multiple Sclerosis (MS) is walking impairment. The distance, speed, and Gait pattern functions are components of the International Classification of Functioning, Disability, and Health (ICF) and are also predictors of dependency in terms of daily living activities in patients with MS (pwMS). AREAS COVERED This article provides an overview of walking impairment in pwMS, with focus on the assessment of gait and the rehabilitation approaches. EXPERT OPINION The authors recommend that pwMS undergo gait assessment integrating the ICF perspective using validated clinical outcome measures that cover spatiotemporal gait parameters. Moreover, assessment of walking speed with short walking capacity tests such as the timed 25-foot walk (T25FW) or the 10-m walk test (10 MWT) and tests for walking distance with middle distance tests such as the 2-min walk test (2MWT) and the 6-min walk test (6MWT). This review further highlights strategies that may restore walking function including pharmacological symptomatic treatment and non-pharmacological rehabilitation approaches such as exercise and task-specific training providing an appraisal of mobility targeted therapies to be considered when planning multidisciplinary comprehensive-care of pwMS. Finally, new and novel strategies such as motor imagery and rhythmic auditory stimulation have been developed to improve walking speed and distance in pwMS.
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Affiliation(s)
- Bernardita Soler
- Neurology Service, Hospital Doctor Sótero Del Río , Santiago, Chile.,Neurology Department, Pontificia Universidad Católica De Chile , Santiago, Chile
| | - Cintia Ramari
- Faculty of Physical Education, University of Brasília , Brasília, Brazil
| | - Maxime Valet
- Cliniques universitaires Saint-Luc, Service de Médecine Physique et Réadaptation , Brussels, Belgium.,Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal lab (NMSK) , Brussels, Belgium
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University , Aarhus, Denmark
| | - Peter Feys
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University , Hasselt, Belgium
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Decavel P, Sagawa Y. Gait quantification in multiple sclerosis: A single-centre experience of systematic evaluation. Neurophysiol Clin 2019; 49:165-171. [DOI: 10.1016/j.neucli.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 01/14/2023] Open
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Jonsdottir J, Gervasoni E, Bowman T, Bertoni R, Tavazzi E, Rovaris M, Cattaneo D. Intensive Multimodal Training to Improve Gait Resistance, Mobility, Balance and Cognitive Function in Persons With Multiple Sclerosis: A Pilot Randomized Controlled Trial. Front Neurol 2018; 9:800. [PMID: 30323787 PMCID: PMC6172314 DOI: 10.3389/fneur.2018.00800] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Persons with multiple sclerosis (MS) have deficits in many aspects of physical and cognitive functioning that can impact on mobility and participation in daily life. The effect of a 4 week intensive multimodal treadmill training on functional mobility, balance, executive functions and participation in persons with MS with moderate to severe disability was investigated. Methods: Thirty eight persons with MS admitted to a rehabilitation center participated in a two arm randomized 2:1 controlled trial. Participants in the experimental group received supervised intensive treadmill training including cognitive and motor dual tasks (DT-group, N = 26), 5 sessions per week and a control group received the same amount of supervised strength training (S-group, N = 12). The participants were assessed before and after the rehabilitation period with the 2 Minutes Walking Test (2MWT), speed and, static and dynamic balance measures, the Frontal Assessment Battery and the Short Form-12 questionnaire. The main hypothesis was related to the superiority of the treadmill intervention based on a greater proportion of people making a clinically relevant gain (15% increase on 2MWT) in gait resistance following treatment. ANCOVA (Analysis of covariance) models adjusting for baseline measurement of the respective outcome variable, as well as sex and age, were used to evaluate differences in efficacy for all variables. P was set at 0.05. Results: Nineteen out of 26 persons in the DT-group made a clinically relevant gain and two out of 12 in the S-Group (P = 0.001). The DT-group improved more in gait resistance, speed and mobility (P < 0.01). Balance and executive functions instead improved moderately in both groups following training while perception of health remained similar in both groups. Conclusion: A four week multimodal training on treadmill was highly effective in augmenting gait resistance and mobility in moderately to severely affected persons with MS.
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Affiliation(s)
- Johanna Jonsdottir
- LaRiCE, Neurorehabilitation, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Elisa Gervasoni
- LaRiCE, Neurorehabilitation, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Thomas Bowman
- LaRiCE, Neurorehabilitation, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Rita Bertoni
- LaRiCE, Neurorehabilitation, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Eleonora Tavazzi
- Department of Multiple Sclerosis, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Marco Rovaris
- Department of Multiple Sclerosis, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | - Davide Cattaneo
- LaRiCE, Neurorehabilitation, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
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