A wearable sensor identifies alterations in community ambulation in multiple sclerosis: contributors to real-world gait quality and physical activity

Abstract

People with multiple sclerosis (pwMS) often suffer from gait impairments. These changes in gait have been wellstudied in laboratory and clinical settings. A thorough investigation of gait alterations during community ambulation and their contributing factors, however, is lacking. The aim of the present study was to evaluate community ambulation and physical activity in pwMS and healthy controls and to compare in-lab gait to community ambulation. To this end, 104 subjects were studied:44 pwMS and 60 healthy controls (whose age was similar to the controls). The subjects wore a tri-axial, lower-back accelerometer during usual-walking and dual-task walking in the lab and during community ambulation (1 week) to evaluate the amount, type, and quality of activity. The results showed that during community ambulation, pwMS took fewer steps and walked more slowly, with greater asymmetry, and larger stride-to-stride variability, compared to the healthy controls (p<0.001). Gait speed during most of community ambulation was significantly lower than the in-lab usual-walking value and similar to the in-lab dual-tasking value. Significant group (pwMS /controls) by walking condition (in-lab/community ambulation) interactions were observed (e.g., gait speed).Greater disability was associated with fewer steps and reduced gait speed during community ambulation. In contrast, physical fatigue was correlated with sedentary activity but was not related to any of the measures of community ambulation gait quality including gait speed. This disparity suggests that more than one mechanism contributes to community ambulation and physical activity in pwMS. Together, these findings demonstrate that during community ambulation, pwMS have marked gait alterations in multiple gait features, reminiscent of dual-task walking measured in the laboratory. Disease-related factors associated with these changes might be targets of rehabilitation.

Wearable sensors can reliably quantify gait alterations associated with disability in people with progressive multiple sclerosis in a clinical setting

“…The proposed gait measures could, therefore, be reliably integrated into the assessment performed in any clinical facility where 10-m walk measures are being currently assessed. Additionally, focusing on the data extracted from the sensor on the lower back might also facilitate the integration of the proposed approach into continuous unsupervised mobility monitoring [ 25 , 46 , 54 , 55 ].…”

“…These have been successfully applied to both older adults [ 23 ], those at risk of falling [ 24 ] or affected by neurological disorders such as Parkinson’s disease, where they have been found to add valuable and complementary information to traditional gait analysis [ 21 ]. In MS, the use of this approach has been limited to understanding the effects of fatigue [ 18 ] and gait changes in the real world [ 25 ], but the feasibility of employing such gait measures as tools for quantifying gait abnormalities in people affected by this condition and for integrating them into routine clinical assessments is yet to be investigated. The present study is, therefore, designed to fill in this gap.…”

Laboratory versus daily life gait characteristics in patients with multiple sclerosis, Parkinson’s disease, and matched controls

“…Recently, the use of wearable technology has made it feasible to quantify gait in the laboratory and during daily life [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Several studies have compared the quality of mobility in the laboratory with daily life walking bouts [5,14,[31][32][33]; however, these studies did not compare similar gait bout lengths in the two environments (laboratory versus daily life) except for the one recent study in children with cerebral palsy [32]. Specifically, Del Din et al [14] compared 10-m walking bout in the laboratory to all walking bouts during daily life in people with PD, Storm et al [31] compared 15-m and 1-min walking bout in the laboratory to all bouts with < 50 steps, between 51 to 100 steps and > 100 steps in people with MS. Hillel et al [5] compared 1-min laboratory walking bout to daily life walking bout of 30-s only in people with PD.…”

“…Specifically, Del Din et al [14] compared 10-m walking bout in the laboratory to all walking bouts during daily life in people with PD, Storm et al [31] compared 15-m and 1-min walking bout in the laboratory to all bouts with < 50 steps, between 51 to 100 steps and > 100 steps in people with MS. Hillel et al [5] compared 1-min laboratory walking bout to daily life walking bout of 30-s only in people with PD. Shema-Shiratzky et al [33] compared the first 30-s of 1-min laboratory walking bout to daily life walking bout of 30-s and more in people with MS. Matching gait bout length is important because many gait measures change with the duration of a walking bout [14], [34].…”

Deep Phenotyping of Parkinson’s Disease

“…Large scale public-private partnerships, such as Mobilise-D, are seeking to develop clinically valid digital mobile assessments that can be applied to PD and other chronic medical conditions. These efforts in multiple sclerosis, for example, employed digital measures alongside traditional measures to assess ambulation in the clinic and in a real-world setting [101]. While larger scale studies and rigorous validation of novel digital measures is needed for PD, the field should recognize that comparison against traditional measures may not be the best approach for such validation, particularly because many of the digital measures can be more accurate and sensitive than traditional "gold" standards.…”