Gait and balance impairment in early multiple sclerosis in the absence of clinical disability

Abstract

This study evaluated the gait and balance performance of two clinically distinct groups of recently diagnosed and minimally impaired multiple sclerosis (MS) patients (Expanded Disability Status Scale range 0-2.5), compared to control subjects. Ten MS patients with mild pyramidal signs (Pyramidal Functional Systems 1.0), 10 MS patients with no pyramidal signs (Pyramidal Functional Systems 0) and 20 age- and gender-matched control subjects were assessed using laboratory-based gait analysis and clinical balance measures. Both MS groups demonstrated reduced speed and stride length (P < 0.001), and prolonged double limb support (P <0.02), compared to the control group, along with alterations in the timing of ankle muscle activity, and the pattern of ankle motion during walking, which occurred independent of gait speed. The pyramidal MS group walked with reduced speed (P = 0.03) and stride length (P = 0.04), and prolonged double limb support (P =0.01), compared to the non-pyramidal group. Both MS groups demonstrated concomitant balance impairment, performing poorly on the Functional Reach Test compared to the control group (P <0.05). The identification of incipient gait and balance impairment in MS patients with recent disease onset suggests that motor function may begin to deteriorate in the early stages of the disease, even in the absence of clinical signs of pyramidal dysfunction.

Step-Length Variability in Minimally Disabled Women with Multiple Sclerosis or Clinically Isolated Syndrome

“…1,[7][8][9] In our study, velocities were not significantly different for the self-selected walking trials between participants with MS/CIS and controls. The discrepancy between our findings and those of previous studies may be partly explained by the instructions given to our participants.…”

“…Gait analysis has previously revealed other abnormal gait parameters in study samples in which participants had minimal abnormal neurologic findings, 7,8 but details concerning gait parameters involving MS study samples with normal neurologic examination results are surprisingly lacking. It remains to be determined if a particular gait parameter may be especially sensitive to subclinical disease activity and whether this could be easily recorded at a bedside assessment.…”

“…6 Gait analysis includes the measurement of the movement of the body in space (kinematics) and the forces involved in producing the movement (kinetics). Prior research investigating kinematic parameters of gait in MS has found decreased gait velocity, 1,7-11 cadence, step length, and stride length 1,[7][8][9] and increased time spent in the double limb support phase of the gait cycle. 1,6,8 Also reported are abnormalities in the joint angles of the hip, knee, and ankle 1,8,12 and kinetic abnormalities demonstrated by altered patterns of electromyography (EMG) activity during regular gait.…”

“…Prior research investigating kinematic parameters of gait in MS has found decreased gait velocity, 1,7-11 cadence, step length, and stride length 1,[7][8][9] and increased time spent in the double limb support phase of the gait cycle. 1,6,8 Also reported are abnormalities in the joint angles of the hip, knee, and ankle 1,8,12 and kinetic abnormalities demonstrated by altered patterns of electromyography (EMG) activity during regular gait. 1,8,13 Of the multitude of abnormal gait parameters reported in MS, those that are most reliable and sensitive to subtle, clinically meaningful change may be of greatest value.…”

“…1,6,8 Also reported are abnormalities in the joint angles of the hip, knee, and ankle 1,8,12 and kinetic abnormalities demonstrated by altered patterns of electromyography (EMG) activity during regular gait. 1,8,13 Of the multitude of abnormal gait parameters reported in MS, those that are most reliable and sensitive to subtle, clinically meaningful change may be of greatest value. Parameters related to gait variability may show promise in meeting these criteria.…”