A Multifactorial Model of Multiple Sclerosis Gait and Its Changes Across Different Disability Levels

Angelini, Lorenza; Buckley, Ellen; Bonci, Tecla; Radford, Alexandra; Sharrack, Basil; Paling, David; Nair, Krishnan Padmakumari Sivaraman; Mazzà, Claudia

doi:10.1109/tbme.2021.3061998

Cited by 12 publications

(19 citation statements)

References 72 publications

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“…In the present study, we were able to show the analytical flows of current methods and highlight the risks of data misinterpretation that could stem from a lack of consistency of the results obtained from the various calculations. In line with previous literature (Angelini et al [5]; Buckley et al [4]), our results indicate that while step and stride regularity have a clear potential as biomarkers of disease progression in MS and PD, step asymmetry seems to be less relevant for these patients. While it might be hypothesized that the proposed index could be sensitive to gait impairments when investigating cohorts with highly asymmetric walking, such as for example hemiplegic patients or those who had a hip replacement, additional investigations would be needed to prove this hypothesis.…”

Section: Discussionsupporting

confidence: 92%

“…These metrics have been shown to carry additional information compared to measures of spatiotemporal symmetry when investigating pathological gait [4]. Recently, regularity and symmetry have been suggested to be potential biomarkers for quantifying gait disability in ageing and diseases, including multiple sclerosis (MS) and Parkinson's disease (PD) [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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A Proposal for a Linear Calculation of Gait Asymmetry

et al. 2021

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Pathological gait is often associated with a lack of symmetry. A possible way to quantify this feature is to use acceleration data measured by a sensor located on the lower trunk. The most common approach calculates a symmetry index starting from the autocorrelation function, aiming to measure the divergence in motion of the left and right sides of the body. The various methods proposed to implement this approach are based on nonlinear and discontinuous functions, and the interpretation of their output is far from straightforward. The aim of this study was to propose a linear and easier to interpret quantification measure for gait asymmetry. The proposed measure was tested on data from healthy controls and from patients with Multiple Sclerosis and Parkinson’s Disease, and it was shown to negate the flaws present in previous methods and to provide more directly interpretable results.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

A Proposal for a Linear Calculation of Gait Asymmetry

et al. 2021

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“…The abnormalities correlated with the level of disability and EDSS scores. The same group recently published an extension of this study [37]. A total of 114 pwMS were compared with 24 HC.…”

Section: Resultsmentioning

confidence: 99%

Sensor-based gait analyses of the six-minute walk test identify qualitative improvement in gait parameters of people with multiple sclerosis after rehabilitation

Berg‐Hansen

Moen²,

Austeng

et al. 2022

J Neurol

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The aim of this work was to determine whether wearable inertial measurement units (IMUs) could detect gait improvements across different disability groups of people with Multiple Sclerosis (pwMS) by the six-minute walk test (6MWT) during a rehabilitation stay in a specialized rehabilitation center. Forty-six pwMS and 20 healthy controls (HC) were included in the study. They performed the 6MWT with two inertial measurement units (IMUs) placed on the feet. Thirty-two of the pwMS were retested at the end of the stay. PwMS were divided in a mild-disability and a moderate-disability group. The 6MWT was divided in six sections of 1 min each for technical analysis, and linear mixed models were used for statistical analyses. The comparison between the two disability groups and HC highlighted significant differences for each gait parameter (all p < 0.001). The crossing effect between the test–retest and the two disability groups showed greater improvement for the moderate-disability group. Finally, the gait parameter with the higher effect size, allowing the best differentiation between the disability groups, was the foot flat ratio (R2 = 0.53). Gait analyses from wearable sensors identified different evolutions of gait patterns during the 6MWT in pwMS with different physical disability. The measured effect of a short-time rehabilitation on gait with 6MWT was higher for pwMS with higher degree of disability. Using IMUs in a clinical setting allowed to identify significant changes in inter-stride gait patterns. Wearable sensors and key parameters have the potential as useful clinical tools for focusing on gait in pwMS.

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“…Published surveys and studies reported that one of the main critical aspects for the routine adoption of these systems is difficulty regarding the time required to understand and interpret the big number of parameters provided [ 9 , 30 ], which are often highly correlated with each other. In this case, the provision of redundant variables does not add further information and makes clinical interpretation unnecessarily complex [ 32 ]. Regarding this point, there is a need to reduce the number of instrumented parameters to a few independent variables to increase clinical interpretability, and, at the same time, minimize information loss [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

Balance Impairments in People with Early-Stage Multiple Sclerosis: Boosting the Integration of Instrumented Assessment in Clinical Practice

Carpinella

Anastasi

Gervasoni

et al. 2022

Sensors

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The balance of people with multiple sclerosis (PwMS) is commonly assessed during neurological examinations through clinical Romberg and tandem gait tests that are often not sensitive enough to unravel subtle deficits in early-stage PwMS. Inertial sensors (IMUs) could overcome this drawback. Nevertheless, IMUs are not yet fully integrated into clinical practice due to issues including the difficulty to understand/interpret the big number of parameters provided and the lack of cut-off values to identify possible abnormalities. In an attempt to overcome these limitations, an instrumented modified Romberg test (ImRomberg: standing on foam with eyes closed while wearing an IMU on the trunk) was administered to 81 early-stage PwMS and 38 healthy subjects (HS). To facilitate clinical interpretation, 21 IMU-based parameters were computed and reduced through principal component analysis into two components, sway complexity and sway intensity, descriptive of independent aspects of balance, presenting a clear clinical meaning and significant correlations with at least one clinical scale. Compared to HS, early-stage PwMS showed a 228% reduction in sway complexity and a 63% increase in sway intensity, indicating, respectively, a less automatic (more conscious) balance control and larger and faster trunk movements during upright posture. Cut-off values were derived to identify the presence of balance abnormalities and if these abnormalities are clinically meaningful. By applying these thresholds and integrating the ImRomberg test with the clinical tandem gait test, balance impairments were identified in 58% of PwMS versus the 17% detected by traditional Romberg and tandem gait tests. The higher sensitivity of the proposed approach would allow for the direct identification of early-stage PwMS who could benefit from preventive rehabilitation interventions aimed at slowing MS-related functional decline during neurological examinations and with minimal modifications to the tests commonly performed.

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A Multifactorial Model of Multiple Sclerosis Gait and Its Changes Across Different Disability Levels

Cited by 12 publications

References 72 publications

A Proposal for a Linear Calculation of Gait Asymmetry

A Proposal for a Linear Calculation of Gait Asymmetry

Sensor-based gait analyses of the six-minute walk test identify qualitative improvement in gait parameters of people with multiple sclerosis after rehabilitation

Balance Impairments in People with Early-Stage Multiple Sclerosis: Boosting the Integration of Instrumented Assessment in Clinical Practice

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