Deterioration of specific aspects of gait during the instrumented 6-min walk test among people with multiple sclerosis

Shema-Shiratzky, Shirley; Gazit, Eran; Sun, Ruopeng; Regev, Keren; Karni, Arnon; Sosnoff, Jacob J.; Herman, Talia; Mirelman, Anat; Hausdorff, Jeffrey M.

doi:10.1007/s00415-019-09500-z

Cited by 46 publications

(69 citation statements)

References 38 publications

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“…Recently, Shema-Shiratzky et al 26 reported the results of a study in which various gait domains (e.g., pace, rhythm, variability, symmetry, and complexity) were measured and compared among mild-and moderate pwMS who performed the 6MWT while wearing body-fixed sensors. They did not recruit participants with severe MS nor reported on PCI values.…”

Section: Discussionmentioning

confidence: 99%

Gait asymmetry, and bilateral coordination of gait during a six-minute walk test in persons with multiple sclerosis

Plotnik

Wagner

Adusumilli

et al. 2020

Sci Rep

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Gait impairments in persons with multiple sclerosis (pwMS) leading to decreased ambulation and reduced walking endurance remain poorly understood. our objective was to assess gait asymmetry (GA) and bilateral coordination of gait (BCG), among pwMS during the six-minute walk test (6MWT), and determine their association with disease severity. We recruited 92 pwMS (age: 46.6 ± 7.9; 83% females) with a range of clinical disability, who completed the 6MWT wearing gait analysis system. GA was assessed by comparing left and right swing times, and BcG was assessed by the phase coordination index (pci). Several functional and subjective gait assessments were performed. Results show that gait is more asymmetric and less coordinated as the disease progresses (p < 0.0001). Participants with mild MS showed significantly better BCG as reflected by lower PCI values in comparison to the other two MS severity groups (severe: p = 0.001, moderate: p = 0.02). GA and PCI also deteriorated significantly each minute during the 6MWT (p < 0.0001). GA and PCI (i.e., BCG) show weaker associations with clinical MS status than associations observed between functional and subjective gait assessments and MS status. Similar to other neurological cohorts, GA and pci may be important parameters to assess and target in interventions among pwMS. Multiple sclerosis (MS) is a degenerative, progressive, autoimmune disease of the central nervous system, often resulting in a continuous deterioration of walking 1. Hence, gait parameters, e.g. cadence, step-length, step-time, are impaired as compared to those measured in abled bodied individuals 1-4. This gait deterioration has been demonstrated as a decline in the ability to walk long distances, based on the 6-min or 500-m walk tests 5,6. One critical component of walking impairment is gait variability. Gait variability tends to change throughout the MS disease course, with greater variability in the higher levels of disability 7,8. Furthermore, gait variability is associated with increased fall risk 9. Human gait requires a high degree of symmetry and coordination. Gait asymmetry is associated with reduced walking velocity 10-12 and increased energy expenditure 13. Spinal cord injury is frequent in persons with multiple sclerosis (pwMS), noted in 83% by MRI and up to 99% at autopsy 14,15. Spinal cord injury is associated with lower extremity sensorimotor deficits and impaired ambulation. It was previously reported that walking velocity in pwMS was reduced when in vivo diffusion tensor imaging (DTI) of the cervical spinal cord reveals myelin and tissue injury within posterior columns (PC) and lateral corticospinal tracts (CST) 16. Since CST injury in pwMS is asymmetric 17 , we hypothesize that MS will be associated with increased gait asymmetry, since asymmetric lesions in the spinal white matter lesions have been shown to correspond to asymmetric motor function 18. Gait coordination is the ability to maintain a consistent phase-dependent cyclical relationship between different body segments or joints in...

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Section: Discussionmentioning

confidence: 99%

Gait asymmetry, and bilateral coordination of gait during a six-minute walk test in persons with multiple sclerosis

Plotnik

Wagner

Adusumilli

et al. 2020

Sci Rep

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“…While further studies are of course needed to fully validate this hypothesis, our results suggest that, in agreement with what is already reported for other neurological diseases, such as Parkinson's disease [53], the gait quality metrics extracted from the upper body accelerations should not be considered as a simple reflection of gait spatio-temporal features and might bring complementary informative content in quantifying patients' gait ability. Additionally, these metrics have been recently shown to be sensitive to fatigue and pathology progression in pwMS [72] and, as such, they are promising candidates for quantification of disease progression and rehabilitation interventions in these patients.…”

Section: Discussionmentioning

confidence: 99%

Is a Wearable Sensor-Based Characterisation of Gait Robust Enough to Overcome Differences Between Measurement Protocols? A Multi-Centric Pragmatic Study in Patients with Multiple Sclerosis

Angelini

Carpinella

Cattaneo

et al. 2019

Sensors

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Inertial measurement units (IMUs) allow accurate quantification of gait impairment of people with multiple sclerosis (pwMS). Nonetheless, it is not clear how IMU-based metrics might be influenced by pragmatic aspects associated with clinical translation of this approach, such as data collection settings and gait protocols. In this study, we hypothesised that these aspects do not significantly alter those characteristics of gait that are more related to quality and energetic efficiency and are quantifiable via acceleration related metrics, such as intensity, smoothness, stability, symmetry, and regularity. To test this hypothesis, we compared 33 IMU-based metrics extracted from data, retrospectively collected by two independent centres on two matched cohorts of pwMS. As a worst-case scenario, a walking test was performed in the two centres at a different speed along corridors of different lengths, using different IMU systems, which were also positioned differently. The results showed that the majority of the temporal metrics (9 out of 12) exhibited significant between-centre differences. Conversely, the between-centre differences in the gait quality metrics were small and comparable to those associated with a test-retest analysis under equivalent conditions. Therefore, the gait quality metrics are promising candidates for reliable multi-centric studies aiming at assessing rehabilitation interventions within a routine clinical context.

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“…Data processing was performed mostly using Matlab (10 papers, 35.7%, [38,41,[44][45][46]51,58,59,62,63]). Eight papers did not report the software used (28.6%, [37,39,40,48,53,56,60,64]), 4 papers used custom software (14.3%, [47,49,50,57]). The remaining 6 papers (21.4%, [42,43,52,54,55,61]) reported the use of other software.…”

Section: Parameters Extracted During the 6mwtmentioning

confidence: 99%

“…A summary of the outcome parameters with a brief description are shown in Table 4. Spatio-temporal Time between heel strike and toe-off [52] Stride time SD Spatio-temporal Stride time is defined as the time between two consecutive heel-strikes of the same foot [46,60] Stride time variability Spatio-temporal Stride time SD divided by mean stride time (%) [37,60] Swing time variability Spatio-temporal Swing time SD divided by mean swing time (%). Swing time is defined as the time interval between toe-off and the subsequent heel-strike of the same foot [37] Step length Spatio-temporal Number of steps between 2 consecutive U-turns divided by time taken [38] Stance ratio Spatio-temporal Percentage of the gait cycle during which the foot is in stance phase (%) [39] Load ratio Spatio-temporal Percentage of the stance corresponding to loading phase defined as the time between heel strike and toe strike (%) [39] Foot flat ratio Spatio-temporal Percentage of the stance corresponding to the foot-flat phase (%) [39] Push ratio Spatio-temporal Percentage of the stance corresponding to push phase defined as the time between heel off and toe off (%) [39] Symmetry of foot pitch angular velocity Spatio-temporal Pearson correlation coefficient (-) [39] Symmetry of foot pitch angular velocity Spatio-temporal Mean absolute difference between each left and right signal sample of cycle n divided by the mean range of the signals in the cycle (-) [39] Coefficient of stride cycle repetition Spatio-temporal Sum of positive autocorrelation coefficients of the three axes as a function of t (-) [39] Coefficient of step repetition Spatio-temporal…”

Section: Parameters Extracted During the 6mwtmentioning

confidence: 99%

Wearable Inertial Sensors to Assess Gait during the 6-Minute Walk Test: A Systematic Review

Storm

Cesareo

Reni

et al. 2020

Sensors

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Wearable sensors are becoming increasingly popular for complementing classical clinical assessments of gait deficits. The aim of this review is to examine the existing knowledge by systematically reviewing a large number of papers focusing on the use of wearable inertial sensors for the assessment of gait during the 6-minute walk test (6MWT), a widely recognized, simple, non-invasive, low-cost and reproducible exercise test. After a systematic search on PubMed and Scopus databases, two raters evaluated the quality of 28 full-text articles. Then, the available knowledge was summarized regarding study design, subjects enrolled (number of patients and pathological condition, if any, age, male/female ratio), sensor characteristics (type, number, sampling frequency, range) and body placement, 6MWT protocol and extracted parameters. Results were critically discussed to suggest future directions for the use of inertial sensor devices in the clinics.

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Deterioration of specific aspects of gait during the instrumented 6-min walk test among people with multiple sclerosis

Cited by 46 publications

References 38 publications

Gait asymmetry, and bilateral coordination of gait during a six-minute walk test in persons with multiple sclerosis

Gait asymmetry, and bilateral coordination of gait during a six-minute walk test in persons with multiple sclerosis

Is a Wearable Sensor-Based Characterisation of Gait Robust Enough to Overcome Differences Between Measurement Protocols? A Multi-Centric Pragmatic Study in Patients with Multiple Sclerosis

Wearable Inertial Sensors to Assess Gait during the 6-Minute Walk Test: A Systematic Review

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