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Thomas B, Pattinson R, Bundy C, Davies JL. Somatosensory processing in long COVID fatigue and its relations with physiological and psychological factors. Exp Physiol 2024. [PMID: 39106091 DOI: 10.1113/ep091988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
Fatigue is prevalent amongst people with long COVID, but is poorly understood. The sensory attenuation framework proposes that impairments in sensory processing lead to heightened perception of effort, driving fatigue. This study aims to investigate the role of somatosensory processing impairments in long COVID fatigue and quantify how sensory processing relates to other prominent symptoms of long COVID including autonomic dysfunction, mood and illness beliefs in driving the experience of fatigue. We will recruit 44 individuals with long COVID fatigue and 44 individuals with neither long COVID nor fatigue (controls). Our primary objective is to compare baseline somatosensory processing between individuals with long COVID fatigue and controls. Additionally, we will explore the associations between somatosensory processing, fatigability and the level of fatigue induced by cognitive and physical exertion. Due to the complex nature of fatigue, we will also investigate how long COVID, state fatigue, perceived effort, mood, illness beliefs, autonomic symptoms and autonomic nervous system function interact to predict trait fatigue. This comprehensive investigation aims to elucidate how sensory processing and other prominent symptoms interact to impact the experience of fatigue.
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Affiliation(s)
- Bethan Thomas
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Christine Bundy
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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2
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Millar SC, Bennett K, Rickman M, Thewlis D. Retention of kinematic patterns during a 6-minute walk test in people with knee osteoarthritis. Gait Posture 2023; 101:106-113. [PMID: 36774788 DOI: 10.1016/j.gaitpost.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/25/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a chronic condition affecting the entire joint and surrounding tissue, resulting in pain, stiffness and impaired movement. Recent studies have suggested the use of physical performance tests, such as the six-minute walk test (6MWT) to assess joint function for those with knee OA. This study assessed lower limb sagittal plane joint angles during a 6MWT for people with mild-moderate knee OA. METHODS Thirty-one participants (18 male, 13 female; 62.9 ± 8.4 years) with knee OA were recruited. Gait data were collected in a single session during which participants completed a 6MWT around a 20 m course. Sagittal plane joint angles for the hip, knee and ankle were calculated during the first and last minute of the 6MWT. Statistical parametric mapping (SPM) was used to investigate changes in kinematic traces over the gait cycle. RESULTS Mean joint angles for the hip and knee showed no significant differences between the first and last minute of the 6MWT. Ankle joint kinematic traces indicated there to be a decrease in plantarflexion approaching toe-off in the last minute of the test - a 1.5° reduction from the first minute. No significant differences were calculated for walking speed or joint range of motion. DISCUSSION The lack of significant change in joint kinematic parameters and walking speed suggests the relative fatigue and pain burden to the participant over the duration of the 6-minute period is insufficient to elicit any mechanical changes to walking gait.
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Affiliation(s)
- Stuart C Millar
- Centre for Orthopaedic and Trauma Research, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; Active Vision Lab, School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia.
| | - Kieran Bennett
- Centre for Orthopaedic and Trauma Research, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Mark Rickman
- Centre for Orthopaedic and Trauma Research, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
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3
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Royer N, Coates K, Aboodarda SJ, Camdessanché JP, Millet GY. How is neuromuscular fatigability affected by perceived fatigue and disability in people with multiple sclerosis? Front Neurol 2022; 13:983643. [DOI: 10.3389/fneur.2022.983643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Whereas fatigue is recognized to be the main complaint of patients with multiple sclerosis (PwMS), its etiology, and particularly the role of resistance to fatigability and its interplay with disability level, remains unclear. The purposes of this review were to (i) clarify the relationship between fatigue/disability and neuromuscular performance in PwMS and (ii) review the corticospinal and muscular mechanisms of voluntary muscle contraction that are altered by multiple sclerosis, and how they may be influenced by disability level or fatigue. Neuromuscular function at rest and during exercise are more susceptible to impairement, due to deficits in voluntary activation, when the disability is greater. Fatigue level is related to resistance to fatigability but not to neuromuscular function at rest. Neurophysiological parameters related to signal transmission such as central motor conduction time, motor evoked potentials amplitude and latency are affected by disability and fatigue levels but their relative role in the impaired production of torque remain unclear. Nonetheless, cortical reorganization represents the most likely explanation for the heightened fatigability during exercise for highly fatigued and/or disabled PwMS. Further research is needed to decipher how the fatigue and disability could influence fatigability for an ecological task, especially at the corticospinal level.
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Abasıyanık Z, Kahraman T, Veldkamp R, Ertekin Ö, Kalron A, Feys P. Changes in Gait Characteristics During and Immediately After the 6-Minute Walk Test in Persons With Multiple Sclerosis: A Systematic Review. Phys Ther 2022; 102:6556167. [PMID: 35358308 DOI: 10.1093/ptj/pzac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 01/02/2022] [Accepted: 02/24/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE There is limited information about gait patterns during prolonged walking in people with multiple sclerosis (PwMS). The aim of this review was to report on gait metrics during and immediately after the 6-Minute Walk Test (6MWT) in PwMS with different levels of disability. METHODS The systematic search was performed in 3 databases (PubMed, Web of Science, and SCOPUS) using keywords related to multiple sclerosis and 6MWT. Studies that reported on quantitative gait outcomes before and after the 6MWT or multiple time points during the 6MWT were included. The Hedges g effect size (ES) was calculated to determine the magnitude of change in each gait parameter. RESULTS Fourteen studies (n = 534 PwMS; n = 166 healthy controls) were eligible. Five studies investigated gait parameters prior to and immediately after the 6MWT. Nine studies collected gait measures during the 6MWT. Speed (ES = -0.43 to 0.19), cadence (ES = -0.46 to 0.16), step length (ES = -0.46 to 0.14), stability (ES = -0.35 to 0.33), and regularity (ES = -0.25 to -0.15) decreased in most studies. In the majority of included studies, step time (ES = 0 to 0.35), stance period (ES = 0.12 to 0.58), double support phase (ES = 0.03 to 0.62), variability (ES = -0.19 to 1.13), and asymmetry (ES = -0.79 to 0.62) increased following the 6MWT. The kinetic and kinematic (mainly in dorsiflexion angle [ES = -0.08 to -0.36]) features of gait were also negatively changed after 6 minutes of walking. Walking speed, cadence, step length, stride length, and stride time after 6MWT at a comfortable speed all increased. Changes in the majority of spatiotemporal parameters were more pronounced in PwMS with moderate-to-severe disability compared with PwMS with mild disability. CONCLUSION Most quantitative gait parameters deteriorated during the 6MWT, especially in PwMS with moderate-to-severe disability. IMPACT The deterioration of gait patterns should be considered when designing therapeutic interventions to increase sustained walking capacity.
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Affiliation(s)
- Zuhal Abasıyanık
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Graduate School of Health Sciences Dokuz Eylül University, Izmir, Turkey.,Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Renee Veldkamp
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,UMSC, Hasselt-Pelt, Belgium
| | - Özge Ertekin
- Department of Neurological Physiotherapy-Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,UMSC, Hasselt-Pelt, Belgium
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Ramari C, Hvid LG, Dalgas U, Diniz AR, von Glehn F, de David AC. Implications of lower extremity muscle power and force for walking and fatigability in multiple sclerosis - An exploratory pilot-study. Clin Biomech (Bristol, Avon) 2022; 96:105668. [PMID: 35594782 DOI: 10.1016/j.clinbiomech.2022.105668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 04/15/2022] [Accepted: 05/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limitations in physical function are common in Multiple Sclerosis (MS), yet it is neither clear how muscle power implicates physical function and walking-fatigability. This pilot-study aims to investigate (1) deficits in muscle power/force alongside walking in persons with MS; (2) associations between muscle power/force and physical functions and (3) the impact of prolonged walking in muscle power/force. METHODS 30 relapse-remitting persons with MS and 28 healthy controls performed chair rise and plantar flexion on a force platform before and after 12-minutes of intermittent walking to measure lower extremity muscle power/force. GaitRite measured walking speed. The percentage change in distance walked was also calculated. Persons with MS were classified into subgroups according to walking-fatigability and mobility disability status (Patient Determined Disease Steps). FINDINGS Higher deficits in muscle power compared to force were observed in persons with MS vs. healthy controls particularly in persons with MS having higher disability. Muscle power and force were associated with walking capacity, mobility disability and subjective fatigue, but not with percentage change in distance walked. Persons with MS slowed down over the course of the 12-min intermittent walking, whereas decrements in walking speed and muscle power/force (derived from chair rise) were observed in persons with MS presenting walking-fatigability only. INTERPRETATION Muscle power and force are impaired in persons with MS and appear to be critical for physical function in MS. This exploratory pilot study further suggests that muscle power/force from chair rise could contributes to walking-fatigability which therefore offer future treatment targets.
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Affiliation(s)
- Cintia Ramari
- Faculty of Physical Education, University of Brasília, Brasília, Brazil; Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium.
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ana R Diniz
- Faculty of Ceilândia, University of Brasília, Brasília, Brazil
| | | | - Ana C de David
- Faculty of Physical Education, University of Brasília, Brasília, Brazil; Faculty of Ceilândia, University of Brasília, Brasília, Brazil
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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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Changes in trunk and head acceleration during the 6-minute walk test and its relation to falls risk for adults with multiple sclerosis. Exp Brain Res 2022; 240:927-939. [PMID: 35088117 DOI: 10.1007/s00221-021-06296-1] [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: 05/28/2021] [Accepted: 12/17/2021] [Indexed: 11/04/2022]
Abstract
For persons with multiple sclerosis (MS), the general decline in neuromuscular function underlies diminished balance, impaired gait and consequently, increased risk of falling. During gait, optimal control of head motion is an important feature which is achieved partly through control of the trunk-neck region to dampen gait-related oscillations. The primary aim of this study was to examine the effect performing a 6-minute walk test (6MWT) has on head, neck and trunk accelerations in individuals with MS. This was addressed using a repeated measures generalized linear model. We were also interested in assessing whether the 6MWT has an impact on a person's falls risk and specific physiological measures related to falls. Finally the relation between the amplitude (i.e., mean RMS) of head and trunk accelerations and falls risk was examined using linear regression. The main results were that over the course of the 6MWT, individuals progressively slowed down coupled with a concurrent increase in gait-related upper body accelerations (p's > 0.05). Despite the increased acceleration, no significant changes in attenuation from the trunk to the head were observed, indicating that persons were able to maintain an optimal level of control over these oscillations. Performing the 6MWT also had a negative impact on posture, with falls risk significantly increasing following this test (p > 0.05). Interestingly, the overall falls risk values were strongly linked with vertical accelerations about the trunk and head, but not average walking speed during the 6MWT. Overall, performing the 6MWT leads to changes in walking speed, upper body acceleration patterns and increases in overall falls risk.
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Daunoraviciene K, Ziziene J, Ovcinikova A, Kizlaitiene R, Griskevicius J. Quantitative body symmetry assessment during neurological examination. Technol Health Care 2021; 28:573-584. [PMID: 32831213 DOI: 10.3233/thc-208003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND A lack of movement coordination characterized by the undershoot or overshoot of the intended location with the hand, arm, or leg is often found in individuals with multiple sclerosis (MS). Standardized as Finger-to-Nose (FNT) and The Heel-to-Shin (HST) tests are the most frequently used tests for qualitative examination of upper and lower body coordination. Inertial sensors facilitate in performing quantitative motion analysis and by estimating body symmetry more accurately assess coordination lesion and imbalance. OBJECTIVES To assess the body symmetry of upper and lower limbs quantitatively, and to find the best body symmetry indices to discriminate MS from healthy individuals (CO). METHODS 28 MS patients and 23 CO participated in the study. Spatiotemporal parameters obtained from six Inertial Measurement Units (IMUs) were placed on the upper and lower extremities during FNT and HST tests. All data were analyzed using statistical methods in MATLAB. RESULTS Asymmetry indices of temporal parameters showed a significant increase in upper body and lower body asymmetry of MS compared to CO. However, CO have a greater kinematic asymmetry compared to MS. CONCLUSION Temporal parameters are the most sensitive to body asymmetry evaluation. However, range of motion is completely inappropriate if it is calculated for one movement cycle.
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Affiliation(s)
- Kristina Daunoraviciene
- Department of Biomechanical Engineering, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Jurgita Ziziene
- Department of Biomechanical Engineering, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Agne Ovcinikova
- Republican Vilnius University Hospital, Vilnius University, Vilnius, Lithuania
| | - Rasa Kizlaitiene
- Centre for Neurology, Department of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania
| | - Julius Griskevicius
- Department of Biomechanical Engineering, Vilnius Gediminas Technical University, Vilnius, Lithuania
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Ibrahim AA, Küderle A, Gaßner H, Klucken J, Eskofier BM, Kluge F. Inertial sensor-based gait parameters reflect patient-reported fatigue in multiple sclerosis. J Neuroeng Rehabil 2020; 17:165. [PMID: 33339530 PMCID: PMC7749504 DOI: 10.1186/s12984-020-00798-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/09/2020] [Indexed: 12/30/2022] Open
Abstract
Background Multiple sclerosis (MS) is a disabling disease affecting the central nervous system and consequently the whole body’s functional systems resulting in different gait disorders. Fatigue is the most common symptom in MS with a prevalence of 80%. Previous research studied the relation between fatigue and gait impairment using stationary gait analysis systems and short gait tests (e.g. timed 25 ft walk). However, wearable inertial sensors providing gait data from longer and continuous gait bouts have not been used to assess the relation between fatigue and gait parameters in MS. Therefore, the aim of this study was to evaluate the association between fatigue and spatio-temporal gait parameters extracted from wearable foot-worn sensors and to predict the degree of fatigue. Methods Forty-nine patients with MS (32 women; 17 men; aged 41.6 years, EDSS 1.0–6.5) were included where each participant was equipped with a small Inertial Measurement Unit (IMU) on each foot. Spatio-temporal gait parameters were obtained from the 6-min walking test, and the Borg scale of perceived exertion was used to represent fatigue. Gait parameters were normalized by taking the difference of averaged gait parameters between the beginning and end of the test to eliminate inter-individual differences. Afterwards, normalized parameters were transformed to principle components that were used as input to a Random Forest regression model to formulate the relationship between gait parameters and fatigue. Results Six principal components were used as input to our model explaining more than 90% of variance within our dataset. Random Forest regression was used to predict fatigue. The model was validated using 10-fold cross validation and the mean absolute error was 1.38 points. Principal components consisting mainly of stride time, maximum toe clearance, heel strike angle, and stride length had large contributions (67%) to the predictions made by the Random Forest. Conclusions The level of fatigue can be predicted based on spatio-temporal gait parameters obtained from an IMU based system. The results can help therapists to monitor fatigue before and after treatment and in rehabilitation programs to evaluate their efficacy. Furthermore, this can be used in home monitoring scenarios where therapists can monitor fatigue using IMUs reducing time and effort of patients and therapists.
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Affiliation(s)
- Alzhraa A Ibrahim
- Machine Learning and Data Analytics Lab, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany. .,Computer Science Department, Faculty of Computers and Information, Assiut University, Asyut, Egypt.
| | - Arne Küderle
- Machine Learning and Data Analytics Lab, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heiko Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Bavaria, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Bavaria, Germany.,Fraunhofer Institut for Integrated Circuits, Erlangen, Bavaria, Germany.,Medical Valley Digital Health Application Center, Bamberg, Bavaria, Germany
| | - Bjoern M Eskofier
- Machine Learning and Data Analytics Lab, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Felix Kluge
- Machine Learning and Data Analytics Lab, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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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: 2] [Impact Index Per Article: 0.5] [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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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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12
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Williams KL, Low Choy NL, Brauer SG. Center-Based Group and Home-Based Individual Exercise Programs Have Similar Impacts on Gait and Balance in People With Multiple Sclerosis: A Randomized Trial. PM R 2020; 13:9-18. [PMID: 32249509 DOI: 10.1002/pmrj.12377] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Group and home-based exercises to improve function in people with multiple sclerosis (MS) are common but have little underpinning evidence. OBJECTIVE To determine the comparative effectiveness of a center-based group versus home-based individual 8-week exercise program to improve gait and balance in people with MS. DESIGN Prospective, randomized controlled trial. SETTING Community center-based and home-based exercise program. PARTICIPANTS Fifty people with MS were randomized and completed allocated intervention (n = 26 center, n = 24 home), 47 completed post-assessment and 44 follow-up assessment. METHODS The center- and home-based groups completed an 8-week progressive functional and balance training exercise program. The center-based groups of four to six were supervised by a physiotherapist. The home-based group was provided with telephone support. MAIN OUTCOME MEASUREMENTS The primary outcome was gait speed (10-meter walk test). Secondary outcomes were gait endurance (6-minute walk test) and balance (Berg Balance Scale). Outcome assessments were conducted at baseline, immediately postintervention and at 8-week follow-up. RESULTS There was no statistically significant difference between groups in gait speed post training, with a mean difference of 0.01 m/s, 95% CI -0.36 to 0.37. There were no group effects, time effects, or interactions for gait speed, endurance, or balance. In both groups, gait speed improved to a level that met minimal clinically important differences. CONCLUSIONS Gait speed, endurance, and balance did not statistically improve in either group; however, gait speed changes met minimally important differences.
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Affiliation(s)
- Katrina Louise Williams
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nancy Louise Low Choy
- School of Physiotherapy, Australian Catholic University (McAuley Campus), Brisbane, Australia
| | - Sandra Gail Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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13
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Van Geel F, Moumdjian L, Lamers I, Bielen H, Feys P. Measuring walking-related performance fatigability in clinical practice: a systematic review. Eur J Phys Rehabil Med 2020; 56:88-103. [DOI: 10.23736/s1973-9087.19.05878-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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14
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Workman CD, Kamholz J, Rudroff T. Transcranial Direct Current Stimulation (tDCS) to Improve Gait in Multiple Sclerosis: A Timing Window Comparison. Front Hum Neurosci 2019; 13:420. [PMID: 31849628 PMCID: PMC6893177 DOI: 10.3389/fnhum.2019.00420] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022] Open
Abstract
Unilateral weakness of the lower limb is a hallmark of multiple sclerosis (MS) and a significant contributor to the progressive worsening of walking ability. There are currently no effective rehabilitation strategies targeting strength asymmetries and/or gait impairments in people with MS (PwMS). Transcranial direct current stimulation (tDCS) has improved motor outcomes in various populations, but the effect of tDCS on gait in PwMS and the ideal timing window of tDCS application are still unknown. This study investigated the effects of tDCS, either before or during a 6 min walk test (6MWT), on the distance walked and gait characteristics in PwMS. Twelve participants were recruited and randomly assigned into BEFORE or DURING groups (both n = 6). The BEFORE group received stimulation before performing a 6MWT (sham/2 mA, 13 min). The DURING group received stimulation only during a 6MWT (sham/2 mA, 6 min). Stimulation was over the more MS-affected primary motor cortex (M1). Distance walked and gait characteristics of the walk were the primary and secondary outcomes. The results indicated a significant decrease in distance walked in the DURING group (p = 0.026) and a significant increase in gait velocity in the BEFORE group (p = 0.04). These changes were accompanied by trends (p < 0.1) in distance walked, gait velocity, and stride length. Overall, the results of this study suggest that tDCS performed before a 6MWT might be more effective than tDCS during a 6MWT and that a single session of tDCS may not be sufficient to influence gait. Clinical Trial Registration: www.ClinicalTrials.gov, identifier #NCT03757819.
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Affiliation(s)
- Craig D Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - John Kamholz
- Department of Neurology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States.,Department of Neurology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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15
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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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16
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Kuwahara W, Kurumadani H, Tanaka N, Nakanishi K, Nakamura H, Ishii Y, Ueda A, Deie M, Adachi N, Sunagawa T. Correlation between spinal and pelvic movements during gait and aggravation of low back pain by gait loading in lumbar spinal stenosis patients. J Orthop Sci 2019; 24:207-213. [PMID: 30322623 DOI: 10.1016/j.jos.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/17/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lumbar alignment of posterior or anterior tilts affects the exacerbation and remission of symptoms of lumbar spinal stenosis patients. This study aimed to clarify the correlation between spinal and pelvic movements during gait and the aggravation of low back pain after gait loading in lumbar spinal stenosis patients. METHODS A total of 29 patients with lumbar spinal stenosis completed leg and low back pain assessments and gait analysis before and after gait loading tests. Patients were divided into leg and low back pain change (n = 8), leg pain only change (n = 12), and non-change (n = 9) groups based on the differences of leg and low back pain between before and after the tests. Peak kinematic values of the anterior tilts of the trunk, thoracic spine, lumbar spine, and pelvis during the stance phase were obtained via three-dimensional gait analysis. RESULTS In the leg and low back pain change group, the anterior lumbar and pelvic tilts were larger after than before the tests; however, in the leg pain only change and non-change groups, only the anterior lumbar tilt was larger after than before the tests. Anterior lumbar tilt before and after the tests negatively correlated with the aggravation of low back pain, and an increase in the anterior pelvic tilt positively correlated with the aggravation of low back pain. CONCLUSIONS In lumbar spinal stenosis patients, smaller anterior lumbar tilt and larger anterior pelvic tilt during gait loading may affect the aggravation of low back pain by gait loading. Increasing in lumbar lordosis during gait might be one of the factors leading to low back pain in lumbar spinal stenosis patients.
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Affiliation(s)
- Wataru Kuwahara
- Health Sciences Major, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Hiroshi Kurumadani
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuhiro Tanaka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Haruka Nakamura
- Department of Rehabilitation, Kibinomori Rehabilitation Hospital, 1-30-1, Kibinomori-Minami, Oamishirasato-shi, Chiba, 299-3241, Japan
| | - Yosuke Ishii
- Health Sciences Major, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Akio Ueda
- Health Sciences Major, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, 480-1195, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Toru Sunagawa
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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17
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Walking endurance and perceived symptom severity after a single maximal exercise test in persons with mild disability because of multiple sclerosis. Int J Rehabil Res 2019; 41:316-322. [PMID: 30020095 DOI: 10.1097/mrr.0000000000000305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
People with multiple sclerosis (PwMS) are less physically active compared with the general population. This might also be because of the perception of temporary worsening of symptoms during physical activity. Forty-two PwMS with a mild level of disability underwent a maximal exercise test on a bicycle ergometer. Fifteen minutes before and 15 and 75 min after the maximal exercise test, the 6-minute walking test was conducted and the rate of perceived exertion was recorded. Twice before and three times after the maximal exercise test, participants rated the symptom inventory, including symptom domains of general fatigue, muscle fatigue, balance, gait pattern, muscle weakness, spasticity, pain, sensory disturbance, dizziness, and visual impairment. The visual analogue scale was used to rate the perceived symptoms from 0 (no intensity) to 10 (maximal intensity). The 6-minute walking test distance increased significantly over time, whereas the rate of perceived exertion increased temporarily after the maximal exercise test. Immediately after the maximal exercise test, significant temporary increases were found in balance, gait pattern, muscle weakness, and visual impairment. General and muscle fatigue were elevated, compared with the baseline, till 15 and 75 min after the maximal exercise test, respectively. A short-term impact of a single maximal exercise test was considered as the temporary worsening of perceived symptoms, especially (muscle) fatigue and the gait pattern, in PwMS with a mild level of disability. However, a recovery was observed after 75 min. Walking endurance was not affected by the maximal exercise test.
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18
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Kalron A, Menascu S, Frid L, Aloni R, Achiron A. Physical activity in mild multiple sclerosis: contribution of perceived fatigue, energy cost, and speed of walking. Disabil Rehabil 2019; 42:1240-1246. [PMID: 30620227 DOI: 10.1080/09638288.2018.1519603] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose: To clarify the relationship between leisure-time physical activity, perceived fatigue, and energy expenditure while walking in people with multiple sclerosis.Methods: Sixty-six people afflicted with multiple sclerosis (MS) (32 women) with a mild neurological disability, participated in this study. Energy expenditure was separately measured at rest, during comfortable walking and during fast walking via a portable metabolic device using breath-by-breath technology (COSMED K5, COSMED Srl, Rome, Italy). The Godin leisure-time exercise questionnaire assessed leisure-time physical activity. The Modified Fatigue Impact Scale determined the level of perceived fatigue.Results: Seventeen people with MS were classified as physically active; 49 were insufficiently active. Scores recorded on the Godin Leisure-Time Exercise Questionnaire were 47.8 (SD = 18.4), 7.0 (SD = 8.2), respectively. Insufficiently physically active people with MS walked slower at both normal and fast walking conditions. However, no differences between groups were observed in energy expenditure measures in both walking speeds. O2 cost was 0.20 (SD = 0.13) and 0.21 (SD = 0.06) in the active and insufficiently active group, respectively. The insufficiently active group reported more perceived fatigue compared with the active patients; 33.3 (SD = 18.6) vs. 15.0 (SD = 19.0), p value = 0.002. Perceived fatigue was a significant variable maintaining a 10.4% variance related to leisure-time physical activity.Conclusions: Leisure-time physical activity was inversely associated with perceived fatigue and walking speed in persons with mild MS. Rehabilitation professionals should be aware of these relationships when planning rehabilitation strategies.Implication for rehabilitationThis study found that perceived fatigue is a barrier to physical activity participation even in people with mild multiple sclerosis and minimal disability.Insufficiently active people with multiple sclerosis expend the same amount of energy while walking as active multiple sclerosis individuals, though walking slower.The relationship between perceived fatigue and physical activity participation requires further exploration in the multiple sclerosis population.
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Affiliation(s)
- Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, and Sagol School of Neurosciences, Tel-Aviv University, Tel Aviv, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Lior Frid
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Aloni
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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19
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Psarakis M, Greene DA, Cole MH, Lord SR, Hoang P, Brodie M. Wearable technology reveals gait compensations, unstable walking patterns and fatigue in people with multiple sclerosis. Physiol Meas 2018; 39:075004. [PMID: 29701182 DOI: 10.1088/1361-6579/aac0a3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE People with multiple sclerosis (PwMS) often experience a decline in gait performance, which can compromise their independence and increase falls. Ankle joint contractures in PwMS are common and often result in compensatory gait patterns to accommodate reduced ankle range of motion (ROM). APPROACH Using advances in wearable technology, the aim of this study was to quantify head and pelvis movement patterns that occur in PwMS with disability and determine how these secondary gait compensations impact on gait stability. Twelve healthy participants and 12 PwMS participated in the study. Head and pelvis movements were measured using two tri-axial accelerometers. Measures of gait compensation, mobility, variability, asymmetry, stability and fatigue were assessed during a 6 min walking test. MAIN RESULTS Compared to healthy controls, PwMS had greater vertical asymmetry in their head and pelvic movements (Cohen's d = 1.85 and 1.60). Lower harmonic ratios indicated that PwMS were more unstable than controls (Cohen's d = -1.61 to -3.06), even after adjusting for their slower walking speeds. In the PwMS, increased compensatory movements were correlated with reduced ankle active ROM (r = -0.71), higher disability (EDSS) scores (r = 0.58), unstable gait (r = -0.76), reduced mobility (r = -0.76) and increased variability (r = 0.83). SIGNIFICANCE Wearable device technology provides an efficient and reliable way to screen for excessive compensatory movements often present in PwMS and provides clinically important information that impacts on mobility, stride time variability and gait stability. This information may help clinicians identify PwMS at high risk of falling and develop better rehabilitation interventions that, in addition to improving mobility, may help target the underlying causes of unstable gait.
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Affiliation(s)
- Michael Psarakis
- Faculty of Health Sciences, Australian Catholic University, Australia
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20
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Ankle Kinematics and Temporal Gait Characteristics over the Duration of a 6-Minute Walk Test in People with Multiple Sclerosis Who Experience Foot Drop. Rehabil Res Pract 2018; 2018:1260852. [PMID: 30057817 PMCID: PMC6051004 DOI: 10.1155/2018/1260852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/30/2018] [Accepted: 06/03/2018] [Indexed: 11/18/2022] Open
Abstract
Foot drop is a common gait impairment in people with MS (pwMS) but in some foot drop may only occur after a period of prolonged walking and may be a sign of motor fatigability. The purpose of the study was to explore whether, for pwMS, an adapted six-minute walk test (6minWT) would result in an increase in foot drop as measured using electrogoniometry. Sagittal ankle kinematics were recorded for fifteen participants (10 females and 5 males, aged 37-64) with MS (EDSS 4-6) throughout the 6minWT. Ankle kinematics and temporal stride parameters were compared between the first and last 10 gait cycles of the 6minWT. Peak dorsiflexion in swing was significantly reduced at the end of the 6minWT compared to the start, with six of the fifteen participants having a decrease of two degrees or more. Statistically significant changes in temporal stride parameters suggested a decrease in walking speed. Our results suggest that with the protocol used in this study it is feasible to identify patients who experience increased foot drop as a result of a prolonged exercise task.
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21
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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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22
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Horn KK, Allen DD, Gibson-Horn C, Widener GL. Effects of Torso-Weighting on Standing Balance and Falls During the Sensory Organization Test in People with Multiple Sclerosis. Int J MS Care 2018; 20:68-75. [PMID: 29681777 DOI: 10.7224/1537-2073.2015-090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background In people with multiple sclerosis (MS), common gait and balance impairments can lead to falls, fear of falling, activity restriction, and social isolation. Sensory augmentation in the form of torso-weighting has resulted in improvement in gait and balance, but research on its effect on falls in MS is lacking. Methods 60 people with MS and 10 bin-matched controls completed the Sensory Organization Test (SOT) while nonweighted and again while weighted using the Balance-Based Torso-Weighting assessment method. This was a quasi-experimental pre-post intervention study. The SOT composite scores, equilibrium scores, and number of falls occurring across six SOT conditions were compared between and within groups using 2-way analysis of variance, α = .05 with planned t test analyses of weighting effects. Results A significant increase in composite score of 9.14 points nonweighted to weighted occurred in the MS group (P < .001) but not in controls (P = .626). Equilibrium scores were significantly higher with weights in the MS group (P < .001) but not in controls (P = .5). Falls during the SOT were reduced by 35% with weights in the MS group versus without weights (P < .001), with the greatest number of falls occurring in the most challenging SOT conditions. Conclusions During a single testing session, torso-weighting produced significant improvements in postural stability and fall reduction during the SOT for people with MS but no change in controls. Further research is needed to determine whether torso-weighting has the potential to reduce falls in MS during real-world activities.
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23
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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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24
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Miller L, McFadyen A, Lord AC, Hunter R, Paul L, Rafferty D, Bowers R, Mattison P. Functional Electrical Stimulation for Foot Drop in Multiple Sclerosis: A Systematic Review and Meta-Analysis of the Effect on Gait Speed. Arch Phys Med Rehabil 2017; 98:1435-1452. [PMID: 28088382 DOI: 10.1016/j.apmr.2016.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/01/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the efficacy of functional electrical stimulation (FES) used for foot drop in people with multiple sclerosis (pwMS) on gait speed in short and long walking performance tests. DATA SOURCES Five databases (Cochrane Library, CINAHL, Embase, MEDLINE, and PubMed) and reference lists were searched. STUDY SELECTION Studies of both observational and experimental design where gait speed data in pwMS could be extracted were included. DATA EXTRACTION Data were independently extracted and recorded. Methodologic quality was assessed using the Effective Public Health Practice Project tool. DATA SYNTHESIS Nineteen studies (described in 20 articles) recruiting 490 pwMS were identified and rated as moderate or weak, with none gaining a strong rating. All studies rated weak for blinding. Initial and ongoing orthotic and therapeutic effects were assessed regarding the effect of FES on gait speed in short and long walking tests. Meta-analyses of the short walk tests revealed a significant initial orthotic effect (t=2.14, P=.016), with a mean increase in gait speed of .05m/s, and ongoing orthotic effect (t=2.81, P=.003), with a mean increase of .08m/s. There were no initial or ongoing effects on gait speed in long walk tests and no therapeutic effect on gait speed in either short or long walk tests. CONCLUSIONS FES used for foot drop has a positive initial and ongoing effect on gait speed in short walking tests. Further fully powered randomized controlled trials comparing FES with alternative treatments are required.
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Affiliation(s)
- Linda Miller
- Multiple Sclerosis Service, NHS Ayrshire and Arran, Irvine, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | | | - Anna C Lord
- Multiple Sclerosis Service, NHS Ayrshire and Arran, Irvine, UK
| | - Rebecca Hunter
- Multiple Sclerosis Service, NHS Ayrshire and Arran, Irvine, UK
| | - Lorna Paul
- School of Medicine, Glasgow University, Glasgow, UK
| | - Danny Rafferty
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Roy Bowers
- Department of Biomedical Engineering, Strathclyde University, Glasgow, UK
| | - Paul Mattison
- Multiple Sclerosis Service, NHS Ayrshire and Arran, Irvine, UK
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25
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Cofré Lizama LE, Khan F, Lee PVS, Galea MP. The use of laboratory gait analysis for understanding gait deterioration in people with multiple sclerosis. Mult Scler 2016; 22:1768-1776. [DOI: 10.1177/1352458516658137] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 05/25/2016] [Accepted: 06/12/2016] [Indexed: 11/16/2022]
Abstract
Laboratory gait analysis or three-dimensional gait analysis (3DGA), which uses motion capture, force plates and electromyography (EMG), has allowed a better understanding of the underlying mechanisms of gait deterioration in patients with multiple sclerosis (PwMS). This review will summarize the current knowledge on multiple sclerosis (MS)-related changes in kinematics (angles), kinetics (forces) and electromyographic (muscle activation) patterns and how these measures can be used as markers of disease progression. We will also discuss the potential causes of slower walking in PwMS and the implications for 3DGA. Finally, we will describe new technologies and methods that will increase precision and clinical utilization of 3DGA in PwMS. Overall, 3DGA studies have shown that functionality of the ankle joint is the most affected during walking and that compensatory actions to maintain a functional speed may be insufficient in PwMS. However, altered gait patterns may be a strategy to increase stability as balance is also affected in PwMS.
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Affiliation(s)
- L Eduardo Cofré Lizama
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Fary Khan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia/Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia/School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Peter VS Lee
- Department of Mechanical Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Mary P Galea
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia/Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
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26
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Barr CJ, Patritti BL, Bowes R, Crotty M, McLoughlin JV. Orthotic and therapeutic effect of functional electrical stimulation on fatigue induced gait patterns in people with multiple sclerosis. Disabil Rehabil Assist Technol 2016; 12:560-572. [PMID: 28612678 DOI: 10.3109/17483107.2015.1136702] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the orthotic and therapeutic effects of prolonged use of functional electrical stimulation (FES) on fatigue induced gait patterns in people with Multiple Sclerosis (MS). METHOD Thirteen people with MS completed 3D gait analysis with FES off and on, before and after a fatiguing 6-minute walk, at baseline and after 8 weeks of use of FES. RESULTS Eleven participants completed all testing. An orthotic effect on gait was not evident on first use of FES. However, therapeutic effects on gait after 8 weeks use were generally positive, including increases in walking speed due to improved neuromuscular control and power generated at the hip and ankle of the more affected limb. The action of FES alone was not sufficient to overcome all fatigue related deficits in gait but there was evidence 8 weeks use of FES can ameliorate some fatigue effects on lower limb kinetics, including benefits to ankle mechanics involved in generating power around push-off during stance. CONCLUSIONS Eight-weeks of FES can benefit the gait pattern of people with MS under non-fatigued and fatigued conditions. Implications for rehabilitation In some people with MS prolonged use of FES may be necessary before observing positive orthotic effects. Improvements in the neuromuscular control of the more affected lower limb may develop with prolonged use of FES in people with MS. Only some therapeutic benefits of FES are maintained during fatigued walking in people with MS. FES may be considered as a gait retraining device as well as an orthotic intervention for people with MS.
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Affiliation(s)
- Christopher J Barr
- a Department of Rehabilitation Aged and Extended Care, School of Health Sciences , Flinders University , Bedford Park , South Australia , Australia
| | | | - Rebecca Bowes
- b Repatriation General Hospital , Daw Park , South Australia , Australia
| | - Maria Crotty
- a Department of Rehabilitation Aged and Extended Care, School of Health Sciences , Flinders University , Bedford Park , South Australia , Australia.,b Repatriation General Hospital , Daw Park , South Australia , Australia
| | - James V McLoughlin
- a Department of Rehabilitation Aged and Extended Care, School of Health Sciences , Flinders University , Bedford Park , South Australia , Australia
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