Inter-Joint Coordination During Gait in People with Multiple Sclerosis: a Focus on the Effect of Disability

Range of motion abnormalities in the lower limb joints during gait in youth with multiple sclerosis

BACKGROUND

The major objective of this study was to examine whether differences occur in the joint angles of the major lower limb joints while walking in youth with multiple sclerosis (YwMS) compared to age-gender-matched healthy youngsters.

METHODS

Gait analysis was collected using a six-camera Cartesian Optoelectronic Dynamic Anthropometer (CODA) 3D motion analysis system. To determine the gait normality in the YwMS group, we compared our results to reference gait data from normal youngsters. Gait data was divided according to gender and age subgroups (8-14, 15-18 years old).

RESULTS

The total sample included 26 YwMS (12 girls, 14 boys), 11 in the 8-14 age subgroup, and 15 in the 15-18 age subgroup. The mean expanded disability status scale score was 1.3 (S.D=1.0), indicating minimal disability. The total range of hip motion was significantly less in the YwMS group aged 15-18 (both genders) compared with the normative values. Additionally, the maximum flexion in the knee joint during gait was significantly less in boys in the 15 to 18 age subgroup (p<0.001). No differences were found in the hip and knee joint angles in the 8-14 age subgroup.

CONCLUSIONS

YwMS experience modifications in their gait pattern compared with age-gender-matched healthy youngsters. The MS teenagers demonstrated less range of movement in the hip joints and walked slower at a decreased pace than the healthy teenagers. By tracking gait patterns, healthcare providers can identify subtle changes that might facilitate timely interventions to prevent further mobility impairment in this young population.

Analysis of inter-joint coordination during the sit-to-stand and stand-to-sit tasks in stroke patients with hemiplegia

BACKGROUND

Inter-joint coordination is an important factor affecting postural stability, and its variability increases after fatigue. This study aimed to investigate the coordination pattern of lower limb joints during the sit-to-stand (Si-St) and stand-to-sit (St-Si) tasks in stroke patients and explore the influence of duration on inter-joint coordination.

METHODS

Thirteen stroke hemiplegia patients (five with left paretic and eight right paretic) and thirteen age-matched healthy subjects were recruited. The Si-St and St-Si tasks were performed while each subject's joint kinematics were recorded using a three-dimensional motion capture system. Sagittal joint angles of the bilateral hip, knee and ankle joints as well as the movement duration were extracted. The angle-angle diagrams for the hip-knee, hip-ankle and knee-ankle joint were plotted to assess the inter-joint coordination. The inter-joint coordination was quantified using geometric characteristics of the angle-angle diagrams, including perimeter, area and dimensionless ratio. The coefficient of variation (CV) was performed to compare variability of the coordination parameters.

RESULTS

There were no significant differences in the perimeter, area and dimensionless ratio values of the bilateral hip-knee, hip-ankle and knee-ankle inter-joints during Si-St and St-Si tasks in the stroke group. The perimeter values of bilateral hip-knee and knee-ankle inter-joints in the stroke group were lower (P<0.05) than in the healthy group during Si-St and St-Si tasks. Although no significant bilateral differences were found, the inter-joint coordination in stroke patients decreased with the increased movement duration of both Si-St and St-Si tasks. Additionally, the CV of the hip-knee inter-joint area during the Si-St task in the stroke group was less than (P<0.05) that in the healthy group.

CONCLUSION

Stroke patients exhibit different inter-joint coordination patterns than healthy controls during the Si-St and St-Si tasks. The duration affects joint coordination, and inter-joint coordination is limited on the hemiplegic side joint pairs, which may lead to inconsistency in the rhythm of the left and right leg inter-joint movements and increase the risk of falls. These findings provide new insights into motor control rehabilitation strategies and may help planning targeted interventions for stoke patients with hemiplegia.

Quantifying lower extremity inter-segmental coordination variability during walking in people with multiple sclerosis with high and low fear of falling

BACKGROUND

Fear of falling (FOF) is associated with gait disturbances in people with multiple sclerosis (PwMS). However, previous studies mostly assessed FOF-related changes in gait patterns of PwMS using spatio-temporal gait parameters. Considering the complex nature of gait control, investigation of the higher order properties of the human movement system, particularly inter-segmental coordination variability may provide valuable information about underlying deficits in motor control patterns in PwMS with different levels of FOF. Therefore, the purpose of this study was to clarify the differences in lower extremity inter-segmental coordination variability between healthy controls and PwMS with high and low FOF.

METHODS

This cross-sectional study examined gait patterns of 40 PwMS and 20 age-and-sex-matched healthy controls during treadmill walking at a preferred walking speed for 3 min. The falls efficacy scale-international questionnaire was used to stratify PwMS into high and low FOF subgroups. Variability in coordinative relationships between shank-thigh and foot-shank segments was determined using deviation phase (DP), which is the average standard deviation calculated from all points of the ensemble continuous relative phase (CRP) curve during the stance and swing phases of gait.

RESULTS

DP values for shank-thigh (p = 0.005 and p < 0.001, respectively) and foot-shank inter-segmental relationships (p < 0.001) during the stance phase as well as for foot-shank inter-segmental relationships during the swing phase (p = 0.03) were significantly greater in PwMS with high FOF compared to those with low FOF and healthy controls. In addition, both groups of PwMS with high and low FOF indicated greater shank-thigh DP values compared to healthy controls during the swing phase (p < 0.001 and p = 0.002, respectively).

CONCLUSION

The findings suggest unsteadiness in neuromuscular organization during walking in PwMS with high FOF. Rehabilitative interventions targeting impairments in lower extremity inter-segmental coordination and FOF may be useful to improve walking and reduce risk of falls in PwMS with high FOF.