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Sagawa Y, Guilhendou C, Moulin T, Soares AV, Decavel P. Neuro-orthopaedic check-up and walking in people with multiple sclerosis: toward a more specific assessment to improve rehabilitation results. J Exerc Rehabil 2024; 20:65-75. [PMID: 38737468 PMCID: PMC11079549 DOI: 10.12965/jer.2448128.064] [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: 03/05/2024] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 05/14/2024] Open
Abstract
The rehabilitation process of people with multiple sclerosis (PwMS) is a challenge, and decision-making requires a thorough assessment to increase the chances of success in rehabilitation planning. The aim of this study was to investigate the importance of the neuroorthopaedic check-Up (NOChU) for gait prognosis. Participated in the study 105 PwMS with different levels of impairment. The NOChU includes measurements of passive range of motion (ROM), muscle strength, and spasticity. Additionally, was carried out the spatial-temporal analysis of the walking, Timed Up and Go test, and 6-min walk test. ROM remained relatively preserved to perform daily life activities except for ankle dorsiflexion. Muscle strength was also relatively preserved. Spasticity affected especially the ankle muscles, clearly the sural triceps. Among the NOChU measurements the catch seemed to have the most impact on walking on its different phases and on other activities. Accurate NOChU measurements play a crucial role in clinical settings, guiding informed decisions in rehabilitation planning. Future research endeavours could focus on exploring the correlations between NOChU deficiencies and the decline in walking capabilities among PwMS, with the goal of proposing personalized treatment strategies that address their specific requirements.
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Affiliation(s)
- Yoshimasa Sagawa
- Integrative and Clinical Neurosciences, UMR 1322 INSERM, University of Franche-Comté, Besançon,
France
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon,
France
| | - Coline Guilhendou
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon,
France
| | - Thierry Moulin
- Integrative and Clinical Neurosciences, UMR 1322 INSERM, University of Franche-Comté, Besançon,
France
| | - Antonio Vinicius Soares
- Integrative and Clinical Neurosciences, UMR 1322 INSERM, University of Franche-Comté, Besançon,
France
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon,
France
- University of Joinville Region, Joinville,
Brazil
| | - Pierre Decavel
- Integrative and Clinical Neurosciences, UMR 1322 INSERM, University of Franche-Comté, Besançon,
France
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Hagen AC, Patrick CM, Bast IE, Fling BW. Propulsive Force Modulation Drives Split-Belt Treadmill Adaptation in People with Multiple Sclerosis. SENSORS (BASEL, SWITZERLAND) 2024; 24:1067. [PMID: 38400224 PMCID: PMC10891828 DOI: 10.3390/s24041067] [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: 01/09/2024] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Most people with multiple sclerosis (PwMS) experience significant gait asymmetries between their legs during walking, leading to an increased risk of falls. Split-belt treadmill training, where the speed of each limb is controlled independently, alters each leg's stepping pattern and can improve gait symmetry in PwMS. However, the biomechanical mechanisms of this adaptation in PwMS remain poorly understood. In this study, 32 PwMS underwent a 10 min split-belt treadmill adaptation paradigm with the more affected (MA) leg moving twice as fast as the less affected (LA) leg. The most noteworthy biomechanical adaptation observed was increased peak propulsion asymmetry between the limbs. A kinematic analysis revealed that peak dorsiflexion asymmetry and the onset of plantarflexion in the MA limb were the primary contributors to the observed increases in peak propulsion. In contrast, the joints in the LA limb underwent only immediate reactive adjustments without subsequent adaptation. These findings demonstrate that modulation during gait adaptation in PwMS occurs primarily via propulsive forces and joint motions that contribute to propulsive forces. Understanding these distinct biomechanical changes during adaptation enhances our grasp of the rehabilitative impact of split-belt treadmill training, providing insights for refining therapeutic interventions aimed at improving gait symmetry.
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Affiliation(s)
- Andrew C. Hagen
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523-1582, USA; (C.M.P.); (I.E.B.)
| | - Christopher M. Patrick
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523-1582, USA; (C.M.P.); (I.E.B.)
- Molecular, Cellular and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO 80523-1617, USA
| | - Isaac E. Bast
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523-1582, USA; (C.M.P.); (I.E.B.)
| | - Brett W. Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523-1582, USA; (C.M.P.); (I.E.B.)
- Molecular, Cellular and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO 80523-1617, USA
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Jeng B, Huynh TLT, Motl RW. Comorbid Conditions and Physical Function in Adults With Multiple Sclerosis. Arch Phys Med Rehabil 2024; 105:251-257. [PMID: 37442217 DOI: 10.1016/j.apmr.2023.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE We examined the total number of comorbid conditions as a correlate of physical function in persons with multiple sclerosis (MS). We further identified the presence of common comorbid conditions and examined physical function outcomes based on presence or absence of the comorbid conditions in persons with MS. DESIGN Cross-sectional, comparative study. SETTING University-based laboratory. PARTICIPANTS Two hundred seven persons with MS (N=207) completed the study. MAIN OUTCOME MEASURES Participants provided demographic, clinical, and comorbidity information. Participants then completed the 6-minute walk (6MW), timed 25-foot walk (T25FW), timed Up and Go (TUG), and short physical performance battery (SPPB). INTERVENTIONS Not applicable. RESULTS The number of comorbid conditions was associated with 6MW, T25FW, TUG, and SPPB scores (all P≤.001). Persons with MS who had hypertension performed worse on the 6MW, T25FW, TUG, and SPPB than persons without hypertension. Persons who had osteoarthritis performed worse on the 6MW, T25FW, and SPPB than persons without osteoarthritis. CONCLUSIONS The results demonstrate that persons who report more comorbid conditions have worse physical function, and this may largely be associated with hypertension or osteoarthritis. There are opportunities for the design of behavioral interventions that target physical activity and/or diet for improving physical function via comorbid conditions in persons with MS.
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Affiliation(s)
- Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL; Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL.
| | - Trinh L T Huynh
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL; Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
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Takla TN, Matsuda PN, Herring TE, Daugherty AM, Fritz NE. Scale development to evaluate differences between concern about falling and fear of falling: the concern and fear of falling evaluation. Front Psychol 2024; 15:1336078. [PMID: 38318081 PMCID: PMC10839088 DOI: 10.3389/fpsyg.2024.1336078] [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: 11/15/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose Individuals with multiple sclerosis (MS) experience fear of falling (FOF), which is associated with negative health and quality-of-life consequences. Prior research has used FOF and concern about falling (CAF) interchangeably, but persons with MS report that CAF and FOF represent separate constructs that lie on a continuum. Unfortunately, no scale exists to understand the differences between CAF and FOF. Therefore, we developed a novel questionnaire, the Concern and Fear of Falling Evaluation (CAFFE), in which respondents rank their CAF and FOF on a continuum across various activities. This study aims to describe the scale development process and examine its psychometric properties. Methods In a single online survey, MS participants responded to demographic questionnaires, indicated whether they experience CAF and FOF, and completed the CAFFE. Psychometric evaluation of the CAFFE involved internal consistency, split-half cross validation, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). Results Out of 1,025 respondents, 64.6% reported CAF and 47.2% reported FOF. The EFA yielded a two-factor solution encompassing activities in open (factor 1) and closed environments (factor 2). The CFA replicated this two-factor solution and the CAFFE demonstrated excellent internal consistency (α = 0.98). Conclusion The 27-item CAFFE is a highly reliable and valid measure capturing the tipping point at which point CAF moves to FOF. Future research should seek to define the tipping point from the MS community, as CAF may be an adaptive mechanism, whereas FOF may be a maladaptive behavior.
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Affiliation(s)
- Taylor N. Takla
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, United States
- Translational Neuroscience Program, Wayne State University, Detroit, MI, United States
| | - Patricia N. Matsuda
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle, WA, United States
| | - Tracy E. Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Ana M. Daugherty
- Translational Neuroscience Program, Wayne State University, Detroit, MI, United States
- Department of Psychology, Wayne State University, Detroit, MI, United States
- Institute of Gerontology, Wayne State University, Detroit, MI, United States
| | - Nora E. Fritz
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, United States
- Translational Neuroscience Program, Wayne State University, Detroit, MI, United States
- 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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Takla TN, Chargo AN, Daugherty AM, Fritz NE. Cognitive Contributors of Backward Walking in Persons with Multiple Sclerosis. Mult Scler Int 2023; 2023:5582242. [PMID: 37600498 PMCID: PMC10438976 DOI: 10.1155/2023/5582242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose Individuals with multiple sclerosis (MS) are at an increased fall risk due to motor and cognitive dysfunction. Our past studies suggest that backward walking (BW) velocity predicts fall risk; however, specific cognitive domains associated with BW velocity remain understudied. The goal of this study was to determine the specific contributions of cognitive functioning to BW velocity in persons with MS. We hypothesized that better visuospatial memory, verbal immediate recall, and faster information processing speed would contribute to faster BW velocity, and deficits in these domains would partially account for disease severity-related impairment in BW velocity. Methods Participants completed demographic questionnaires, walking tests, and cognitive assessments. Applied structural equation modeling was used to test our hypothesized model of competing cognitive mediators. Within the model, disease severity was a predictor of BW via three intercorrelated cognitive mediators. Results Participants included 39 individuals with relapsing-remitting MS. Results indicated that 35.3% of the significant total effect of disease severity on BW was accounted for by specific cognitive deficits. Verbal immediate recall had the largest contribution, followed by visuospatial memory and information processing speed. Conclusions When examining the unique effects of cognitive domains on disease severity-related deficits in BW, a meaningful source of impairment related to visuospatial memory and verbal immediate recall was demonstrated. Considering the utility of BW velocity as a predictor of falls, these results highlight the importance of assessing cognition when evaluating fall risk in MS. Cognitive-based intervention studies investigating fall prevention may find BW as a more specific and sensitive predictor of fall risk than forward walking.
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Affiliation(s)
- Taylor N. Takla
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
| | - Alexis N. Chargo
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Ana M. Daugherty
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Nora E. Fritz
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
- Department of Health Care Sciences, Wayne State University, Detroit, MI, USA
- Department of Neurology, Wayne State University, Detroit, MI, USA
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Kaur R, Levy J, Motl RW, Sowers R, Hernandez ME. Deep Learning for Multiple Sclerosis Differentiation Using Multi-Stride Dynamics in Gait. IEEE Trans Biomed Eng 2023; 70:2181-2192. [PMID: 37819835 DOI: 10.1109/tbme.2023.3238680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a chronic neurological condition of the central nervous system leading to various physical, mental and psychiatric complexities. Mobility limitations are amongst the most frequent and early markers of MS. We evaluated the effectiveness of a DeepMS2G (deep learning (DL) for MS differentiation using multistride dynamics in gait) framework, which is a DL-based methodology to classify multi-stride sequences of persons with MS (PwMS) from healthy controls (HC), in order to generalize over newer walking tasks and subjects. METHODS We collected single-task Walking and dual-task Walking-while-Talking gait data using an instrumented treadmill from a balanced collection of 20 HC and 20 PwMS. We utilized domain knowledge-based spatiotemporal and kinetic gait features along with two normalization schemes, namely standard size-based and multiple regression normalization strategies. To differentiate between multi-stride sequences of HC and PwMS, we compared 16 traditional machine learning and DL algorithms. Further, we studied the interpretability of our highest-performing models; and discussed the association between the lower extremity function of participants and our model predictions. RESULTS We observed that residual neural network (ResNet) based models with regression-based normalization were the top performers across both task and subject generalization classification designs. Considering regression-based normalization, a multi-scale ResNet attained a subject classification accuracy and F 1-score of 1.0 when generalizing from single-task Walking to dual-task Walking-while-Talking; and a ResNet resulted in the top subject-wise accuracy and F 1 of 0.83 and 0.81 (resp.), when generalizing over unseen participants. CONCLUSION We used advanced DL and dynamics across domain knowledge-based spatiotemporal and kinetic gait parameters to successfully classify MS gait across distinct walking trials and unseen participants. SIGNIFICANCE Our proposed DL algorithms might contribute to efforts to automate MS diagnoses.
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Chang MC, Lee BJ, Yang D, Kim CR, Park D, Kim S. The association between cognition and gait disturbance in central nervous system demyelinating disorder with mild disability. BMC Neurol 2023; 23:177. [PMID: 37120584 PMCID: PMC10148385 DOI: 10.1186/s12883-023-03210-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 04/14/2023] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Gait disturbance in central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS) and neuromyelitis optica (NMO) is one of the most troublesome problems that has a direct impact on the quality of life. However, the associations between gait disturbance and other clinical variables of these two diseases have not been fully elucidated. OBJECTIVE This study aimed to evaluate gait disturbance using a computerized gait analysis system and its association with various clinical variables in patients with MS and NMO. METHODS A total of 33 patients (14 with MS and 19 with NMO) with minor disabilities, who were able to walk independently and had passed their acute phase, were enrolled in the study. Gait analysis were performed using a computer-based instrumented walkway system. (Walk-way MG-1000, Anima, Japan) Clinical variables, such as disease duration, medication, body mass index (BMI), hand grip power, and muscle mass were recorded. The Montreal Cognitive Assessment (MOCA), Beck Depression Inventory score-II (BDI), and fatigue scale were measured using the Functional Assessment of Chronic Illness Therapy-fatigue scale (FACIT-fatigue) scale. A trained neurologist scored the Expanded Disability Status Scale (EDSS). RESULTS Gait speed was the single parameter that showed a significant positive correlation with MOCA (p < 0.001). The stance phase time was the single parameter that showed a significant negative correlation with EDSS (p < 0.001). Hand grip strength showed a significant positive correlation with skeletal muscle mass as assessed by bioimpedance analysis (p < 0.05). The FACIT-fatigue scale score showed a significant negative correlation with the BDI (p < 0.001). CONCLUSION In our patients with MS/NMO with mild disability, cognitive impairment was significantly correlated with gait speed, and the degree of disability was significantly correlated with stance phase time. Our findings may imply that early detection of a decrease in gait speed and an increase in stance phase time can predict the progression of cognitive impairment in patients with MS/NMO with mild disability.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Byung Joo Lee
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Ayang-Ro 99 Gil, Dong-Gu, Daegu, 41199, Republic of Korea
| | - Dongseok Yang
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Chung Reen Kim
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Ayang-Ro 99 Gil, Dong-Gu, Daegu, 41199, Republic of Korea.
| | - Sunyoung Kim
- Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, 877 Bangeojin sunhwando-ro, Dong-gu, 44033, Ulsan, Korea.
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DelMastro HM, Ruiz JA, Simaitis LB, Gromisch ES, Neto LO, Cohen ET, Wong E, Krug RJ, Lo AC. Effect of Backward and Forward Walking on Lower Limb Strength, Balance, and Gait in Multiple Sclerosis: A Randomized Feasibility Trial. Int J MS Care 2023; 25:45-50. [PMID: 36923577 PMCID: PMC10010109 DOI: 10.7224/1537-2073.2022-010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Backward walking (BW) interventions have improved gait and balance in persons with stroke, cerebral palsy, and Parkinson disease but have not been studied in persons with multiple sclerosis (MS). We examined the feasibility of a BW intervention and how it affected strength, balance, and gait vs forward walking (FW) in persons with MS. METHODS Sixteen persons with MS with a Patient-Determined Disease Steps (PDDS) scale score of 3 to 5 (gait impairment-late cane) were randomized to the FW (n = 8) or BW (n = 8) group. Participants did 30 minutes of FW or BW on a treadmill 3 times per week for 8 weeks (24 visits). Enrollment, adherence rate, and safety were tracked. The Timed Up and Go test, Six-Spot Step Test, single-leg stance, and abbreviated Activities-specific Balance Confidence scale were used to measure balance. Hip and knee flexion and extension strength (isometric peak torque), gait speed, and spatiotemporal gait parameters were measured. A 2×2 factorial multivariate analysis of covariance was used to examine changes in strength, balance, and gait, with the PDDS scale score as the covariate. RESULTS Treatment adherence rate was 99.7%, with no safety concerns. After controlling for baseline differences in disability (PDDS scale score; P = .041), the BW group improved dominant hip flexion strength preintervention to postintervention compared with the FW group (F 1,13 = 9.03; P = .010). No other significant differences were seen between groups. CONCLUSIONS This was the first study to look at BW as an intervention in persons with MS. Based on its feasibility, safety, and significant finding, BW should be studied in a larger, definitive trial in the future.
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Affiliation(s)
- Heather M. DelMastro
- From the Joyce D. and Andrew J. Mandell Center for Comprehensive Multiple Sclerosis Care and Neuroscience Research, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA (HMDM, JAR, ESG, LON, ACL)
- Department of Rehabilitative Medicine (HMDM, JAR, ESG, LON), Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Jennifer A. Ruiz
- From the Joyce D. and Andrew J. Mandell Center for Comprehensive Multiple Sclerosis Care and Neuroscience Research, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA (HMDM, JAR, ESG, LON, ACL)
- Department of Rehabilitative Medicine (HMDM, JAR, ESG, LON), Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Medical Sciences (JAR, ESG, EW), Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Laura B. Simaitis
- Department of Physical Therapy (LBS), School of Health Sciences at Quinnipiac University, North Haven, CT, USA
| | - Elizabeth S. Gromisch
- From the Joyce D. and Andrew J. Mandell Center for Comprehensive Multiple Sclerosis Care and Neuroscience Research, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA (HMDM, JAR, ESG, LON, ACL)
- Department of Rehabilitative Medicine (HMDM, JAR, ESG, LON), Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Medical Sciences (JAR, ESG, EW), Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA (ESG)
| | - Lindsay O. Neto
- From the Joyce D. and Andrew J. Mandell Center for Comprehensive Multiple Sclerosis Care and Neuroscience Research, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA (HMDM, JAR, ESG, LON, ACL)
- Department of Rehabilitative Medicine (HMDM, JAR, ESG, LON), Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Evan T. Cohen
- School of Health Professions, Rutgers, The State University of New Jersey, Blackwood, NJ, USA (ETC)
| | - Edgar Wong
- Department of Medical Sciences (JAR, ESG, EW), Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Robert J. Krug
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA (RJK)
| | - Albert C. Lo
- From the Joyce D. and Andrew J. Mandell Center for Comprehensive Multiple Sclerosis Care and Neuroscience Research, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA (HMDM, JAR, ESG, LON, ACL)
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Phothirook P, Amatachaya S, Peungsuwan P. Muscle Activity and Co-Activation of Gait Cycle during Walking in Water and on Land in People with Spastic Cerebral Palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1854. [PMID: 36767224 PMCID: PMC9914649 DOI: 10.3390/ijerph20031854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the differences in the muscle activity and co-activation index (CoA) of the rectus femoris (RF), biceps femoris (BF), gastrocnemius medialis (GM,) and tibialis anterior (TA) during walking on land and in water in healthy adolescents compared with those with spastic diplegia cerebral palsy (CP) adolescents. METHODS Four healthy individuals (median; age: 14 years, height: 1.57 cm, BMI: 16.58 kg/m2) and nine CP individuals (median; age: 15 years, height: 1.42 cm, BMI: 17.82 kg/m2) participated in this study and performed three walking trials under both conditions. An electromyography (EMG) collection was recorded with a wireless system Cometa miniwave infinity waterproof device, and the signals were collected using customized software named EMG and Motion Tools, Inc. software version 7 (Cometa slr, Milan, Italy) and was synchronized with an underwater VDO camera. RESULTS A significant decrease in the muscle activity of all muscles and CoA of RF/BF muscles, but an increase in TA/GM was observed within the CP group while walking in water during the stance phase. Between groups, there was a lower CoA of RF/BF and a greater CoA of TA/GM during the stance phase while walking in water and on land in the CP group. A non-significant difference was observed within the healthy group. CONCLUSION Walking in water can decrease muscle activity in lower limbs and co-activation of thigh muscles in people with spastic CP, whereas CoA muscles around ankle joints increased to stabilize foot weight acceptance.
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Affiliation(s)
- Pariyaporn Phothirook
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Punnee Peungsuwan
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
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Dong X, Ge Y, Li K, Li X, Liu Y, Xu D, Wang S, Gu X. A high-pressure resistant ternary network hydrogel based flexible strain sensor with a uniaxially oriented porous structure toward gait detection. SOFT MATTER 2022; 18:9231-9241. [PMID: 36427226 DOI: 10.1039/d2sm01286c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Gait abnormalities have been widely investigated in the diagnosis and treatment of neurodegenerative diseases. However, it is still a great challenge to achieve a comfortable, convenient, sensitive and high-pressure resistant flexible gait detection sensor for real-time health monitoring. In this work, a polyaniline (PANI)@(polyacrylic acid (PAA)-polyvinyl alcohol (PVA)) (PANI@(PVA-PAA)) ternary network hydrogel with a uniaxially oriented porous featured structure was successfully prepared using a simple freeze-thaw method and in situ polymerization. The PANI@(PVA-PAA) hydrogel shows excellent compressive mechanical properties (423.44 kPa), favorable conductivity (2.02 S m-1) and remarkable durability (500 loading-unloading cycle), and can sensitively detect the effect of pressure with a fast response time (200 ms). The PANI@(PVA-PAA) hydrogel assembled into a flexible sensor can effectively identify the movement state of the shoulder, knee and even the sole of the plantar for gait detection. The uniaxially oriented porous structure enables the hydrogel-based sensor to have a high rate of change in the longitudinal direction and can effectively distinguish various gaits. The construction of a hydrogen bond between PANI and the PVA-PAA hydrogel ensures the uniform distribution of PANI in the hydrogel to form a ternary network structure, which improves the pressure resistance and conductivity of the PANI@(PVA-PAA) hydrogel. Thus, PANI@(PVA-PAA) hydrogel flexible sensor for gait detection can not only effectively monitor some serious diseases but also detect some unscientific exercise in people's daily life.
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Affiliation(s)
- Xin Dong
- Shandong Provincial Key Laboratory of Preparation and Measurement of Building Materials, University of Jinan, China.
| | - Yaqing Ge
- College of Medicine and Nursing, Shandong Provincial Engineering Laboratory of Novel Pharmaceutical Excipients, Sustained and Controlled Release Preparations, Dezhou University, China.
| | - Keyi Li
- College of Chemistry and Chemical Engineering, Shandong University of Technology, China
| | - Xinyi Li
- College of Medicine and Nursing, Shandong Provincial Engineering Laboratory of Novel Pharmaceutical Excipients, Sustained and Controlled Release Preparations, Dezhou University, China.
| | - Yong Liu
- College of Medicine and Nursing, Shandong Provincial Engineering Laboratory of Novel Pharmaceutical Excipients, Sustained and Controlled Release Preparations, Dezhou University, China.
| | - Dongyu Xu
- College of Civil Engineering and Architecture, Linyi University, China
| | - Shoude Wang
- Shandong Provincial Key Laboratory of Preparation and Measurement of Building Materials, University of Jinan, China.
| | - Xiangling Gu
- College of Medicine and Nursing, Shandong Provincial Engineering Laboratory of Novel Pharmaceutical Excipients, Sustained and Controlled Release Preparations, Dezhou University, China.
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Khalifeloo M, Naghdi S, Ansari NN, Dommerholt J, Sahraian MA. Dry needling for the treatment of muscle spasticity in a patient with multiple sclerosis: a case report. Physiother Theory Pract 2022; 38:3248-3254. [PMID: 34546842 DOI: 10.1080/09593985.2021.1978118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Spasticity is a common cause of disability in multiple sclerosis (MS), which can negatively affect the patient's walking and balance. OBJECTIVE To evaluate the immediate effect of dry needling (DN) on spasticity and mobility in a female with MS. CASE DESCRIPTION In this case, a 38-year-old female with a 4-year history of MS was treated. The hamstring muscles (biceps femoris and semitendinosus) were needled for 1 minute in a single session. The main outcome measures were the Modified Modified Ashworth Scale (MMAS) to evaluate spasticity, the Timed 25-Foot Walk (T25FW) for the assessment of mobility and leg function performance, and stiffness as a biomechanical index of spasticity measured by a dynamometer. The assessments were done before and immediately after DN. OUTCOMES The MMAS scores decreased in the hamstrings (1 to 0) and quadriceps (2 to 1). The mobility improved as the time for T25FW decreased from 16.30 to 9.29 seconds. The stiffness of hamstring decreased after treatment (0.451 to 0.312). CONCLUSION One session of DN for the hamstring muscle decreased spasticity and improved mobility in this patient with MS. Further studies are suggested.
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Affiliation(s)
- Maede Khalifeloo
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Ali Sahraian
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
- Sina Ms Research Center, Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran
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12
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Hardin EC, Bailey SN, Kobetic R, Lombardo LM, Foglyano KM, Schnellenberger JR, Selkirk SM. Development and deployment of cyclical focal muscle vibration system to improve walking performance in multiple sclerosis. J Med Eng Technol 2022; 46:393-401. [PMID: 35674709 DOI: 10.1080/03091902.2022.2080880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Vibration, a potent mechanical stimulus for activating muscle spindle primary afferents, may improve gait performance in persons with multiple sclerosis (MS), but has yet to be developed and deployed for multiple leg muscles with application during walking training. This study explored the development of a cyclic focal muscle vibration (FMV) system, and the deployment feasibility to correct MS walking swing phase deficits in order to determine whether this intervention warrants comprehensive study. The system was deployed during twelve, two-hour sessions of walking with cyclic FMV over six weeks. Participants served as their own control. Blood pressure, heart rate, walking speed, kinematics (peak hip, knee and ankle angles during swing), toe clearance, and step length were measured before and after deployment with blood pressure and heart rate monitored during deployment. During system deployment, there were no untoward sensations and physiological changes in blood pressure and heart rate, and volitional improvements were found in walking speed, improved swing phase kinematics, toe clearance and step length. This FMV training system was developed and deployed to improve joint flexion during walking in those with MS, and it demonstrated feasibility and benefits. Further study will determine the most effective vibration frequency and dose, carryover effects, and those most likely to benefit from this intervention.
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Affiliation(s)
- Elizabeth C Hardin
- Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Stephanie Nogan Bailey
- Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Rudolf Kobetic
- Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Lisa M Lombardo
- Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Kevin M Foglyano
- Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - John R Schnellenberger
- Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Stephen M Selkirk
- Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
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13
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Molina-Rueda F, Fernández-Vázquez D, Navarro-López V, Miangolarra-Page JC, Carratalá-Tejada M. The Timing of Kinematic and Kinetic Parameters during Gait Cycle as a Marker of Early Gait Deterioration in Multiple Sclerosis Subjects with Mild Disability. J Clin Med 2022; 11:jcm11071892. [PMID: 35407499 PMCID: PMC8999659 DOI: 10.3390/jcm11071892] [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: 02/16/2022] [Revised: 03/18/2022] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
This study aimed to evaluate walking in multiple sclerosis (MS) patients with mild disability. A case control study with 8 mild disability MS patients and 10 controls was conducted. This study analyzed spatiotemporal, kinematic, and kinetic parameters. We also analyzed the timing of these parameters, as a percentage of the gait cycle. The MS patients and controls walked with a similar gait pattern. However, there were differences in the timing of the biomechanical parameters. The timing of toe-off was at 62–63% of gait cycle in MS subjects while in controls it was at 59.94% (p = 0.009 to 0.027 vs. to controls). The peak of knee flexion during swing was at 74–76% of gait cycle in MS subjects while in controls was at 72% (p = 0.027 to 0.034). While the peak of ankle dorsiflexion during stance occurred at 48–50% in MS subjects, while in controls it was at 46% (p = 0.001 to 0.009), and the peak of plantar flexion during pre-swing was at 66% in MS subjects vs. 64% in controls (p = 0.001). At the kinetic pattern, the first peak of the vertical ground reaction force occurred at 14% of gait cycle in controls while in MS patients it was at 17–20% (p = 0.012 to 0.021). MS subjects with mild disability walked with similar spatiotemporal parameters, joint angles and moments compared to controls. However, our results suggest that those changed the temporal occurrences, expressed as percentage of the gait cycle, of the kinematic and kinetic parameters.
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Affiliation(s)
- Francisco Molina-Rueda
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (V.N.-L.); (J.C.M.-P.); (M.C.-T.)
- Movement Analysis, Biomechanics, Ergonomics, and Motor Control Laboratory, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Diego Fernández-Vázquez
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (V.N.-L.); (J.C.M.-P.); (M.C.-T.)
- Movement Analysis, Biomechanics, Ergonomics, and Motor Control Laboratory, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Correspondence:
| | - Víctor Navarro-López
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (V.N.-L.); (J.C.M.-P.); (M.C.-T.)
- Movement Analysis, Biomechanics, Ergonomics, and Motor Control Laboratory, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Juan Carlos Miangolarra-Page
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (V.N.-L.); (J.C.M.-P.); (M.C.-T.)
- Movement Analysis, Biomechanics, Ergonomics, and Motor Control Laboratory, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Physical Medicine and Rehabilitation Service, University Hospital of Fuenlabrada, 28942 Madrid, Spain
| | - María Carratalá-Tejada
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (V.N.-L.); (J.C.M.-P.); (M.C.-T.)
- Movement Analysis, Biomechanics, Ergonomics, and Motor Control Laboratory, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
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14
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Salchow-Hömmen C, Skrobot M, Jochner MCE, Schauer T, Kühn AA, Wenger N. Review-Emerging Portable Technologies for Gait Analysis in Neurological Disorders. Front Hum Neurosci 2022; 16:768575. [PMID: 35185496 PMCID: PMC8850274 DOI: 10.3389/fnhum.2022.768575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/07/2022] [Indexed: 01/29/2023] Open
Abstract
The understanding of locomotion in neurological disorders requires technologies for quantitative gait analysis. Numerous modalities are available today to objectively capture spatiotemporal gait and postural control features. Nevertheless, many obstacles prevent the application of these technologies to their full potential in neurological research and especially clinical practice. These include the required expert knowledge, time for data collection, and missing standards for data analysis and reporting. Here, we provide a technological review of wearable and vision-based portable motion analysis tools that emerged in the last decade with recent applications in neurological disorders such as Parkinson's disease and Multiple Sclerosis. The goal is to enable the reader to understand the available technologies with their individual strengths and limitations in order to make an informed decision for own investigations and clinical applications. We foresee that ongoing developments toward user-friendly automated devices will allow for closed-loop applications, long-term monitoring, and telemedical consulting in real-life environments.
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Affiliation(s)
- Christina Salchow-Hömmen
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matej Skrobot
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Magdalena C E Jochner
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Schauer
- Control Systems Group, Technische Universität Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Charité-Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, DZNE, Berlin, Germany
| | - Nikolaus Wenger
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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15
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Wijeyaratnam DO, Edwards T, Pilutti LA, Cressman EK. Assessing visually guided reaching in people with multiple sclerosis with and without self-reported upper limb impairment. PLoS One 2022; 17:e0262480. [PMID: 35061785 PMCID: PMC8782348 DOI: 10.1371/journal.pone.0262480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
The ability to accurately complete goal-directed actions, such as reaching for a glass of water, requires coordination between sensory, cognitive and motor systems. When these systems are impaired, like in people with multiple sclerosis (PwMS), deficits in movement arise. To date, the characterization of upper limb performance in PwMS has typically been limited to results attained from self-reported questionnaires or clinical tools. Our aim was to characterize visually guided reaching performance in PwMS. Thirty-six participants (12 PwMS who reported upper limb impairment (MS-R), 12 PwMS who reported not experiencing upper limb impairment (MS-NR), and 12 age- and sex-matched control participants without MS (CTL)) reached to 8 targets in a virtual environment while seeing a visual representation of their hand in the form of a cursor on the screen. Reaches were completed with both the dominant and non-dominant hands. All participants were able to complete the visually guided reaching task, such that their hand landed on the target. However, PwMS showed noticeably more atypical reaching profiles when compared to control participants. In accordance with these observations, analyses of reaching performance revealed that the MS-R group was more variable with respect to the time it took to initiate and complete their movements compared to the CTL group. While performance of the MS-NR group did not differ significantly from either the CTL or MS-R groups, individuals in the MS-NR group were less consistent in their performance compared to the CTL group. Together these findings suggest that PwMS with and without self-reported upper limb impairment have deficits in the planning and/or control of their movements. We further argue that deficits observed during movement in PwMS who report upper limb impairment may arise due to participants compensating for impaired movement planning processes.
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Affiliation(s)
- Darrin O. Wijeyaratnam
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas Edwards
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lara A. Pilutti
- Interdisciplinary School of Health Science, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin K. Cressman
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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16
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Kaur R, Chen Z, Motl R, Hernandez ME, Sowers R. Predicting Multiple Sclerosis From Gait Dynamics Using an Instrumented Treadmill: A Machine Learning Approach. IEEE Trans Biomed Eng 2021; 68:2666-2677. [PMID: 33378257 DOI: 10.1109/tbme.2020.3048142] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multiple Sclerosis (MS) is a neurological condition which widely affects people 50-60 years of age. While clinical presentations of MS are highly heterogeneous, mobility limitations are one of the most frequent symptoms. This study examines a machine learning (ML) framework for identifying MS through spatiotemporal and kinetic gait features. METHODS In this study, gait data during self-paced walking on an instrumented treadmill from 20 persons with MS and 20 age, weight, height, and gender-matched healthy older adults (HOA) were obtained. We explored two strategies to normalize data and minimize dependence on subject demographics; size-normalization (standard body size-based normalization) and regress-normalization (regression-based normalization using scaling factors derived by regressing gait features on multiple subject demographics); and proposed an ML based methodology to classify individual strides of older persons with MS (PwMS) from healthy controls. We generalized both across different walking tasks and subjects. RESULTS We observed that regress-normalization improved the accuracy of identifying pathological gait using ML when compared to size-normalization. When generalizing from comfortable walking to walking while talking, gradient boosting machine achieved the optimal subject classification accuracy and AUC of 94.3 and 1.0, respectively and for subject generalization, a multilayer perceptron resulted in the best accuracy and AUC of 80% and 0.86, respectively, both with regression-normalized data. CONCLUSION The integration of gait data and ML may provide a viable patient-centric approach to aid clinicians in monitoring MS. SIGNIFICANCE The results of this study have future implications for the way regression normalized gait features may be clinically used to design ML-based disease prediction strategies and monitor disease progression in PwMS.
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17
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Cicirelli G, Impedovo D, Dentamaro V, Marani R, Pirlo G, D'Orazio TR. Human Gait Analysis in Neurodegenerative Diseases: a Review. IEEE J Biomed Health Inform 2021; 26:229-242. [PMID: 34181559 DOI: 10.1109/jbhi.2021.3092875] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper reviews the recent literature on technologies and methodologies for quantitative human gait analysis in the context of neurodegnerative diseases. The use of technological instruments can be of great support in both clinical diagnosis and severity assessment of these pathologies. In this paper, sensors, features and processing methodologies have been reviewed in order to provide a highly consistent work that explores the issues related to gait analysis. First, the phases of the human gait cycle are briefly explained, along with some non-normal gait patterns (gait abnormalities) typical of some neurodegenerative diseases. The work continues with a survey on the publicly available datasets principally used for comparing results. Then the paper reports the most common processing techniques for both feature selection and extraction and for classification and clustering. Finally, a conclusive discussion on current open problems and future directions is outlined.
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18
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Monaghan AS, Huisinga JM, Peterson DS. The application of principal component analysis to characterize gait and its association with falls in multiple sclerosis. Sci Rep 2021; 11:12811. [PMID: 34140612 PMCID: PMC8211858 DOI: 10.1038/s41598-021-92353-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 02/05/2023] Open
Abstract
People with multiple sclerosis (PwMS) demonstrate gait impairments that are related to falls. However, redundancy exists when reporting gait outcomes. This study aimed to develop an MS-specific model of gait and examine differences between fallers and non-fallers. 122 people with relapsing-remitting MS and 45 controls performed 3 timed up-and-go trials wearing inertial sensors. 21 gait parameters were entered into a principal component analysis (PCA). The PCA-derived gait domains were compared between MS fallers (MS-F) and MS non-fallers (MS-NF) and correlated to cognitive, clinical, and quality-of-life outcomes. Six distinct gait domains were identified: pace, rhythm, variability, asymmetry, anterior-posterior dynamic stability, and medial-lateral dynamic stability, explaining 79.15% of gait variance. PwMS exhibited a slower pace, larger variability, and increased medial-lateral trunk motion compared to controls (p < 0.05). The pace and asymmetry domains were significantly worse (i.e., slower and asymmetrical) in MS-F than MS-NF (p < 0.001 and p = 0.03, respectively). Fear of falling, cognitive performance, and functional mobility were associated with a slower gait (p < 0.05). This study identified a six-component, MS-specific gait model, demonstrating that PwMS, particularly fallers, exhibit deficits in pace and asymmetry. Findings may help reduce redundancy when reporting gait outcomes and inform interventions targeting specific gait domains.
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Affiliation(s)
- Andrew S. Monaghan
- grid.215654.10000 0001 2151 2636College of Health Solutions, Arizona State University, 425 N 5th St., Phoenix, AZ 85282 USA
| | - Jessie M. Huisinga
- grid.412016.00000 0001 2177 6375Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, USA
| | - Daniel S. Peterson
- grid.215654.10000 0001 2151 2636College of Health Solutions, Arizona State University, 425 N 5th St., Phoenix, AZ 85282 USA ,grid.416818.20000 0004 0419 1967Phoenix VA Health Care Center, Phoenix, AZ USA
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19
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Lencioni T, Anastasi D, Carpinella I, Castagna A, Crippa A, Gervasoni E, Marzegan A, Rabuffetti M, Pelosin E, Cattaneo D, Ferrarin M. Strategies for maintaining dynamic balance in persons with neurological disorders during overground walking. Proc Inst Mech Eng H 2021; 235:1079-1087. [PMID: 34112028 DOI: 10.1177/09544119211023624] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Maintaining a stable gait requires a dynamic balance control, that can be altered in persons with Multiple Sclerosis (MS), Stroke (ST), and Parkinson's disease (PD). The understanding of the strategy for Center of Mass (CoM) positioning adopted by patients during walking is important to be able to program treatments aimed at improving gait control and preventing falls. Forty-four persons with a mild-to-moderate neurological disorder (20 with MS, 14 with ST, 10 with PD) underwent clinical examination and gait analysis. Ten Healthy Subjects (HS) walking at matched speed provided the normative data. Dynamic balance was assessed using the margin of stability (MoS). It was calculated as the distance between the extrapolated Center of Pressure and the extrapolated CoM at mid-stance. The MoS values for lower limbs were calculated in patients and compared with speed-matched values of HS. Persons with neurological disorder showed increased MoS in the medio-lateral direction with respect to HS. Within-group comparison analysis showed a symmetry between lower limbs in HS (Mean (95%CI) [mm], dominant vs non-dominant limb, 43.3 (31.9-54.6) vs 42.9 (28.8-56.9)) and PD (less affected vs more affected limb, 71.1 (59.8-82.5) vs 72.5 (58.5-86.6)), while a significant asymmetry was found in MS (54.4 (46.4-62.4) vs 81.1 (71.2-91.1)) and ST (52.1 (42.6-61.7) vs 74.7 (62.8-86.6)) participants. The history of falls was comparable among PD, MS, and ST groups, and the MoS in the frontal plane showed a strong correlation with these records. Objective assessment of MoS revealed pathology-specific strategies showing different impacts in MS, ST, and PD on the ability to control CoM information to manage the balance between limbs during gait. MoS evaluation will provide useful information to address a tailored rehabilitation program and to monitor disease progression.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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20
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Jacob L, Smith L, Koyanagi A, Haro JM, Konrad M, Tanislav C, Kostev K. Is there an association between multiple sclerosis and osteoarthritis in Germany? A retrospective cohort study of 8,600 patients from Germany. Mult Scler J Exp Transl Clin 2021; 7:20552173211022784. [PMID: 34262785 PMCID: PMC8243106 DOI: 10.1177/20552173211022784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/15/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The goal of this retrospective cohort study was to investigate the multiple sclerosis-osteoarthritis relationship in adults followed in general practices in Germany. METHODS Patients aged 18-70 years who were diagnosed for the first time with multiple sclerosis in one of 1,193 general practices in Germany between 2005 and 2018 (index date) were included in this retrospective cohort study. Patients without multiple sclerosis were matched (1:1) to those with multiple sclerosis by sex, age, index year, general practice, obesity, injuries, and other types of arthritis (index date: a randomly selected visit date). The association between multiple sclerosis and the 10-year incidence of osteoarthritis was analyzed using Cox regression models. RESULTS There were 4,300 patients with multiple sclerosis and 4,300 patients without multiple sclerosis included in this study. The proportion of women was 69.3% and mean (SD) age was 43.6 (12.6) years. There was no significant association between multiple sclerosis and incident osteoarthritis in the overall sample (HR = 0.95, 95% CI: 0.83-1.09) as well as sex and age subgroups. CONCLUSIONS Based on these findings, multiple sclerosis is not significantly associated with osteoarthritis. Further studies of longitudinal nature are warranted to corroborate or invalidate these results.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari
Sant Joan de Déu, CIBERSAM, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Salud Mental (CIBERSAM), Madrid, Spain
- Faculty of Medicine, University of Versailles
Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise
Sciences, Anglia Ruskin
University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari
Sant Joan de Déu, CIBERSAM, Barcelona, Spain
- Institució Catalana de Recerca i Estudis
Avançats (ICREA), Barcelona, Spain
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari
Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | - Marcel Konrad
- Health & Social, FOM University of Applied
Sciences for Economics and Management, Frankfurt am Main, Germany
| | - Christian Tanislav
- Department of Geriatrics and Neurology,
Diakonie Hospital Jung Stilling, Siegen, Germany
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21
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Swanson CW, Richmond SB, Sharp BE, Fling BW. Middle-age people with multiple sclerosis demonstrate similar mobility characteristics to neurotypical older adults. Mult Scler Relat Disord 2021; 51:102924. [PMID: 33813095 DOI: 10.1016/j.msard.2021.102924] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical trials often report significant mobility differences between neurotypical and atypical groups, however, these analyses often do not determine which measures are capable of discriminating between groups. Additionally, indirect evidence supports the notion that some mobility impaired populations demonstrate similar mobility deficits. Thus, the current study aimed to provide a comprehensive analysis of three distinct aspects of mobility (walking, turning, and balance) to determine which variables were significantly different and were also able to discriminate between neurotypical older adults (OA) and middle-aged people with multiple sclerosis (PwMS), and between middle-aged neurotypical adults and PwMS. METHODS This study recruited 21 neurotypical OA, 19 middle-aged neurotypical adults, and 30 people with relapsing remitting MS. Participants came into the laboratory on two separate occasions to complete mobility testing while wearing wireless inertial sensors. Testing included a self-selected pace two-minute walk, a series of 180˚ and 360˚ turns, and a clinical balance test capturing a total of 99 distinct mobility characteristics. We determined significant differences for gait and turning measures through univariate analyses and a series of repeated measures analysis of variance in determining significance for balance conditions and measures. In determining discrimination between groups, the Area Under the Curve (AUC) was calculated for all individual mobility measures with a threshold of 0.80, denoting excellent discrimination. Additionally, a stepwise regression of the top five AUC producing variables was performed to determine whether a combination of variables could enhance discrimination while accounting for multicollinearity. RESULTS The results between neurotypical OA and middle-aged PwMS demonstrated significant differences for three gait and one turning variable, with no variable or combination of variables able to provide excellent discrimination between groups. Between middle-age neurotypical adults and PwMS a variety of mean and variability gait measures demonstrated significant differences between groups; however, no variable or combination of variables met discriminatory threshold. For turning, five 360˚ turn variables demonstrated significant differences and furthermore, the combination of 360˚ mean turn duration and variability of peak turn velocity were able to discriminate between groups. Finally, the majority of postural sway measures demonstrated significant group differences and the ability to discriminate between groups, particularly during more challenging balance conditions where participants stood on a compliant surface. CONCLUSION These results offer a comprehensive analysis of mobility differences and measures capable of discriminating between middle-age neurotypical adults and PwMS. Additionally, these results provide evidence that OA and middle-age PwMS display similar movement characteristics and thus a potential indicator of advanced aging from a mobility perspective.
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Affiliation(s)
- Clayton W Swanson
- Department of Health & Exercise Science, Colorado State University, Fort Collins, Colorado, USA
| | - Sutton B Richmond
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Benjamin E Sharp
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Brett W Fling
- Department of Health & Exercise Science, Colorado State University, Fort Collins, Colorado, USA; Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, Colorado, USA
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22
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Gait Pattern in People with Multiple Sclerosis: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11040584. [PMID: 33805095 PMCID: PMC8064080 DOI: 10.3390/diagnostics11040584] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the present systematic review was to describe the gait pattern in people with multiple sclerosis (MS) by compiling the main findings obtained from studies using three-dimensional capture systems of human movement. The search was carried out in PubMed, Web of Science, Physiotherapy Evidence Database (PEDro), and the Cumulative Index to Nursing and Allied Health (CINAHL) databases. Studies that used three-dimensional gait analysis systems and that analyzed spatiotemporal, kinematic, kinetic, or electromyographic parameters, were included. The quality of the studies was assessed using the Critical Review Form-Quantitative Studies scale. 12 articles were included with 523 (342 women and 181 men) people with a diagnosis of MS. The present work suggests that people with MS have a decrease in speed and stride length, as well as an increase in double-stance intervals during gait. Likewise, it is common to observe a decrease in hip extension during the stance period, a decrease in knee flexion in the swing period, a decrease in ankle dorsiflexion in the initial contact and a decrease in ankle plantar flexion during the pre-swing phase. The subjects with MS decrease the hip extensor moment and the ankle power during the stance period of walking.
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Jung WC, Lee JK. Treadmill-to-Overground Mapping of Marker Trajectory for Treadmill-Based Continuous Gait Analysis. SENSORS 2021; 21:s21030786. [PMID: 33503973 PMCID: PMC7866024 DOI: 10.3390/s21030786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/06/2021] [Accepted: 01/20/2021] [Indexed: 12/02/2022]
Abstract
A treadmill was used to perform continuous walking tests in a limited space that can be covered by marker-based optical motion capture systems. Most treadmill-based gait data are analyzed based on gait cycle percentage. However, achieving continuous walking motion trajectories over time without time normalization is often required, even if tests are performed under treadmill walking conditions. This study presents a treadmill-to-overground mapping method of optical marker trajectories for treadmill-based continuous gait analysis, by adopting a simple concept of virtual origin. The position vector from the backward moving virtual origin to a targeted marker within a limited walking volume is the same as the position vector from the fixed origin to the forward moving marker over the ground. With the proposed method, it is possible (i) to observe the change in physical quantity visually during the treadmill walking, and (ii) to obtain overground-mapped gait data for evaluating the accuracy of the inertial-measurement-unit-based trajectory estimation. The accuracy of the proposed method was verified from various treadmill walking tests, which showed that the total travel displacement error rate was 0.32% on average.
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A KH, Gh A, M A, M B, Z S, A B, M K. Design and Preliminary Evaluation of a New Ankle Foot Orthosis on Kinetics and Kinematics parameters for Multiple Sclerosis Patients. J Biomed Phys Eng 2020; 10:783-792. [PMID: 33364216 PMCID: PMC7753254 DOI: 10.31661/jbpe.v0i0.2007-1136] [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: 07/05/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022]
Abstract
Background: The damage of the central nervous system due to Multiple Sclerosis (MS) leads to many walking disorders in this population. However, current ankle-foot orthoses prescribed for improving walking disorders for these patients are not clinically cost-efficient. Objective: This study aimed to design and fabricate a dynamic ankle foot orthosis and a new spring-damper joint mechanism that could adapt the walking problems of MS patients and evaluate the immediate effect of the new orthosis on the speed, range of motion, moment, total work and ground reaction force during walking. Material and Methods: In this case-series study, after the design and fabrication of a new orthosis, the kinetics and kinematics of walking of four patients with MS were assessed in a case series study. Results: Walking speed improved with the new orthosis in two participants. The sagittal range of motion (ROM) increased for most of the participants. The sagittal moments increased for hip, knee and ankle joints in most of the measurements. The total joint work showed noticeable difference in the ankle joint. The increased values of vertical component of the ground reaction force (VGRF) were negligible and the increase in the impulse of VGRF was noticeable for only one participant. Conclusion: The new orthosis had positive effects kinetic and kinematic parameters of walking such as the increased velocity by two subjects and also a more normal sagittal ROM, moment and work, suggesting the potential usefulness of the new orthotic device for MS population.
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Affiliation(s)
- Keyvani Hafshejani A
- PhD Candidate, Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Aminian Gh
- PhD, Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Azimian M
- MD, MS Clinic, Rofeideh Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Bahramizadeh M
- PhD, Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Safaeepour Z
- PhD, Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Biglarian A
- PhD, Department of Biostatistics and Epidemiology, Social Determinants of Health Research Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Keivani M
- MD, Department of Radiology, Shahrekord Univer-sity of Medical Sciences, Shahrekord, Iran
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Andreopoulou G, Mercer TH, Enriquez JG, Justin M, MacLeod N, Harrison E, Mahad DJ, van der Linden ML. Exercise-induced changes in gait kinematics in multiple sclerosis with minimal neurological disability. Mult Scler Relat Disord 2020; 47:102630. [PMID: 33232909 DOI: 10.1016/j.msard.2020.102630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exercise-induced gait deterioration is a frequently encountered symptom that limits ambulation throughout the clinical course, becoming more prominent with increasing neurological disability in people with MS (pwMS). OBJECTIVE We attempted to objectively document exercise-induced gait changes in pwMS with minimal neurological disability and stable disease. METHODS Gait kinematics and spatio-temporal parameters were recorded using 3D motion analysis before and after a 20-minute treadmill walk (Group A, n=15)/run (Group B, n=15) at a self-selected speed in pwMS and compared with healthy controls (n=15). RESULTS Gait analysis revealed a significant decrease in peak ankle dorsiflexion in swing of the most affected leg, post-exercise task, in both Group A (EDSS 2.5-3.5) and Group B (EDSS 1-2.5) and not in healthy controls. Fourteen out of 30 MS participants showed an exercise-induced gait deterioration, based on minimal detectable change. Pre-exercise gait parameters in Group A showed a significantly higher peak dorsiflexion in swing with shorter step length and higher cadence, whereas Group B was comparable to healthy controls. CONCLUSION The detection of exercise-induced gait deterioration (foot drop) in pwMS with minimal neurological disability and stable disease indicates the potential of gait kinematics, before and after an exercise task, to monitor subtle neurological deficits from an early stage of MS.
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Affiliation(s)
- Georgia Andreopoulou
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Musselburgh, UK
| | - Thomas H Mercer
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Musselburgh, UK
| | | | - Matthew Justin
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, UK
| | - Nicola MacLeod
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, UK
| | - Emily Harrison
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, UK
| | - Don J Mahad
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, UK.
| | - Marietta L van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Musselburgh, UK.
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Celik Y, Stuart S, Woo WL, Godfrey A. Gait analysis in neurological populations: Progression in the use of wearables. Med Eng Phys 2020; 87:9-29. [PMID: 33461679 DOI: 10.1016/j.medengphy.2020.11.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
Gait assessment is an essential tool for clinical applications not only to diagnose different neurological conditions but also to monitor disease progression as it contributes to the understanding of underlying deficits. There are established methods and models for data collection and interpretation of gait assessment within different pathologies. This narrative review aims to depict the evolution of gait assessment from observation and rating scales to wearable sensors and laboratory technologies and provide limitations and possible future directions in the field of gait assessment. In this context, we first present an extensive review of current clinical outcomes and gait models. Then, we demonstrate commercially available wearable technologies with their technical capabilities along with their use in gait assessment studies for various neurological conditions. In the next sections, a descriptive knowledge for existing inertial and EMG based algorithms and a sign based guide that shows the outcomes of previous neurological gait assessment studies are presented. Finally, we state a discussion for the use of wearables in gait assessment and speculate the possible research directions by revealing the limitations and knowledge gaps in the literature.
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Affiliation(s)
- Y Celik
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - S Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - W L Woo
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - A Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.
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Karpatkin HI, Benson A, Gardner N, Leb N, Ramos N, Xu H, Cohen ET. Pilot trial of speed-intensive gait training on balance and walking in people with multiple sclerosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2020.0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background/Aims Diminished walking speed and endurance is commonly experienced by individuals with multiple sclerosis. Speed-intensive gait training has led to improvements in walking speed and endurance in other neurological populations; however, its effect in persons with multiple sclerosis is unknown. This pilot study examined the feasibility, safety and efficacy of speed-intensive gait training in a sample of people with multiple sclerosis. Methods A total of eight participants (five women, median Expanded Disability Status Scale 3.5) underwent a 6-week, twice weekly speed-intensive gait training programme. Walking speed and endurance, balance and fatigue were measured pre- and post-intervention. Results Speed-intensive gait training was feasible, with excellent adherence and safety. It proved effective, with improvements in walking speed (P=0.05), walking endurance (P=0.036) and balance (P=0.041) without an increase in fatigue. Conclusions The intermittent design of speed-intensive gait training may enable individuals with multiple sclerosis to achieve higher training volumes than traditional models. Although further study is warranted, rehabilitation clinicians should consider adding speed-intensive gait training as an intervention to improve walking and balance in this patient group.
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Affiliation(s)
- Herb I Karpatkin
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Allison Benson
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Nolan Gardner
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Naomi Leb
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Nicole Ramos
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Huiman Xu
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, USA
| | - Evan T Cohen
- Department of Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, Blackwood, NJ, USA
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Taborri J, Studer V, Grossi P, Brambilla L, Patanè F, Ferrò MT, Mantegazza R, Rossi S. Reliability and Repeatability Analysis of Indices to Measure Gait Deterioration in MS Patients during Prolonged Walking. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5063. [PMID: 32899946 PMCID: PMC7570495 DOI: 10.3390/s20185063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022]
Abstract
Gait deterioration caused by prolonged walking represents one of the main consequences of multiple sclerosis (MS). This study aims at proposing quantitative indices to measure the gait deterioration effects. The experimental protocol consisted in a 6-min walking test and it involved nine patients with MS and twenty-six healthy subjects. Pathology severity was assessed through the Expanded Disability Status Scale. Seven inertial units were used to gather lower limb kinematics. Gait variability and asymmetry were assessed by coefficient of variation (CoV) and symmetry index (SI), respectively. The evolution of ROM (range of motion), CoV, and SI was computed analyzing data divided into six 60-s subgroups. Maximum difference among subgroups and the difference between the first minute and the remaining five were computed. The indices were analyzed for intra- and inter-day reliability and repeatability. Correlation with clinical scores was also evaluated. Good to excellent reliability was found for all indices. The computed standard deviations allowed us to affirm the good repeatability of the indices. The outcomes suggested walking-related fatigue leads to an always more variable kinematics in MS, in terms of changes in ROM, increase of variability and asymmetry. The hip asymmetry strongly correlated with the clinical disability.
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Affiliation(s)
- Juri Taborri
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy;
| | - Valeria Studer
- Multiple Sclerosis Center, Neurology Department, Martini Hospital, 10121 Turin, Italy;
| | - Paola Grossi
- Neuroimmunology Center for Multiple Sclerosis, Cerebrovascular Department, ASST Crema, 52242 Crema, Italy; (P.G.); (M.T.F.)
| | - Laura Brambilla
- Operating Units of Autoimmune and Neuromuscular Diseases, IRCCS Foundation Neurological Institute Carlo Besta, 20133 Milano, Italy; (L.B.); (R.M.)
| | - Fabrizio Patanè
- Department of Engineering, Mech. Meas. and Microelectr.lab (M3lab), University Niccolò Cusano, 00166 Rome, Italy;
| | - Maria Teresa Ferrò
- Neuroimmunology Center for Multiple Sclerosis, Cerebrovascular Department, ASST Crema, 52242 Crema, Italy; (P.G.); (M.T.F.)
| | - Renato Mantegazza
- Operating Units of Autoimmune and Neuromuscular Diseases, IRCCS Foundation Neurological Institute Carlo Besta, 20133 Milano, Italy; (L.B.); (R.M.)
| | - Stefano Rossi
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy;
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Weller D, Filli L, Meyer C, Lörincz L, Linnebank M, Weller M, Curt A, Zörner B. Impaired speed-dependent modulation of the gait pattern in multiple sclerosis. J Neurol 2020; 267:2998-3007. [PMID: 32500374 DOI: 10.1007/s00415-020-09965-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Walking dysfunction is common in people with multiple sclerosis (MS). Besides walking speed or endurance, one crucial feature of ambulatory function is the ability to adjust the gait pattern according to walking speed which relies on the integrity of spinal motor centres, their reciprocal connections to supraspinal networks and peripheral sensory input. OBJECTIVE To investigate the capacity of people with MS to modify their gait pattern in response to changes in walking speed. METHODS 3D gait analysis during free treadmill walking was performed in 35 people with MS and 20 healthy controls. Twelve kinematic parameters ranging from basic spatiotemporal measures to complex indicators of intralimb coordination were assessed at different absolute and relative walking speeds. RESULTS Cadence, double-limb support time, trunk movements and especially measures of intralimb coordination demonstrated significantly less speed-dependent modifications in MS than in controls. These limitations were more prominent in subjects with stronger MS-related impairment (worse outcome in clinical walking tests, higher Expanded Disability Status Scale). CONCLUSION The incapacity to modify specific elements of the walking pattern according to walking speed contributes to gait dysfunction in people with MS limiting activities of daily living. Gait modulation may serve as sensitive marker of walking function in MS. TRIAL REGISTRATION Clinicaltrials.gov, NCT01576354; first posted April 12, 2012.
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Affiliation(s)
- David Weller
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Linard Filli
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christian Meyer
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lilla Lörincz
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Michael Linnebank
- Department of Neurology, University Witten/Herdecke and Evangelische Kliniken Gelsenkirchen, Munckelstraße 32, 45879, Gelsenkirchen, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Björn Zörner
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
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Pilloni G, Choi C, Coghe G, Cocco E, Krupp LB, Pau M, Charvet LE. Gait and Functional Mobility in Multiple Sclerosis: Immediate Effects of Transcranial Direct Current Stimulation (tDCS) Paired With Aerobic Exercise. Front Neurol 2020; 11:310. [PMID: 32431658 PMCID: PMC7214839 DOI: 10.3389/fneur.2020.00310] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/31/2020] [Indexed: 12/22/2022] Open
Abstract
Walking impairments are a debilitating feature of multiple sclerosis (MS) because of the direct interference with daily activity. The management of motor symptoms in those with MS remains a therapeutic challenge. Transcranial direct current stimulation (tDCS) is a type of non-invasive brain stimulation that is emerging as a promising rehabilitative tool but requires further characterization to determine its optimal therapeutic use. In this randomized, sham-controlled proof-of-concept study, we tested the immediate effects of a single tDCS session on walking and functional mobility in those with MS. Seventeen participants with MS completed one 20-min session of aerobic exercise, randomly assigned to be paired with either active (2.5 mA, n = 9) or sham (n = 8) tDCS over the primary motor cortex (M1). The groups (active vs. sham) were matched according to gender (50% vs. 60% F), age (52.1 ± 12.85 vs. 54.2 ± 8.5 years), and level of neurological disability (median Expanded Disability Status Scale score 5.5 vs. 5). Gait speed on the 10-m walk test and the Timed Up and Go (TUG) time were measured by a wearable inertial sensor immediately before and following the 20-min session, with changes compared between conditions and time. There were no significant differences in gait speed or TUG time changes following the session in the full sample or between the active vs. sham groups. These findings suggest that a single session of anodal tDCS over M1 is not sufficient to affect walking and functional mobility in those with MS. Instead, behavioral motor response of tDCS is likely to be cumulative, and the effects of multiple tDCS sessions require further study. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03658668.
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Affiliation(s)
- Giuseppina Pilloni
- NYU Langone Health, Department of Neurology, New York, NY, United States.,Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Claire Choi
- SUNY Downstate, Department of Medicine, New York, NY, United States
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Lauren B Krupp
- NYU Langone Health, Department of Neurology, New York, NY, United States
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Leigh E Charvet
- NYU Langone Health, Department of Neurology, New York, NY, United States
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Mañago MM, Kline PW, Alvarez E, Christiansen CL. Trunk and pelvis movement compensation in people with multiple sclerosis: Relationships to muscle function and gait performance outcomes. Gait Posture 2020; 78:48-53. [PMID: 32200163 DOI: 10.1016/j.gaitpost.2020.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Problems with gait are common in people with multiple sclerosis (MS), but little is known about pelvis and trunk kinematics, especially in the frontal plane. RESEARCH QUESTION Are pelvis and trunk kinematics in people with MS related to muscle function, spatiotemporal parameters, and gait performance? METHODS In this cross-sectional study, 20 people with MS (Expanded Disability Status Scale 1.5-5.5) and 10 people with comparable age and sex (CTL) underwent threedimensional gait analysis, muscle function assessments (hip and trunk strength and endurance), and gait performance measures (Timed 25-Foot Walk - T25FW, 2-Minute Walk Test - 2MWT). Frontal and sagittal plane pelvis and trunk excursion during the stance period of walking were compared between groups; and in the MS group, associations were determined between kinematic variables, muscle function, spatiotemporal parameters, and gait performance. RESULTS Compared to the CTL group, the MS group had significantly greater sagittal plane trunk and pelvis excursion for both the stronger (p = 0.031) and weaker (p = 0.042) sides; less frontal plane trunk and pelvis excursion for both the stronger (p = 0.008) and weaker (p = 0.024) sides; and more sagittal plane trunk excursion for the stronger side (p = 0.047) during stance phase. There were low-to-moderate correlations in the MS group for sagittal plane pelvis excursion with muscle function (p = 0.019 to 0.030), spatiotemporal parameters (p < 0.001 to 0.005), and gait performance (p = < 0.001 to 0.001). Using linear regression, frontal and sagittal plane pelvis excursion were significant predictors of both T25FW and 2MWT, explaining 34 % and 46 % of the variance of each gait performance measure, respectively. SIGNIFICANCE Rehabilitation interventions may consider addressing pelvis movement compensations in order to improve spatiotemporal parameters and gait performance in people with MS.
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Affiliation(s)
- M M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 E 17th Ave., Room 3108, Aurora, CO, 80045, United States; Department of Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Aurora, CO, 80045, United States.
| | - P W Kline
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 E 17th Ave., Room 3108, Aurora, CO, 80045, United States; Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, 1700 N Wheeling St., Aurora, CO, 80045, United States
| | - E Alvarez
- Department of Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Aurora, CO, 80045, United States
| | - C L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 E 17th Ave., Room 3108, Aurora, CO, 80045, United States; Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, 1700 N Wheeling St., Aurora, CO, 80045, United States
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Buoite Stella A, Morelli ME, Giudici F, Sartori A, Manganotti P, di Prampero PE. Comfortable walking speed and energy cost of locomotion in patients with multiple sclerosis. Eur J Appl Physiol 2020; 120:551-566. [PMID: 31919582 DOI: 10.1007/s00421-019-04295-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022]
Abstract
Comfortable walking speed and energy cost of walking are physiological markers of metabolic activity during gait. People with multiple sclerosis are characterized by altered gait biomechanics and energetics, related to the degree of disability and spasticity, which lead to an increased energy cost of walking. Several studies concerning the energy cost of walking in multiple sclerosis have been published. Nevertheless, differences in protocols and characteristics of the sample have led to different outcomes. The aim of the present meta-analysis is to summarize results from studies with specific inclusion characteristics, and to present data about the comfortable walking speed and the energy cost of walking at that speed. Moreover, a detailed discussion of the potential mechanisms involved in the altered metabolic activity during exercise was included. A total of 19 studies were considered, 12 of which were also part of the quantitative analysis. Despite the strict selection process, high between-group heterogeneity was found for both outcomes. Nevertheless, the overall results suggest a pooled mean comfortable walking speed of 1.12 m/s (95% CI 1.05-1.18) and energy cost of 0.19 mLO2/kg/m (95% CI 0.17-0.21). These findings support the results of previous studies suggesting that energy cost of walking may be increased by 2-3 times compared to healthy controls (HC), and encourage the use of this marker in association with other parameters of the disease.
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Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
| | - Maria Elisa Morelli
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Fabiola Giudici
- Unit of Statistics, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Pietro Enrico di Prampero
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
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Massot C, Guyot MA, Donze C, Simoneau E, Gillet C, Leteneur S. Ankle dysfunction in multiple sclerosis and the effects on walking. Disabil Rehabil 2019; 43:2454-2463. [PMID: 31854195 DOI: 10.1080/09638288.2019.1702726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Even in the early stage of the disease, for patients suffering from multiple sclerosis (MS), the most common and reported biomechanical alterations in the lower limb are located at the ankle joint. However, the effects of these impairments on gait deterioration should be discussed. MATERIALS AND METHODS This review was written according to the PRISMA guidelines. The search focussed on biomechanical changes (kinetic, kinematic, and electromyographic data) at the ankle during gait in MS patients. The search was performed in the databases: Pubmed, Web of Science, and Cochrane Library. RESULTS Eleven studies were included. The reduction in the ankle range of motion (RoM) induced by increased cocontractions of the tibialis anterior and triceps surae muscles could be a compensatory strategy to improve body-weight support and balance during the stance phase. CONCLUSIONS Future rehabilitation programmes should consider the control of weight support at the ankle during gait training.Implications for rehabilitationThe ankle supports and stabilises the body during the stance phase of gait.The reduced ankle range of motion in multiple sclerosis (MS), even at an early stage of the disease, is due to cocontractions of tibialis anterior and triceps surae and could be a compensatory strategy to be more stable.Rehabilitation programmes for MS patients should focus on the control of body segments motion during the weight transfer above the ankle.
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Affiliation(s)
- Caroline Massot
- Service de Médecine Physique et de Réadaptation, Hôpital Saint Philibert, Lomme, France
| | - Marc-Alexandre Guyot
- Service de Médecine Physique et de Réadaptation, Hôpital Saint Philibert, Lomme, France
| | - Cécile Donze
- Service de Médecine Physique et de Réadaptation, Hôpital Saint Philibert, Lomme, France
| | - Emilie Simoneau
- Université Lille Nord de France, Lille, France.,UPHF, LAMIH, Valenciennes, France.,CNRS, UMR, Valenciennes, France
| | - Christophe Gillet
- Université Lille Nord de France, Lille, France.,UPHF, LAMIH, Valenciennes, France.,CNRS, UMR, Valenciennes, France
| | - Sébastien Leteneur
- Université Lille Nord de France, Lille, France.,UPHF, LAMIH, Valenciennes, France.,CNRS, UMR, Valenciennes, France
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Test-retest reliability and minimal detectable change of ankle kinematics and spatiotemporal parameters in MS population. Gait Posture 2019; 74:218-222. [PMID: 31561120 DOI: 10.1016/j.gaitpost.2019.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/03/2019] [Accepted: 09/13/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many people with multiple sclerosis (pwMS) experience walking impairments often including foot drop, evident as either reduced dorsiflexion at initial contact and/or at the swing phase of the gait cycle. To measure even subtle differences in ankle kinematics, 3D gait analysis is considered a 'gold' standard. However, the psychometric properties of ankle kinematics in the MS population have not yet been examined. OBJECTIVE The aim of the study was to examine test-retest relative and absolute reliability of sagittal ankle kinematics and spatiotemporal parameters in two groups of pwMS with different levels of walking impairment. METHODS Two groups of pwMS underwent 3D gait analysis on two occasions 7-14 days apart. Group A consisted of 21 (14 female) people with Expanded Disability Status Scale (EDSS) 1-3.5 and group B consisted of 28 participants (14 female) with EDSS 4-6. The Intraclass Correlation Coefficient (ICC2,2), standard error of measurement (SEM) and minimal detectable change (MDC95%) were calculated for peak dorsiflexion (DF) in swing, ankle angle at initial contact (IC), gait profile score (GPS), walking speed, cadence and step length. RESULTS Both groups presented 'excellent' ICC values (>0.75) for DF in swing, IC and step length of most and least affected limbs, walking speed and cadence, with GPS for both limbs exhibiting 'fair' to 'good' ICCs (0.489-0.698). The MDC95% values for all ankle kinematic parameters in group A were lower (1.9°-4.2°) than those in group B (2.2°-7.7°). CONCLUSION The present results suggest that ankle kinematic and spatiotemporal parameters derived from 3D gait analysis are reliable outcome measures to be used in the MS population. Further, this study provides indices of reliability that can be applied to both clinical decision making and in the design of studies aimed at treating foot drop in people with MS.
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Vienne-Jumeau A, Oudre L, Moreau A, Quijoux F, Vidal PP, Ricard D. Comparing Gait Trials with Greedy Template Matching. SENSORS 2019; 19:s19143089. [PMID: 31336957 PMCID: PMC6679258 DOI: 10.3390/s19143089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 01/15/2023]
Abstract
Gait assessment and quantification have received an increased interest in recent years. Embedded technologies and low-cost sensors can be used for the longitudinal follow-up of various populations (neurological diseases, elderly, etc.). However, the comparison of two gait trials remains a tricky question as standard gait features may prove to be insufficient in some cases. This article describes a new algorithm for comparing two gait trials recorded with inertial measurement units (IMUs). This algorithm uses a library of step templates extracted from one trial and attempts to detect similar steps in the second trial through a greedy template matching approach. The output of our method is a similarity index (SId) comprised between 0 and 1 that reflects the similarity between the patterns observed in both trials. Results on healthy and multiple sclerosis subjects show that this new comparison tool can be used for both inter-individual comparison and longitudinal follow-up.
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Affiliation(s)
- Aliénor Vienne-Jumeau
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France
| | - Laurent Oudre
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France.
- L2TI, University Paris 13, 93430 Villetaneuse, France.
- CMLA (UMR 8536), CNRS ENS Paris-Saclay, 94235 Cachan, France.
| | - Albane Moreau
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France
| | - Flavien Quijoux
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France
- ORPEA Group, 92813 Puteaux, France
| | - Pierre-Paul Vidal
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France
- Hangzhou Dianzi University, 310005 Hangzhou, China
| | - Damien Ricard
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France
- Service de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, 92190 Clamart, France
- Ecole du Val-de-Grâce, Ecole de Santé des Armées, 75005 Paris, France
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Kaur R, Menon S, Zhang X, Sowers R, Hernandez ME. Exploring Characteristic Features in Gait Patterns for Predicting Multiple Sclerosis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2019:4217-4220. [PMID: 31946799 DOI: 10.1109/embc.2019.8857604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Multiple Sclerosis (MS), an autoimmune and demyelinating disease, is one the most prevalent neurological disabilities in young adults. It results in damage of the central nervous system, disrupting communication between the patient's brain, spinal cord and body. Mobility limitations is one of the earliest symptoms and affects a majority of persons with Multiple Sclerosis. We are working towards an effort to characterize individuals with MS, from those without, on the basis of variations in the gait patterns. In the proposed work, statistical methods were used to identify differentiating gait data features for MS characterization. The prediction algorithms built upon these characteristic features will help clinicians develop effective and early cure and therapy designs for persons with Multiple Sclerosis.
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Why patients with multiple sclerosis perceive improvement of gait during treatment with natalizumab? J Neural Transm (Vienna) 2019; 126:731-737. [DOI: 10.1007/s00702-019-02013-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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Neamtu MC, Neamtu OM, Marin MI, Rusu L. Morphofunctional muscle changes influence on foot stability in multiple sclerosis during gait prediction: The rehabilitation potential. J Back Musculoskelet Rehabil 2018; 31:469-474. [PMID: 29171982 DOI: 10.3233/bmr-170925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Multiple sclerosis patients may suffer muscle changes that involve gait disorders of the kinetic and kinematic parameters also their gait may be clinically symmetrical or asymmetrical. OBJECTIVE The aim of this study is to analyze how the muscle change, could affect the biomechanical parameters of foot stability during the gait, by disturb the motor control. METHODS The study group consisted of 13 patients diagnosed with multiple sclerosis, presenting clinically detectable abnormal gait. The biomechanical evaluation included the foot axes and angles -external and internal rotation; the foot angle deviation from the gait direction; the subtalar angle. RESULTS The values of the foot angle were between -10.74∘ to 26.38∘ for the left foot and between -11.16∘ to 30.04∘ for the right foot. The foot axis angle is the axis of the foot in relation to the gait direction, and the subtalar angle is in relation to the vertical axis of the foot. The rotation of the right foot into pronation during the initial contact phase was followed by supination in the semi-support phase, to return to the neutral position during the propulsion phase, which meant being in free zone of minimal risk. CONCLUSIONS Biomechanical analysis of the foot angle and of subtalar angle in the patients with multiple sclerosis allows us to objectify the existence of a right-left asymmetry, the behavior ankle-foot during the gait. At the same time this evolution is closely correlated with the contact surface that tends to increase, which means involving the reflex mechanisms that place the foot in the zone of minimum risk and assure the stability of the body.
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Affiliation(s)
- Marius Cristian Neamtu
- Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania.,Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Oana Maria Neamtu
- Department of Sports Medicine and Kinesiology, University of Craiova, Craiova, Romania.,Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Mihnea Ion Marin
- Department of Applied Mechanics, University of Craiova, Craiova, Romania.,Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Ligia Rusu
- Department of Sports Medicine and Kinesiology, University of Craiova, Craiova, Romania.,Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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39
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Brincks J, Christensen LE, Rehnquist MV, Petersen J, Sørensen H, Dalgas U. Mildly disabled persons with multiple sclerosis use similar net joint power strategies as healthy controls when walking speed increases. NeuroRehabilitation 2018; 42:69-79. [PMID: 29400680 DOI: 10.3233/nre-172225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To improve walking in persons with multiple sclerosis (MS), it is essential to understand the underlying mechanisms of walking. This study examined strategies in net joint power generated or absorbed by hip flexors, hip extensors, hip abductors, knee extensors, and plantar flexors in mildly disabled persons with MS and healthy controls at different walking speeds. METHODS Thirteen persons with MS and thirteen healthy controls participated and peak net joint power was calculated using 3D motion analysis. RESULTS In general, no differences were found between speed-matched healthy controls and persons with MS, but the fastest walking speed was significantly higher in healthy controls (2.42 m/s vs. 1.70 m/s). The net joint power increased in hip flexors, hip extensors, hip abductors, knee extensors and plantar flexors in both groups, when walking speed increased. Significant correlations between changes in walking speed and changes in net joint power of plantar flexors, hip extensors and hip flexors existed in healthy controls and persons with MS, and in net knee extensor absorption power of persons with MS only. CONCLUSION In contrast to previous studies, these findings suggest that mildly disabled persons with MS used similar kinetic strategies as healthy controls to increase walking speed.
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Affiliation(s)
- John Brincks
- Department of Rehabilitation and Health Promotion Research, Faculty of Health Science, VIA University College, Aarhus N, Denmark
| | - Lars Ejsing Christensen
- Department of Rehabilitation and Health Promotion Research, Faculty of Health Science, VIA University College, Aarhus N, Denmark
| | - Mette Voigt Rehnquist
- Department of Rehabilitation and Health Promotion Research, Faculty of Health Science, VIA University College, Aarhus N, Denmark
| | - Jesper Petersen
- Department of Public Health - Section of Sport Science, Aarhus University, Aarhus, Denmark
| | - Henrik Sørensen
- Department of Public Health - Section of Sport Science, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Department of Public Health - Section of Sport Science, Aarhus University, Aarhus, Denmark
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40
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Mañago MM, Hebert JR, Kittelson J, Schenkman M. Contributions of Ankle, Knee, Hip, and Trunk Muscle Function to Gait Performance in People With Multiple Sclerosis: A Cross-Sectional Analysis. Phys Ther 2018; 98:595-604. [PMID: 29660080 DOI: 10.1093/ptj/pzy048] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 04/05/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND The relative importance of lower extremity and trunk muscle function to gait in people with multiple sclerosis (MS) is unknown. OBJECTIVE This study aimed to investigate the association of lower extremity and trunk muscle function with gait performance in people who have MS and mild-to-moderate disability. DESIGN This was a cross-sectional, observational study. METHODS Participants were people who had an Expanded Disability Status Scale score of ≤ 5.5. Eleven lower extremity and trunk muscles were assessed using handheld dynamometry or endurance tests. Gait performance was assessed with the Timed 25-Foot (7.62 m) Walk (T25FW) and 6-Minute Walk Test (6MWT). Regression analysis was used to quantify the association between gait outcomes and muscle variables. RESULTS Seventy-two participants with MS and a mean Expanded Disability Status Scale score of 3.5 (SD = 1.14) were enrolled. Adjusted for age and sex, the multivariate model including hip abduction, ankle plantar flexion, trunk flexion, and knee flexion explained 57% of the adjusted variance in the T25FW; hip abduction, ankle plantar flexion, and trunk flexion explained 61% of the adjusted variance in the 6MWT. The strongest predictors were ankle plantar flexion endurance for the T25FW and hip abduction strength for the 6MWT: a 1-SD increase in ankle plantar flexion (15.2 heel-raise repetitions) was associated with a 0.33-second reduction in the T25WT (95% CI = - 0.71 to - 0.14 seconds); a 1-SD increase in normalized hip abduction strength (0.14 kg/body mass index) was associated with a 54.4-m increase in the 6MWT (28.99 to 79.81 m). LIMITATIONS Different measurement scales for independent variables were included because the muscle function assessment used either force or endurance. CONCLUSIONS For the major muscles in the lower extremity and trunk, hip abduction, ankle plantar flexion, trunk flexion, and knee flexion were the strongest predictors of gait performance.
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Affiliation(s)
- Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora, Colorado, and Department of Rehabilitation, University of Colorado Hospital, 1635 Aurora Ct, Aurora, CO 80045
| | - Jeffrey R Hebert
- Department of Physical Medicine and Rehabilitation and Department of Neurology, School of Medicine, University of Colorado Denver, Aurora. Dr. Hebert is a multiple sclerosis certified specialist through the Consortium of MS Centers
| | - John Kittelson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Margaret Schenkman
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver, Aurora. Dr Schenkman is a Catherine Worthingham Fellow of the American Physical Therapy Association
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Ghai S, Ghai I. Effects of Rhythmic Auditory Cueing in Gait Rehabilitation for Multiple Sclerosis: A Mini Systematic Review and Meta-Analysis. Front Neurol 2018; 9:386. [PMID: 29942278 PMCID: PMC6004404 DOI: 10.3389/fneur.2018.00386] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/11/2018] [Indexed: 12/15/2022] Open
Abstract
Rhythmic auditory cueing has been shown to enhance gait performance in several movement disorders. The "entrainment effect" generated by the stimulations can enhance auditory motor coupling and instigate plasticity. However, a consensus as to its influence over gait training among patients with multiple sclerosis is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing in studies gait performance in patients with multiple sclerosis. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until Dec 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 602 records, five studies (PEDro score: 5.7 ± 1.3) involving 188 participants (144 females/40 males) met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e., velocity (Hedge's g: 0.67), stride length (0.70), and cadence (1.0), and reduction in timed 25 feet walking test (-0.17). Underlying neurophysiological mechanisms, and clinical implications are discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance gait performance in the multiple sclerosis community.
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Affiliation(s)
- Shashank Ghai
- Institute of Sports Science, Leibniz University Hanover, Hanover, Germany
| | - Ishan Ghai
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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Turning is an important marker of balance confidence and walking limitation in persons with multiple sclerosis. PLoS One 2018; 13:e0198178. [PMID: 29879144 PMCID: PMC5991680 DOI: 10.1371/journal.pone.0198178] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/15/2018] [Indexed: 11/19/2022] Open
Abstract
The standard functional tool for gait assessment in multiple sclerosis (MS) clinical trials has been the 25-Foot Timed Walk Test, a measure of gait speed. Straight-line gait assessment may not reflect adequately upon balance and coordination. Walking tests with turns may add additional information towards understanding gait and balance status, and be more reflective of ambulation in the community. Understanding the impact of turn parameters on patient-reported outcomes of balance and walking would help MS clinicians better formulate treatment plans for persons with gait limitations. In this study, ninety-one persons with MS (Expanded Disability Status Score; EDSS, range: 0–6.5) were enrolled in an initial cross-sectional study. Twenty-four subjects (EDSS, range:1.0–6.0) completed a follow-up visit an average of 12 months later. Spatiotemporal gait analysis was collected at both visits using APDM Opal wireless body-worn sensors while performing the Timed-Up-and-Go (TUG) and 6-Minute Walk Test (6MWT). For both cross-sectional and longitudinal data, regression analyses determined the impact on the addition of turning parameters to stride velocity (SV), in the prediction of self-reported balance confidence (Activities-Specific Balance Confidence Scale (ABC)) and walking limitation (12-item Multiple Sclerosis Walking Scale (MSWS-12)). The addition of 6MWT peak turn velocity (PTV) to 6MWT SV increased the predictive power of the 6MWT for the ABC from 20% to 33%, and increased the predictive power from 28% to 41% for the MSWS-12. TUG PTV added to TUG SV also strengthened the relationship of the TUG for the ABC from 19% to 28%, and 27% to 36% for the MSWS-12. For those with 1 year follow-up, percent change in turn number of steps (TNS%Δ) during the 6MWT added to 6MWT SV%Δ improved the modeling of ABC%Δ from 24% to 33%. 6MWT PTV%Δ added to 6MWT SV%Δ increased the predictive power of MSWS-12%Δ from 8% to 27%. Conclusively, turn parameters improved modeling of self-perceived balance confidence and walking limitations when added to the commonly utilized measure of gait speed. Tests of longer durations with multiple turns, as opposed to shorter durations with a single turn, modeled longitudinal change more accurately. Turn speed and stability should be qualitatively assessed during the clinic visit, and use of multi-faceted tests such as the TUG or 6MWT may be required to fully understand gait deterioration in persons with MS.
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Brincks J, Andersen ED, Sørensen H, Dalgas U. Impaired postural balance correlates with complex walking performance in mildly disabled persons with multiple sclerosis. NeuroRehabilitation 2018; 41:227-235. [PMID: 28527234 DOI: 10.3233/nre-171475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is relevant to understand the possible influence of impaired postural balance on walking performance in multiple sclerosis (MS) gait rehabilitation. OBJECTIVE We expected associations between impaired postural balance and complex walking performance in mildly disabled persons with MS, but not in healthy controls. METHODS Thirteen persons with MS (Expanded Disability Status Scale = 2.5) and 13 healthy controls' walking performance were measured at fast walking speed, Timed Up & Go and Timed 25 Feet Walking. Postural balance was measured by stabilometry, 95% confidence ellipse sway area and sway velocity. RESULTS Except from sway velocity (p = 0.07), significant differences were found between persons with MS and healthy controls in postural balance and walking. Significant correlations were observed between sway area and Timed Up & Go (r = 0.67) and fastest safe walking speed (r = -0.63) in persons with MS but not in healthy controls (r = 0.52 and r = 0.24, respectively). No other significant correlations were observed between postural balance and walking performance in neither persons with MS nor healthy controls. CONCLUSION Findings add to the understanding of postural balance and walking in persons with MS, as impaired postural balance was related to complex walking performance. Exercises addressing impaired postural balance are encouraged in early MS gait rehabilitation.
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Affiliation(s)
- John Brincks
- Department of Rehabilitation and Health Promotion Research, Faculty of Health Science, VIA University College, Aarhus N, Denmark
| | - Elisabeth Due Andersen
- Department of Rehabilitation and Health Promotion Research, Faculty of Health Science, VIA University College, Aarhus N, Denmark
| | - Henrik Sørensen
- Department of Public Health - Section of Sport Science, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Department of Public Health - Section of Sport Science, Aarhus University, Aarhus, Denmark
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Filli L, Sutter T, Easthope CS, Killeen T, Meyer C, Reuter K, Lörincz L, Bolliger M, Weller M, Curt A, Straumann D, Linnebank M, Zörner B. Profiling walking dysfunction in multiple sclerosis: characterisation, classification and progression over time. Sci Rep 2018; 8:4984. [PMID: 29563533 PMCID: PMC5862880 DOI: 10.1038/s41598-018-22676-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/27/2018] [Indexed: 01/28/2023] Open
Abstract
Gait dysfunction is a common and relevant symptom in multiple sclerosis (MS). This study aimed to profile gait pathology in gait-impaired patients with MS using comprehensive 3D gait analysis and clinical walking tests. Thirty-seven patients with MS walked on the treadmill at their individual, sustainable speed while 20 healthy control subjects walked at all the different patient's paces, allowing for comparisons independent of walking velocity. Kinematic analysis revealed pronounced restrictions in knee and ankle joint excursion, increased gait variability and asymmetry along with impaired dynamic stability in patients. The most discriminative single gait parameter, differentiating patients from controls with an accuracy of 83.3% (χ2 test; p = 0.0001), was reduced knee range of motion. Based on hierarchical cluster and principal component analysis, three principal pathological gait patterns were identified: a spastic-paretic, an ataxia-like, and an unstable gait. Follow-up assessments after 1 year indicated deterioration of walking function, particularly in patients with spastic-paretic gait patterns. Our findings suggest that impaired knee/ankle control is common in patients with MS. Personalised gait profiles and clustering algorithms may be promising tools for stratifying patients and to inform patient-tailored exercise programs. Responsive, objective outcome measures are important for monitoring disease progression and treatment effects in MS trials.
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Affiliation(s)
- Linard Filli
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
| | - Tabea Sutter
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Christopher S Easthope
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Tim Killeen
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christian Meyer
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Katja Reuter
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Lilla Lörincz
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Dominik Straumann
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Michael Linnebank
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
- Department of Neurology, Helios-Klinik Hagen-Ambrock, /University Witten/Herdecke, Ambrocker Weg 60, 58091, Hagen, Germany
| | - Björn Zörner
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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Shanahan CJ, Boonstra FMC, Cofré Lizama LE, Strik M, Moffat BA, Khan F, Kilpatrick TJ, van der Walt A, Galea MP, Kolbe SC. Technologies for Advanced Gait and Balance Assessments in People with Multiple Sclerosis. Front Neurol 2018; 8:708. [PMID: 29449825 PMCID: PMC5799707 DOI: 10.3389/fneur.2017.00708] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/07/2017] [Indexed: 12/13/2022] Open
Abstract
Subtle gait and balance dysfunction is a precursor to loss of mobility in multiple sclerosis (MS). Biomechanical assessments using advanced gait and balance analysis technologies can identify these subtle changes and could be used to predict mobility loss early in the disease. This update critically evaluates advanced gait and balance analysis technologies and their applicability to identifying early lower limb dysfunction in people with MS. Non-wearable (motion capture systems, force platforms, and sensor-embedded walkways) and wearable (pressure and inertial sensors) biomechanical analysis systems have been developed to provide quantitative gait and balance assessments. Non-wearable systems are highly accurate, reliable and provide detailed outcomes, but require cumbersome and expensive equipment. Wearable systems provide less detail but can be used in community settings and can provide real-time feedback to patients and clinicians. Biomechanical analysis using advanced gait and balance analysis technologies can identify changes in gait and balance in early MS and consequently have the potential to significantly improve monitoring of mobility changes in MS.
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Affiliation(s)
- Camille J Shanahan
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, VIC, Australia
| | | | - L Eduardo Cofré Lizama
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia.,Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Myrte Strik
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, VIC, Australia.,Department of Anatomy and Neuroscience, VU Medical Centre, Amsterdam, Netherlands
| | - Bradford A Moffat
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, VIC, Australia
| | - Fary Khan
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia.,Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Trevor J Kilpatrick
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | | | - Mary P Galea
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia.,Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Scott C Kolbe
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
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46
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Mofateh R, Salehi R, Negahban H, Mehravar M, Tajali S. Effects of cognitive versus motor dual-task on spatiotemporal gait parameters in healthy controls and multiple sclerosis patients with and without fall history. Mult Scler Relat Disord 2017; 18:8-14. [PMID: 29141826 DOI: 10.1016/j.msard.2017.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/25/2017] [Accepted: 09/03/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of the current study was to compare the effects of cognitive or motor tasks on gait performance between healthy controls and multiple sclerosis (MS) patients with and without fall history. METHODS The investigation included MS patients with fall history (n = 25) and without fall history (n = 25) and matched healthy controls (n = 25). Participants walked at their preferred speed on a motorized treadmill under three walking conditions in a randomized order: walking only, walking while performing a concurrent cognitive task (counting backward aloud by 3s), and walking while performing a concurrent motor task (carrying a tray with glasses). RESULTS The findings showed that in patients with MS, regardless of fall history, spatiotemporal gait parameters were different compared to healthy controls. In contrast to average gait parameters, variability in stride length and stride time could discriminate between MS fallers and non-fallers. Simultaneous performance of cognitive task and walking resulted in higher dual-task costs (DTC) in gait performance compared to the motor dual-task. However, the pattern of change was not different among the three groups. All participants responded to the cognitive task challenges by increasing stride length and decreasing cadence and stride length variability while maintaining cognitive task performance. CONCLUSIONS The findings may reflect successful adaptation of locomotor system to preserve cognitive task performance under cognitive dual-task condition. Future studies should examine more complex concurrent cognitive and motor tasks to better understand the dual-task-related gait changes and their contribution to falls in patients with MS.
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Affiliation(s)
- Razieh Mofateh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Reza Salehi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Shirin Tajali
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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47
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Criado MB, Santos MJ, Machado J, Gonçalves AM, Greten HJ. Effects of Acupuncture on Gait of Patients with Multiple Sclerosis. J Altern Complement Med 2017; 23:852-857. [DOI: 10.1089/acm.2016.0355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Maria João Santos
- ICBAS—Abel Salazar Institute for Biomedical Sciences, University of Porto, Porto, Portugal
| | - Jorge Machado
- ICBAS—Abel Salazar Institute for Biomedical Sciences, University of Porto, Porto, Portugal
| | | | - Henry Johannes Greten
- ICBAS—Abel Salazar Institute for Biomedical Sciences, University of Porto, Porto, Portugal
- Heidelberg School of Chinese Medicine, Heidelberg, Germany
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48
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Effect of walking on sand on gait kinematics in individuals with multiple sclerosis. Mult Scler Relat Disord 2017; 16:15-21. [DOI: 10.1016/j.msard.2017.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/19/2017] [Accepted: 05/21/2017] [Indexed: 11/21/2022]
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49
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Arpin DJ, Gehringer JE, Wilson TW, Kurz MJ. A reduced somatosensory gating response in individuals with multiple sclerosis is related to walking impairment. J Neurophysiol 2017; 118:2052-2058. [PMID: 28724780 DOI: 10.1152/jn.00260.2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/26/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022] Open
Abstract
When identical stimuli are presented in rapid temporal succession, neural responses to the second stimulation are often weaker than those observed for the first. This phenomenon is termed sensory gating and is believed to be an adaptive feature that helps prevent higher-order cortical centers from being flooded with unnecessary information. Recently, sensory gating in the somatosensory system has been linked to deficits in tactile discrimination. Additionally, studies have linked poor tactile discrimination with impaired walking and balance in individuals with multiple sclerosis (MS). In this study, we examine the neural basis of somatosensory gating in patients with MS and healthy controls and assess the relationship between somatosensory gating and walking performance. We used magnetoencephalography to record neural responses to paired-pulse electrical stimulation applied to the right posterior tibial nerve. All participants also walked across a digital mat, which recorded their spatiotemporal gait kinematics. Our results showed the amplitude of the response to the second stimulation was sharply reduced only in controls, resulting in a significantly reduced somatosensory gating in the patients with MS. No group differences were observed in the amplitude of the response to the first stimulation nor the latency of the neural response to either the first or second stimulation. Interestingly, the altered somatosensory gating responses were correlated with aberrant spatiotemporal gait kinematics in the patients with MS. These results suggest that inhibitory GABA circuits may be altered in patients with MS, which impacts somatosensory gating and contributes to the motor performance deficits seen in these patients.NEW & NOTEWORTHY We aimed to determine whether somatosensory gating in patients with multiple sclerosis (MS) differed compared with healthy controls and whether a relationship exists between somatosensory gating and walking performance. We found reduced somatosensory gating responses in patients with MS, and these altered somatosensory gating responses were correlated with the mobility impairments. These novel findings show that somatosensory gating is impaired in patients with MS and is related to the mobility impairments seen in these patients.
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Affiliation(s)
- David J Arpin
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska; and
| | - James E Gehringer
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska; and
| | - Tony W Wilson
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska; and.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Max J Kurz
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska; .,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska; and
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50
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Severini G, Manca M, Ferraresi G, Caniatti LM, Cosma M, Baldasso F, Straudi S, Morelli M, Basaglia N. Evaluation of Clinical Gait Analysis parameters in patients affected by Multiple Sclerosis: Analysis of kinematics. Clin Biomech (Bristol, Avon) 2017; 45:1-8. [PMID: 28390935 DOI: 10.1016/j.clinbiomech.2017.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 03/10/2017] [Accepted: 04/02/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical Gait Analysis is commonly used to evaluate specific gait characteristics of patients affected by Multiple Sclerosis. The aim of this report is to present a retrospective cross-sectional analysis of the changes in Clinical Gait Analysis parameters in patients affected by Multiple Sclerosis. METHODS In this study a sample of 51 patients with different levels of disability (Expanded Disability Status Scale 2-6.5) was analyzed. We extracted a set of 52 parameters from the Clinical Gait Analysis of each patient and used statistical analysis and linear regression to assess differences among several groups of subjects stratified according to the Expanded Disability Status Scale and 6-Minutes Walking Test. The impact of assistive devices (e.g. canes and crutches) on the kinematics was also assessed in a subsample of patients. FINDINGS Subjects showed decreased range of motion at hip, knee and ankle that translated in increased pelvic tilt and hiking. Comparison between the two stratifications showed that gait speed during 6-Minutes Walking Test is better at discriminating patients' kinematics with respect to Expanded Disability Status Scale. Assistive devices were shown not to significantly impact gait kinematics and the Clinical Gait Analysis parameters analyzed. INTERPRETATION We were able to characterize disability-related trends in gait kinematics. The results presented in this report provide a small atlas of the changes in gait characteristics associated with different disability levels in the Multiple Sclerosis population. This information could be used to effectively track the progression of MS and the effect of different therapies.
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Affiliation(s)
- Giacomo Severini
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland.
| | - Mario Manca
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Via della Fiera, 44100 Ferrara, Italy
| | - Giovanni Ferraresi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Via della Fiera, 44100 Ferrara, Italy
| | - Luisa Maria Caniatti
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Via della Fiera, 44100 Ferrara, Italy
| | - Michela Cosma
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Via della Fiera, 44100 Ferrara, Italy
| | - Francesco Baldasso
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Via della Fiera, 44100 Ferrara, Italy
| | - Sofia Straudi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Via della Fiera, 44100 Ferrara, Italy
| | - Monica Morelli
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Via della Fiera, 44100 Ferrara, Italy
| | - Nino Basaglia
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Via della Fiera, 44100 Ferrara, Italy
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