Effects of Muscle Function and Limb Loading Asymmetries on Gait and Balance in People With Multiple Sclerosis

Abstract

People with MS (PwMS) often have a more- and less-affected side of the body which results in a variety of asymmetries, including measures of power, strength, muscle activity, and limb loading. Though many studies have identified asymmetries, their impact on gait and balance in PwMS is currently unclear. In this mini-review we first summarize previous findings of asymmetries in muscle function and limb loading and their impact on gait and balance in PwMS. We then provide potential explanations for this lack of consistency in the current literature, and propose study guidelines to improve future lower limb asymmetry studies. Making use of a unified approach to study lower limb asymmetry may then provide more clarity regarding their impact on mobility, specifically gait and balance, in PwMS.

Reference Values for Isometric, Dynamic, and Asymmetry Leg Extension Strength in Patients with Multiple Sclerosis

“…An interesting aspect is the study of the degree of symmetry in the lower limbs, as often the disease does not affect both sides of the body equally [45], and PwMS most often present asymmetry in force between limb [17,18,[46][47][48][49], and some studies have found that the degree of asymmetry is inversely related to walking ability [24,32,47]. The lower-limb explained a 20-30% of the variance functional capacity tests between PwMS, which is the reason why muscle training is recommended to minimize strength asymmetry between limbs [46], although other studies have not corroborated this association [50].…”

“…The studies that have been carried out on symmetry in PwMS have been of a transverse type, so we can only analyze the association of asymmetry with other disease parameters, physiological or functional; longitudinal studies are needed to explain the causal factors of asymmetry, including studies with more standardized methodologies and protocols [18]. For potential use by health or physical activity professionals caring for PwMS, for the variables analyzed in this study we showed reference values with points of separation between quartiles, grouped by type of MS and degree of neurological disability.…”

“…On this scale, the ambulatory capacity of the patient has a great weight in the resulting score, but the level of muscular strength is not considered, which is also an important factor for the level of functional independence. Characteristically, MS often affects both sides of the body unevenly, either in sensory or motor functions [17,18].…”

The Effect of Exercise Training on Gait, Balance, and Physical Fitness Asymmetries in Persons With Chronic Neurological Conditions: A Systematic Review of Randomized Controlled Trials

“…The current review aimed to summarize studies examining the efficacy of exercise training on asymmetry in physical fitness, physical function, and gait in persons diagnosed with either MS, PD, or having experienced an ischemic stroke. These conditions were selected given the presence of reported asymmetries in function within these groups (Djaldetti et al, 2006;Lauziere et al, 2014;Rudroff and Proessl, 2018). Exercise training was defined as any "planned structured and repetitive bodily movement done to improve or maintain one or more components of physical fitness" (Bouchard et al, 1994).…”

“…In persons with CNCs, impairments in body functions often present in an asymmetrical pattern, creating a significant difference between contralateral limbs and muscle groups (Rudroff and Proessl, 2018), often described as an "affected" and "non-affected" limb (Sun et al, 2018). Indeed, asymmetries have been observed for temporal and spatial gait outcomes, limb loading, and muscular strength and power in these populations (Djaldetti et al, 2006;Lauziere et al, 2014;Rudroff and Proessl, 2018).…”