The Dresden Protocol for Multidimensional Walking Assessment (DMWA) in Clinical Practice

Abstract

Walking impairments represent one of the most debilitating symptom areas for people with multiple sclerosis (MS). It is important to detect even slightest walking impairments in order to start and optimize necessary interventions in time to counteract further progression of the disability. For this reason, a regular monitoring through gait analysis is highly necessary. At advanced stages of MS with significant walking impairment, this assessment is also necessary to optimize symptomatic treatment, choose the most suitable walking aid and plan individualized rehabilitation. In clinical practice, walking impairment is only assessed at higher levels of the disease using e.g., the Expanded Disability Status Scale (EDSS). In contrast to the EDSS, standardized functional tests such as walking speed, walking endurance and balance as well as walking quality and gait-related patient-reported outcomes allow a more holistic and sensitive assessment of walking impairment. In recent years, the MS Center Dresden has established a standardized monitoring procedure for the routine multidimensional assessment of gait and balance disorders. In the following protocol, we present the techniques and procedures for the analysis of gait and balance of people with MS at the MS Center Dresden. Patients are assessed with a multidimensional gait analysis at least once a year. This enables long-term monitoring of walking impairment, which allows early active intervention regarding further progression of disease and improves the current standard clinical practice.

Using Machine Learning Algorithms for Identifying Gait Parameters Suitable to Evaluate Subtle Changes in Gait in People with Multiple Sclerosis

“…Subjects were tested with GAITRite (CIR-Systems Inc., Franklin, NJ, USA) according to the Dresden Protocol for Multidimensional Gait Assessment (DMWA) [33]. The GAITRite was investigated in numerous studies and has demonstrated high reliability and validity [34][35][36].…”

“…Selected gait parameters for people with MS and healthy controls (N = 60). Key parameters used in clinical routine according our DMWA protocol[33]; MS = multiple sclerosis; HC = healthy controls; EMIQ = Early Mobility Impairment Questionnaire; MSWS = Multiple Sclerosis Walking Scale; GCT = Gait Cycle Time; L = left; R = right; standard deviation = SD; data in mean ± SD; ( )-dimensionless values; p-value via Mann-Whitney U-Test for differences between groups.…”

Digital Twins for Multiple Sclerosis

“…In recent years, the Expanded Disease Disability Scale (EDSS) has been an essential, irreplaceable scale in MS which has been improved in the past years by different approaches (127)(128)(129). However, other additional clinical instruments have been introduced to quantitate the different multidimensional aspects of MS as fatigue, cognition or walking function (130,131). The Multiple Sclerosis Functional Composite (MSFC) provides a functional assessment of different key functions (upper and lower extremities, cognition) that is used more and more frequently in MS and has been proven to be highly sensitive in the evaluation of very important clinical trials.…”

“…The Multiple Sclerosis Performance Test (MSPT) is a digital adaptation of the MSFC with additional elements added ( 160 , 161 ) and measures health status via iPad with questionnaire on health status, processing speed with Processing Speed Test (PST) ( 162 ), manual skills with 9-Hole-Peg-Test (9-HPT) and walking speed with Timed 25-Foot-Walk (T25-FW) ( 160 ). Multidimensional gait analysis can be performed with measurement of walking speed (T25-FW), measurement of endurance [2-Minute Walk Test, 2MWT ( 163 , 164 )] and measurement of balance and gait quality on a sensor-based walking mat (GAITRite ® -System, Mobility Lab-System) ( 131 ). For the digital measurement of data in patient-specific everyday life (at home) there are various patient apps such as Floodlight, diverse fitness tracker and health apps available ( 165 , 166 ).…”

“…Thanks to the visualized simulation of the DT, the HCP has time to address all patients’ questions and concerns in detail. Examples of existing dashboards for displaying individual patient data at a glance include the walking assessment dashboard as part of the multidimensional digital patient management system MSDS 3D ( 201 , 202 ), showing the results of clinical multidimensional walking assessment and daily smart monitoring longitudinally ( 131 ), and the MS BioScreen, that integrates multiple dimensions of disease information: clinical evolution, therapeutic interventions, brain, eye, and spinal cord imaging, environmental exposures, genomics, and biomarker data ( 56 , 203 ).…”