Profiling walking dysfunction in multiple sclerosis: characterisation, classification and progression over time

Abstract

Gait dysfunction is a common and relevant symptom in multiple sclerosis (MS). This study aimed to profile gait pathology in gait-impaired patients with MS using comprehensive 3D gait analysis and clinical walking tests. Thirty-seven patients with MS walked on the treadmill at their individual, sustainable speed while 20 healthy control subjects walked at all the different patient’s paces, allowing for comparisons independent of walking velocity. Kinematic analysis revealed pronounced restrictions in knee and ankle joint excursion, increased gait variability and asymmetry along with impaired dynamic stability in patients. The most discriminative single gait parameter, differentiating patients from controls with an accuracy of 83.3% (χ2 test; p = 0.0001), was reduced knee range of motion. Based on hierarchical cluster and principal component analysis, three principal pathological gait patterns were identified: a spastic-paretic, an ataxia-like, and an unstable gait. Follow-up assessments after 1 year indicated deterioration of walking function, particularly in patients with spastic-paretic gait patterns. Our findings suggest that impaired knee/ankle control is common in patients with MS. Personalised gait profiles and clustering algorithms may be promising tools for stratifying patients and to inform patient-tailored exercise programs. Responsive, objective outcome measures are important for monitoring disease progression and treatment effects in MS trials.

Biomechanical Analysis of an Unpowered Hip Flexion Orthosis on Individuals With and Without Multiple Sclerosis

“…Our hypothesis that hip kinematics in the assisted leg would shift towards exion was largely supported by subjects with MS and several controls, particularly in the B1 condition. This change opposes the shift toward hip extension during swing that has been noted in the literature (7). These effects were more pronounced for subjects with MS, indicating that the HFO was able to "target" the pathological gait patterns exhibited in this group.…”

“…Symptoms can vary throughout the day due to fatigue, and as the disease progresses, individuals can experience relapses, remissions, and increasing disability (3,5,6). The effects of MS on gait often include reductions in step length, walking speed, dynamic stability, and range of motion (ROM) in lower limb joints (7)(8)(9)(10).…”

A Survey of Assistive Technologies for Assessment and Rehabilitation of Motor Impairments in Multiple Sclerosis

“…This study considered PwMs with mild MS who had EDSS score between 2 and 4 and severe MS with EDSS score ≥6. Another study by Filli et al [50] characterized MS-related gait pathology, aimed at defining and detecting specific gait patterns in patients and monitored deterioration of walking function over a period of one year. PwMS recruited for this study had a mean EDSS score of 4.5 ± 1.0.…”

“…Based on the studies presented above, it is evident that an inertial sensor-based setup is most commonly used in several studies [24,26,27,49,50,52] and measurements from these sensors have also been proven to be reliable to categorize patients to a specific disease state and differentiate an MS patient from a healthy subject [52]. An inertial sensor like the BioStamp sensor or the Xsens sensor usually consists of a 3-dimensional gyroscope and tri-axial accelerometer sensors.…”

“…The sensor placement also differed based on the kind of parameters to be measured. It is important to note that there is a need for remote monitoring of patients to accommodate longitudinal monitoring of gait and balance impairments in PwMS [50]. Most of these sensors being wearable and lightweight provides an avenue for development of remote monitoring systems which would help clinicians and health care providers make better treatment and rehabilitation plan.…”