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Bergamini E, Cereatti A, Pavei G. Walking symmetry is speed and index dependent. Sci Rep 2024; 14:19548. [PMID: 39174605 PMCID: PMC11341956 DOI: 10.1038/s41598-024-69461-w] [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: 05/24/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024] Open
Abstract
Gait symmetry is one of the most informative aspects describing the quality of gait. Many indices have been proposed to quantify gait symmetry. Among them, indices focusing on the comparison of the two body sides (e.g., Symmetry Angle, SA) and indices based on the analysis of the locomotor act as a whole, dealing with the body center of mass (e.g., Symmetry Index, SIBCoM) or lower trunk accelerometry (e.g., improved Harmonic Ratio, iHR) have been proposed. Remarkably, the relationship between these indices has received little attention so far, as well as the influence of gait speed on their values. The aim of this study is to investigate this relationship by comparing the SA, SIBCoM, and iHR, and to explore the effect of walking speed on these indices. Ten healthy adults walked for 60 s on a treadmill at seven different speeds (from 0.28 to 1.95 m s-1) and simulate an asymmetric gait (ASYM) at 0.83 m s-1. Marker-based trajectories were recorded, and the body center of mass 3D trajectory was obtained. Simultaneously, lower trunk 3D linear accelerations were collected using a triaxial accelerometer. SIBCoM, iHR, and SA were calculated for each stride, each anatomical direction, and each condition. Perfect symmetry was never displayed in any axes and any indices. Significant differences existed between SIBCoM, and iHR in all anatomical directions (p < 0.0001). The walking speed significantly affected SIBCoM and iHR values in anteroposterior and craniocaudal directions, but not in mediolateral. Conversely, no walking speed effect was found for SA (p = 0.28). All three indices significantly discriminated between ASYM and the corresponding walking condition (p < 0.05). Gait symmetry may differ significantly according to the data source, mathematical approach, and walking speed. Healthy individuals display an asymmetrical gait and acknowledging this aspect is crucial when establishing rehabilitation objectives and assessing the quality of gait in the clinical setting.
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Affiliation(s)
- Elena Bergamini
- Department of Management, Information and Production Engineering, University of Bergamo, Via Marconi 4, 24044, Dalmine, Bergamo, Italy.
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis 15, 00135, Rome, Italy.
| | - Andrea Cereatti
- Department of Electronics and Telecommunications, Politecnico di Torino, Corso Castelfidardo, 39, 10129, Turin, Italy
| | - Gaspare Pavei
- Laboratory of Physiomechanics of Locomotion, Department of Pathophysiology and Transplantation, University of Milan, Via Luigi Mangiagalli 32, 20133, Milan, Italy
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Gervasoni E, Anastasi D, Di Giovanni R, Solaro C, Rovaris M, Brichetto G, Confalonieri P, Tacchino A, Carpinella I, Cattaneo D. Uncovering Subtle Gait Deterioration in People with Early-Stage Multiple Sclerosis Using Inertial Sensors: A 2-Year Multicenter Longitudinal Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:9249. [PMID: 38005634 PMCID: PMC10674176 DOI: 10.3390/s23229249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
Limited longitudinal studies have been conducted on gait impairment progression overtime in non-disabled people with multiple sclerosis (PwMS). Therefore, a deeper understanding of gait changes with the progression of the disease is essential. The objective of the present study was to describe changes in gait quality in PwMS with a disease duration ≤ 5 years, and to verify whether a change in gait quality is associated with a change in disability and perception of gait deterioration. We conducted a multicenter prospective cohort study. Fifty-six subjects were assessed at baseline (age: 38.2 ± 10.7 years, Expanded Disability Status Scale (EDSS): 1.5 ± 0.7 points) and after 2 years, participants performed the six-minute walk test (6MWT) wearing inertial sensors. Quality of gait (regularity, symmetry, and instability), disability (EDSS), and walking perception (multiple sclerosis walking scale-12, MSWS-12) were collected. We found no differences on EDSS, 6MWT, and MSWS-12 between baseline and follow-up. A statistically significant correlation between increased EDSS scores and increased gait instability was found in the antero-posterior (AP) direction (r = 0.34, p = 0.01). Seventeen subjects (30%) deteriorated (increase of at least 0.5 point at EDSS) over 2 years. A multivariate analysis on deteriorated PwMS showed that changes in gait instability medio-lateral (ML) and stride regularity, and changes in ML gait symmetry were significantly associated with changes in EDSS (F = 7.80 (3,13), p = 0.003, R2 = 0.56). Moreover, gait changes were associated with a decrease in PwMS perception on stability (p < 0.05). Instrumented assessment can detect subtle changes in gait stability, regularity, and symmetry not revealed during EDSS neurological assessment. Moreover, instrumented changes in gait quality impact on subjects' perception of gait during activities of daily living.
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Affiliation(s)
- Elisa Gervasoni
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy; (E.G.); (D.A.); (M.R.); (D.C.)
| | - Denise Anastasi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy; (E.G.); (D.A.); (M.R.); (D.C.)
| | - Rachele Di Giovanni
- Department of Rehabilitation, Centro di Recupero e Rieducazione Funzionale (CRRF) “Mons. Luigi Novarese”, 13040 Moncrivello, Italy;
| | | | - Marco Rovaris
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy; (E.G.); (D.A.); (M.R.); (D.C.)
| | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation, Scientific Research Area, 16126 Genoa, Italy; (G.B.); (A.T.)
| | - Paolo Confalonieri
- IRCCS Foundation “Carlo Besta” Neurological Institute, 20133 Milan, Italy;
| | - Andrea Tacchino
- Italian Multiple Sclerosis Foundation, Scientific Research Area, 16126 Genoa, Italy; (G.B.); (A.T.)
| | - Ilaria Carpinella
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy; (E.G.); (D.A.); (M.R.); (D.C.)
| | - Davide Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy; (E.G.); (D.A.); (M.R.); (D.C.)
- Department of Physiopathology and Transplants, University of Milan, 20122 Milan, Italy
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Dorsch EM, Röhling HM, Zocholl D, Hafermann L, Paul F, Schmitz-Hübsch T. Progression events defined by home-based assessment of motor function in multiple sclerosis: protocol of a prospective study. Front Neurol 2023; 14:1258635. [PMID: 37881311 PMCID: PMC10597627 DOI: 10.3389/fneur.2023.1258635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
Background This study relates to emerging concepts of appropriate trial designs to evaluate effects of intervention on the accumulation of irreversible disability in multiple sclerosis (MS). Major starting points of our study are the known limitations of current definitions of disability progression by rater-based clinical assessment and the high relevance of gait and balance dysfunctions in MS. The study aims to explore a novel definition of disease progression using repeated instrumental assessment of relevant motor functions performed by patients in their home setting. Methods The study is a prospective single-center observational cohort study with the primary outcome acquired by participants themselves, a home-based assessment of motor functions based on an RGB-Depth (RGB-D) camera, a camera that provides both depth (D) and color (RGB) data. Participants are instructed to perform and record a set of simple motor tasks twice a day over a one-week period every 6 months. Assessments are complemented by a set of questionnaires. Annual research grade assessments are acquired at dedicated study visits and include clinical ratings as well as structural imaging (MRI and optical coherence tomography). In addition, clinical data from routine visits is provided semiannually by treating neurologists. The observation period is 24 months for the primary endpoint with an additional clinical assessment at 27 month to confirm progression defined by the Expanded Disability Status Scale (EDSS). Secondary analyses aim to explore the time course of changes in motor parameters and performance of the novel definition against different alternative definitions of progression in MS. The study was registered at Deutsches Register für Klinische Studien (DRKS00027042). Discussion The study design presented here investigates disease progression defined by marker-less home-based assessment of motor functions against 3-month confirmed disease progression (3 m-CDP) defined by the EDSS. The technical approach was chosen due to previous experience in lab-based settings. The observation time per participant of 24, respectively, 27 months is commonly conceived as the lower limit needed to study disability progression. Defining a valid digital motor outcome for disease progression in MS may help to reduce observation times in clinical trials and add confidence to the detection of progression events in MS.
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Affiliation(s)
- Eva-Maria Dorsch
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Hanna Marie Röhling
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Motognosis GmbH, Berlin, Germany
| | - Dario Zocholl
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lorena Hafermann
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Liuzzi P, Carpinella I, Anastasi D, Gervasoni E, Lencioni T, Bertoni R, Carrozza MC, Cattaneo D, Ferrarin M, Mannini A. Machine learning based estimation of dynamic balance and gait adaptability in persons with neurological diseases using inertial sensors. Sci Rep 2023; 13:8640. [PMID: 37244933 PMCID: PMC10224964 DOI: 10.1038/s41598-023-35744-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023] Open
Abstract
Poor dynamic balance and impaired gait adaptation to different contexts are hallmarks of people with neurological disorders (PwND), leading to difficulties in daily life and increased fall risk. Frequent assessment of dynamic balance and gait adaptability is therefore essential for monitoring the evolution of these impairments and/or the long-term effects of rehabilitation. The modified dynamic gait index (mDGI) is a validated clinical test specifically devoted to evaluating gait facets in clinical settings under a physiotherapist's supervision. The need of a clinical environment, consequently, limits the number of assessments. Wearable sensors are increasingly used to measure balance and locomotion in real-world contexts and may permit an increase in monitoring frequency. This study aims to provide a preliminary test of this opportunity by using nested cross-validated machine learning regressors to predict the mDGI scores of 95 PwND via inertial signals collected from short steady-state walking bouts derived from the 6-minute walk test. Four different models were compared, one for each pathology (multiple sclerosis, Parkinson's disease, and stroke) and one for the pooled multipathological cohort. Model explanations were computed on the best-performing solution; the model trained on the multipathological cohort yielded a median (interquartile range) absolute test error of 3.58 (5.38) points. In total, 76% of the predictions were within the mDGI's minimal detectable change of 5 points. These results confirm that steady-state walking measurements provide information about dynamic balance and gait adaptability and can help clinicians identify important features to improve upon during rehabilitation. Future developments will include training of the method using short steady-state walking bouts in real-world settings, analysing the feasibility of this solution to intensify performance monitoring, providing prompt detection of worsening/improvements, and complementing clinical assessments.
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Affiliation(s)
- Piergiuseppe Liuzzi
- AIRLab, IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy
- Scuola Superiore Sant'Anna, Istituto di BioRobotica, 56025, Pontedera, Italy
| | - Ilaria Carpinella
- LAMoBIR and LaRiCE, IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy.
| | - Denise Anastasi
- LAMoBIR and LaRiCE, IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - Elisa Gervasoni
- LAMoBIR and LaRiCE, IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - Tiziana Lencioni
- LAMoBIR and LaRiCE, IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - Rita Bertoni
- LAMoBIR and LaRiCE, IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | | | - Davide Cattaneo
- LAMoBIR and LaRiCE, IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università di Milano, 20122, Milan, Italy
| | - Maurizio Ferrarin
- LAMoBIR and LaRiCE, IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - Andrea Mannini
- AIRLab, IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy
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Sainz de la Maza S, Gómez-Ballesteros R, Borges M, Martín-Martínez J, Sotoca J, Alonso A, Caminero AB, Borrega L, Sánchez-Menoyo JL, Barrero-Hernández FJ, Calles C, Brieva L, Blasco-Quílez MR, Dotor García-Soto J, del Campo-Amigo M, Navarro-Cantó L, Agüera E, Garcés-Redondo M, Carmona O, Gabaldón-Torres L, Forero L, Hervàs M, Medrano N, Maurino J, Castillo-Triviño T. Detecting disability using self-reported and clinical assessments in early-stage relapsing-remitting multiple sclerosis: Looking for a complementary approach. Mult Scler J Exp Transl Clin 2023; 9:20552173231169475. [PMID: 37187856 PMCID: PMC10176560 DOI: 10.1177/20552173231169475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/23/2023] [Indexed: 05/17/2023] Open
Abstract
Disability accrual is mainly driven by progression independent of relapse activity, which is present even in early stages of relapsing-remitting multiple sclerosis (RRMS) and sometimes overlooked. This multicenter, non-interventional study evaluated whether patient-reported outcomes measures (PROMs) could capture disability in 189 early-stage RRMS patients (mean age: 36.1 ± 9.4 years, 71.4% female, mean disease duration: 1.4 ± 0.8 years, median EDSS: 1.0). The 9-Hole Peg Test (9-HPT), NeuroQoL Upper Extremity (NeuroQoL-UE), Timed 25-Foot Walk (T25-FW), Multiple Sclerosis Walking Scale (MSWS-12), Symbol Digit Modalities Test (SDMT), and Perceived Deficits Questionnaire (PDQ-5) were used to assess hand function, gait, and cognition, respectively. These functions were at least mildly affected in this early-stage population, finding significant correlations between PROMs and clinical assessments. PROMs could enable early-stage RRMS patients to communicate their perceived disability in different domains, assisting clinicians in disease monitoring and decision making.
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Affiliation(s)
- Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario
Ramón y Cajal, IRyCIS, Universidad de Alcalá, Madrid, Spain
| | | | - Mónica Borges
- Department of Neurology, Hospital Universitario Virgen
Macarena, Sevilla, Spain
| | | | - Javier Sotoca
- Department of Neurology, Hospital Universitari Mútua
Terrassa, Terrassa, Spain
| | - Ana Alonso
- Department of Neurology, Hospital Regional
Universitario de Málaga, Málaga, Spain
| | - Ana B Caminero
- Department of Neurology, Complejo Asistencial de
Ávila, Ávila, Spain
| | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación
Alcorcón, Alcorcón, Spain
| | | | | | - Carmen Calles
- Department of Neurology, Hospital Universitari
Son Espases, Palma de Mallorca, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de
Vilanova, Lleida, Spain
| | | | | | - María del Campo-Amigo
- Department of Neurology, Complexo Hospitalario
Universitario de Pontevedra, Pontevedra, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de
Elche, Elche, Spain
| | - Eduardo Agüera
- Department of Neurology, Hospital
Universitario Reina Sofía, Córdoba, Spain
| | - Moisés Garcés-Redondo
- Department of Neurology, Hospital Clínico Universitario
Lozano Blesa, Zaragoza, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut
Empordà, Figueres, Spain
| | | | - Lucía Forero
- Department of Neurology, Hospital
Universitario Puerta del Mar, Cádiz, Spain
| | - Mariona Hervàs
- Department of Neurology, Consorci Corporació Sanitària
Parc Taulí, Sabadell, Spain
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Cofré Lizama LE, Panisset MG, Peng L, Tan Y, Kalincik T, Galea MP. Optimal sensor location and direction to accurately classify people with early-stage multiple sclerosis using gait stability. Gait Posture 2023; 102:39-42. [PMID: 36889202 DOI: 10.1016/j.gaitpost.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/18/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND The local divergence exponent (LDE) has been used to assess gait stability in people with multiple sclerosis (pwMS). Although previous studies have consistently found that stability is lower in pwMS, inconsistent methodologies have been used to assess patients with a broad range of disability levels. QUESTIONS What sensor location and movement direction(s) are better able to classify pwMS at early stages of the disease? METHODS 49 pwMS with EDSS ≤ 2.5 and 24 healthy controls walked overground for 5 min while 3D acceleration data was obtained from sensors placed at the sternum (STR) and lumbar (LUM) areas. Unidirectional (vertical [VT], mediolateral [ML], and anteroposterior [AP]) and 3-dimensional (3D) LDEs were calculated using STR and LUM data over 150 strides. ROC analyses were performed to assess classification models using single and combined LDEs, with and without velocity per lap (VELLAP) as a covariate. RESULTS Four models performed equally well by using combinations of VELLAP, LUM3D, LUMVT, LUMML, LUMAP, STRML, and STRAP (AUC = 0.879). The best model using single sensor LDEs included VELLAP, STR3D, STRML, and STRAP (AUC = 0.878), whereas using VELLAP + STRVT (AUC = 0.869) or VELLAP + STR3D (AUC=0.858) performed best using a single LDE. SIGNIFICANCE The LDE offers an alternative to currently insensitive tests of gait impairment in pwMS at early stages, when deterioration is not clinically evident. For clinical purposes, the implementation of this measure can be simplified using a single sensor at the sternum and a single LDE measure, but speed should be considered. Longitudinal studies to determine the predictive power and responsiveness of the LDE to MS progression are still needed.
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Affiliation(s)
- L Eduardo Cofré Lizama
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Maya G Panisset
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Liuhua Peng
- School of Mathematics and Statistics, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Ying Tan
- Department of Mechanical Engineering, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia; Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Australia
| | - Mary P Galea
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia; Australian Rehabilitation Research Centre, Royal Park Campus, Parkville, VIC 3052, Australia
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Carpinella I, Anastasi D, Gervasoni E, Di Giovanni R, Tacchino A, Brichetto G, Confalonieri P, Rovaris M, Solaro C, Ferrarin M, Cattaneo D. Balance Impairments in People with Early-Stage Multiple Sclerosis: Boosting the Integration of Instrumented Assessment in Clinical Practice. SENSORS (BASEL, SWITZERLAND) 2022; 22:9558. [PMID: 36502265 PMCID: PMC9736931 DOI: 10.3390/s22239558] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/15/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
The balance of people with multiple sclerosis (PwMS) is commonly assessed during neurological examinations through clinical Romberg and tandem gait tests that are often not sensitive enough to unravel subtle deficits in early-stage PwMS. Inertial sensors (IMUs) could overcome this drawback. Nevertheless, IMUs are not yet fully integrated into clinical practice due to issues including the difficulty to understand/interpret the big number of parameters provided and the lack of cut-off values to identify possible abnormalities. In an attempt to overcome these limitations, an instrumented modified Romberg test (ImRomberg: standing on foam with eyes closed while wearing an IMU on the trunk) was administered to 81 early-stage PwMS and 38 healthy subjects (HS). To facilitate clinical interpretation, 21 IMU-based parameters were computed and reduced through principal component analysis into two components, sway complexity and sway intensity, descriptive of independent aspects of balance, presenting a clear clinical meaning and significant correlations with at least one clinical scale. Compared to HS, early-stage PwMS showed a 228% reduction in sway complexity and a 63% increase in sway intensity, indicating, respectively, a less automatic (more conscious) balance control and larger and faster trunk movements during upright posture. Cut-off values were derived to identify the presence of balance abnormalities and if these abnormalities are clinically meaningful. By applying these thresholds and integrating the ImRomberg test with the clinical tandem gait test, balance impairments were identified in 58% of PwMS versus the 17% detected by traditional Romberg and tandem gait tests. The higher sensitivity of the proposed approach would allow for the direct identification of early-stage PwMS who could benefit from preventive rehabilitation interventions aimed at slowing MS-related functional decline during neurological examinations and with minimal modifications to the tests commonly performed.
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Affiliation(s)
| | - Denise Anastasi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy
| | - Elisa Gervasoni
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy
| | - Rachele Di Giovanni
- Department of Rehabilitation, Centro di Recupero e Rieducazione Funzionale (CRRF) “Mons. Luigi Novarese”, 13040 Moncrivello, Italy
| | - Andrea Tacchino
- Italian Multiple Sclerosis Foundation, Scientific Research Area, 16126 Genoa, Italy
| | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation, Scientific Research Area, 16126 Genoa, Italy
| | - Paolo Confalonieri
- IRCCS Foundation “Carlo Besta” Neurological Institute, 20133 Milan, Italy
| | - Marco Rovaris
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy
| | - Claudio Solaro
- Department of Rehabilitation, Centro di Recupero e Rieducazione Funzionale (CRRF) “Mons. Luigi Novarese”, 13040 Moncrivello, Italy
| | | | - Davide Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy
- Department of Physiopathology and Transplants, University of Milan, 20122 Milan, Italy
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8
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Zhang Y, Xu P, Deng Y, Duan W, Cui J, Ni C, Wu M. Effects of vibration training on motor and non-motor symptoms for patients with multiple sclerosis: A systematic review and meta-analysis. Front Aging Neurosci 2022; 14:960328. [PMID: 36034149 PMCID: PMC9415382 DOI: 10.3389/fnagi.2022.960328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
Background Vibration therapy is one of the rehabilitation programs that may be effective in treating both motor and non-motor symptoms in Multiple Sclerosis patients. We conducted a comprehensive systematic review and meta-analysis to assess the effects of vibration therapy on motor and non-motor symptoms (functional mobility, balance, walking endurance, gait speed, fatigue, and quality of life) of this population. Methods A systematic search of PubMed, Embase, the Cochrane Library, Web of Science, Physiotherapy Evidence Database, Scopus, Google Search Engine, and the China National Knowledge Infrastructure (CNKI). Two reviewers independently assessed the study quality. Results Fourteen studies with 393 participants were finally included in the meta-analysis. The pooled results showed that vibration therapy had a significant advantage over the control intervention in improving balance function [mean difference (MD) = 2.04, 95% confidence interval (CI): 0.24-3.84, P = 0.03], and walking endurance (SMD = 0.34, 95% CI: 0.07-0.61, P = 0.01). Meanwhile, the degree of disability subgroup analysis revealed that the Expanded Disability Status Scale (EDSS) score (3.5-6) significantly improved functional mobility (MD: -1.18, 95% CI: -2.09 to 0.28, P = 0.01) and balance function (MD: 3.04, 95% CI: 0.49-5.59, P = 0.02) compared with the control group, and the EDSS (0-3.5) were more beneficial in walking endurance. The duration subgroup analysis indicated a significant difference in the effect of the duration (<4 weeks) on enhancing walking endurance (SMD: 0.46, 95% CI: 0.04-0.87, P = 0.03). However, no significant improvement was found in functional mobility, gait speed, fatigue, and quality of life. Conclusion Vibration therapy may improve balance function and walking endurance, and the degree of disability and duration of intervention may affect outcomes. The evidence for the effects of vibration therapy on functional mobility, gait speed, fatigue, and quality of life remains unclear. More trials with rigorous study designs and a larger sample size are necessary to provide this evidence. Systematic Review Registration PROSPERO, https://www.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42022326852.
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Affiliation(s)
| | | | | | | | | | | | - Ming Wu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Gervasoni E, Anastasi D, Giovanni RD, Solaro C, Rovaris M, Brichetto G, Carpinella I, Confalonieri P, Tacchino A, Rabuffetti M, Cattaneo D. Physical activity in non-disabled People with early Multiple Sclerosis: a multicenter cross-sectional study. Mult Scler Relat Disord 2022; 64:103941. [DOI: 10.1016/j.msard.2022.103941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/16/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
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Cofré Lizama LE, Strik M, Van der Walt A, Kilpatrick TJ, Kolbe SC, Galea MP. Gait stability reflects motor tracts damage at early stages of multiple sclerosis. Mult Scler 2022; 28:1773-1782. [DOI: 10.1177/13524585221094464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Gait in people with multiple sclerosis (PwMS) is affected even when no changes can be observed on clinical examination. A sensitive measure of gait deterioration is stability; however, its correlation with motor tract damage has not yet been established. Objective: To compare stability between PwMS and healthy controls (HCs) and determine associations between stability and diffusion magnetic resonance image (MRI) measures of axonal damage in selected sensorimotor tracts. Methods: Twenty-five PwMS (Expanded Disability Status Scale (EDSS) < 2.5) and 15 HCs walked on a treadmill. Stability from sacrum (LDESAC), shoulder (LDESHO) and cervical (LDECER) was calculated using the local divergence exponent (LDE). Participants underwent a 7T-MRI brain scan to obtain fibre-specific measures of axonal loss within the corticospinal tract (CST), interhemispheric sensorimotor tract (IHST) and cerebellothalamic tract (CTT). Correlation analyses between LDE and fibre density (FD) within tracts, fibre cross-section (FC) and FD modulated by FC (FDC) were conducted. Between-groups LDE differences were analysed using analysis of variance (ANOVA). Results: Correlations between all stability measures with CSTFD, between CSTFDC with LDESAC and LDECER, and LDECER with IHSTFD and IHSTFDC were significant yet moderate ( R < −0.4). Stability was significantly different between groups. Conclusions: Poorer gait stability is associated with corticospinal tract (CST) axonal loss in PwMS with no-to-low disability and is a sensitive indicator of neurodegeneration.
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Affiliation(s)
- L Eduardo Cofré Lizama
- School of Allied Health, Human Services and Sports, La Trobe University, Bundoora, VIC, Australia/Department of Medicine and Radiology, The University of Melbourne, Parkville, VIC, Australia
| | - Myrte Strik
- Melbourne Brain Centre Imaging Unit, Department of Radiology, The University of Melbourne, Parkville, VIC, Australia
| | - Anneke Van der Walt
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Trevor J Kilpatrick
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia/Florey Department of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia/Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Scott C Kolbe
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mary P Galea
- Galea Department of Medicine and Radiology, The University of Melbourne, Parkville, VIC, Australia
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Carpinella I, Gervasoni E, Anastasi D, Di Giovanni R, Tacchino A, Brichetto G, Confalonieri P, Solaro C, Rovaris M, Ferrarin M, Cattaneo D. Walking With Horizontal Head Turns Is Impaired in Persons With Early-Stage Multiple Sclerosis Showing Normal Locomotion. Front Neurol 2022; 12:821640. [PMID: 35153994 PMCID: PMC8833075 DOI: 10.3389/fneur.2021.821640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022] Open
Abstract
Background Turning the head while walking (an action often required during daily living) is particularly challenging to maintain balance. It can therefore potentially reveal subtle impairments in early-stage people with multiple sclerosis who still show normal locomotion (NW-PwMS). This would help in identifying those subjects who can benefit from early preventive exercise aimed at slowing the MS-related functional decline. Objectives To analyze if the assessment of walking with horizontal head turns (WHHT) through inertial sensors can discriminate between healthy subjects (HS) and NW-PwMS and between NW-PwMS subgroups. To assess if the discriminant ability of the instrumented WHHT is higher compared to clinical scores. To assess the concurrent validity of the sensor-based metrics. Methods In this multicenter study, 40 HS and 59 NW-PwMS [Expanded Disability Status Scale (EDSS) ≤ 2.5, disease duration ≤ 5 years] were tested. Participants executed Item-6 of the Fullerton Advanced Balance scale-short (FAB-s) wearing three inertial sensors on the trunk and ankles. The item required to horizontally turn the head at a beat of the metronome (100 bpm) while walking. Signals of the sensors were processed to compute spatiotemporal, regularity, symmetry, dynamic stability, and trunk sway metrics descriptive of WHHT. Results Mediolateral regularity, anteroposterior symmetry, and mediolateral stability were reduced in NW-PwMS vs. HS (p ≤ 0.001), and showed moderate discriminant ability (area under the receiver operator characteristic curve [AUC]: 0.71–0.73). AP symmetry and ML stability were reduced (p ≤ 0.026) in EDSS: 2–2.5 vs. EDSS: 0–1.5 subgroup (AUC: 0.69–0.70). The number of NW-PwMS showing at least one abnormal instrumented metric (68%) was larger (p ≤ 0.002) than the number of participants showing abnormal FAB-s-Item6 (32%) and FAB-s clinical scores (39%). EDSS: 2–2.5 subgroup included more individuals showing abnormal instrumented metrics (86%) compared to EDSS: 0–1.5 subgroup (57%). The instrumented metrics significantly correlated with FAB-s-Item6 and FAB-s scores (|Spearman's rs| ≥ 0.37, p < 0.001), thus demonstrating their concurrent validity. Conclusion The instrumented assessment of WHHT provided valid objective metrics that discriminated, with higher sensitivity than clinical scores, between HS and NW-PwMS and between EDSS subgroups. The method is a promising tool to complement clinical evaluation, and reveal subclinical impairments in persons who can benefit from early preventive rehabilitative interventions.
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Affiliation(s)
| | | | | | - Rachele Di Giovanni
- Centro di Recupero e Rieducazione Funzionale (CRRF) Mons. Luigi Novarese, Moncrivello, Italy
| | - Andrea Tacchino
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | | | - Claudio Solaro
- Centro di Recupero e Rieducazione Funzionale (CRRF) Mons. Luigi Novarese, Moncrivello, Italy
| | | | | | - Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Physiopathology and Transplants, University of Milan, Milan, Italy
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Robot-Assisted Gait Training in Patients with Multiple Sclerosis: A Randomized Controlled Crossover Trial. ACTA ACUST UNITED AC 2021; 57:medicina57070713. [PMID: 34356994 PMCID: PMC8306232 DOI: 10.3390/medicina57070713] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 02/04/2023]
Abstract
Background and Objectives: Gait disorders represent one of the most disabling aspects in multiple sclerosis (MS) that strongly influence patient quality of life. The improvement of walking ability is a primary goal for rehabilitation treatment. The aim of this study is to evaluate the effectiveness of robot-assisted gait training (RAGT) in association with physiotherapy treatment in patients affected by MS in comparison with ground conventional gait training. Study design: Randomized controlled crossover trial. Materials and Methods: Twenty-seven participants affected by MS with EDSS scores between 3.5 and 7 were enrolled, of whom seventeen completed the study. They received five training sessions per week over five weeks of conventional gait training with (experimental group) or without (control group) the inclusion of RAGT. The patients were prospectively evaluated before and after the first treatment session and, after the crossover phase, before and after the second treatment session. The evaluation was based on the 25-foot walk test (25FW, main outcome), 6 min walk test (6MWT), Tinetti Test, Modified Ashworth Scale, and modified Motricity Index for lower limbs. We also measured disability parameters using Functional Independence Measure and Quality of Life Index, and instrumental kinematic and gait parameters: knee extensor strength, double-time support, step length ratio; 17 patients reached the final evaluation. Results: Both groups significantly improved on gait parameters, motor abilities, and autonomy recovery in daily living activities with generally better results of RAGT over control treatment. In particular, the RAGT group improved more than control group in the 25FW (p = 0.004) and the 6MWT (p = 0.022). Conclusions: RAGT is a valid treatment option that in association with physiotherapy could induce positive effects in MS-correlated gait disorders. Our results showed greater effectiveness in recovering gait speed and resistance than conventional gait training.
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