Motor determinants of gait in 100 ambulatory patients with multiple sclerosis

Abstract

A prospective analysis of gait and strength parameters was performed in 100 patients diagnosed with MS and pyramidal involvement admitted in a rehabilitation unit The patients were divided into two groups based on their ability to walk in daily life (nonassisted or cane-assisted gait) and into four clinical subgroups depending on associated involvements such as sensory loss or cerebellar ataxia. Twenty healthy subjects were studied as a control group. Gait parameters were evaluated with a Locometre and muscle strength with an isokinetic dynamometer. The results showed that the average velocity and strength of the hamstring and quadriceps were strongly correlated and reduced in the MS group in comparison with the control, and in the cane-assisted group compared with the nonassisted group. Gait velocity tended to be more correlated to hamstring strength in the nonassisted group with a determination coefficient (r2) reaching a value of 0.44 in the sensory subgroup. These findings provide evidence that a correlation between strength reduction and gait impairment is obvious whatever the clinical form in patients with MS. This correlation is higher with hamstrings but may change depending on the disability level and the clinical form. This could be taken into account in the individual assessment of further rehabilitation programmes.

Lower-limb performance disparities: Implications for exercise prescription in multiple sclerosis

“…Chung et al in 2008 observed that lower knee extensor power asymmetry was greater in individuals with MS than in controls [3]. Unilateral leg weakness has also been observed in individuals with MS [6][7]. In a 2011 study, Larson and White observed bilateral differences in hip bone density in ambulatory individuals with MS, which may illustrate consequences of altered bilateral function [8].…”

Orthotic and therapeutic effect of functional electrical stimulation on fatigue induced gait patterns in people with multiple sclerosis

“…The increased (hyper)extension during midstance resulting from first walking with the FES on may be a strategy used by the participants to counteract the action of the FES in assisting forward progression of the shank over the ankle. A possible reason for this may be to avoid increased eccentric loading of the knee extensors, indicated by the decreased knee extensor moment, which are known to be weak in people with MS [9,22] and a predictor of their walking performance [39]. The pattern of knee hyperextension was slightly greater when fatigued with the FES on which may have been done to further compensate for eccentric demands imposed on the knee extensors which are likely to have been weakened further after the fatiguing walk [21].…”

“…Perceptions of fatigue have also been associated with impaired central drive [20] contributing to a reduction in lower limb strength [21] which is a factor in gait deficits exhibited by people with MS [9,22]. The ankle dorsiflexor muscles are particularly susceptible to the effects of fatigue, with both central and peripheral factors, including impaired central drive, contributing to weakness of these muscles [23].…”

Correlation of the VEMP score, ambulation and upper extremity function in clinically isolated syndrome

“…(12,13,14) Furthermore, several MRI studies tried to correlate MRI burden of the disease with walking impairment. (15,16) However, as the information provided by evoked potentials is more related to function unlike the information provided by MRI, which is more related to anatomy, evoked potentials may prove to be more useful in monitoring disease evolution in MS (17).…”