Gait Initiation in Multiple Sclerosis

Abstract

Individuals with multiple sclerosis (MS) often have poor balance control that is especially apparent during dynamic tasks such as gait initiation (GI). The purpose of this study was to investigate how balance symptoms due to MS alter spatiotemporal variables, coordination, and temporal margins within the stability boundary during gait initiation. Twelve women with MS (Expanded Disability Status Scale [EDSS] mean = 4.0, SD = 1.4) and 12 women without MS (control group) initiated gait at their preferred speed. MS participants attained a slower anterior velocity because of smaller anterior center of mass displacements and took longer to complete the initiation of gait than the control group. MS participants exhibited a smaller posterior shift in center of pressure during GI and stepped with a longer dual support time than the control group. However, these changes may be due to differences in initiation velocity. Relative timing analysis showed invariance in postural and locomotor phases of gait initiation between groups. The MS group showed different coordination between anterior-posterior and medio-lateral center of pressure components while increasing temporal margins to the posterior and lateral stability boundaries in comparison with the control group. Overall, during gait initiation at their preferred speed the MS participants adopted a functional strategy that produces lower speed and reduced proximity to the stability boundaries prior to stepping.

Postural Control in Multiple Sclerosis: Implications for Fall Prevention

“…In addition, Karst et al [5] found that people with MS had a significantly reduced center of pressure displacement during voluntary leaning and reaching. Consistent with the finding that people with MS can lean less far when standing, it was reported recently that during gait initiation, when one needs to lean forward to displace one's center of mass anteriorly, people with MS displace their center of mass less far and less quickly and get less close to their stability boundaries [18].…”

“…When trying to reach or step, people with MS move less far and less quickly than healthy controls [2,5,11,17,18]. Martin et al [11] found that people with MS had significantly reduced functional reach distance when standing compared with controls.…”

“…Many studies have also found that people with MS walk more slowly [11,15,18,[22][23][24][25][26][27][28], take shorter steps (decreased step length) [11,22,23,25,28], step more slowly (decreased cadence) [23,25,26,28], have less joint motion during gait [11,22,25,27], and demonstrate more variability in most gait parameters [27] than healthy controls. In addition, people with MS slow down more and demonstrate more swing time variability when they walk while performing a cognitive task than do healthy controls, suggesting that they need to devote greater cognitive reserve to walking than do people without MS [29•].…”

Gait Abnormalities in Multiple Sclerosis: Pathogenesis, Evaluation, and Advances in Treatment

“…This method provides detailed quantitative measures of kinematic, kinetic, and spatiotemporal parameters of gait and can thus provide information about the mechanisms underlying the gait dysfunction as well as precise spatiotemporal data. This type of gait analysis can be used to identify subtle gait impairments [4] and abnormal postural control strategies [8] not captured by other methods of gait analysis. Because performing 3-D gait analysis requires specialized expensive equipment, is time consuming, and requires highly trained and experienced personnel, this method of gait analysis can be a valuable research tool but it has a limited role in clinical practice.…”

“…Studies show that people with MS have a range of gait abnormalities including decreased step length [3•, 4], decreased cadence [3•, 5], reduced joint motion [4,6,7], and more variability of most gait parameters [7] compared with healthy controls. These abnormalities result in reduced gait speed [3,[5][6][7][8], reduced walking endurance [9], an increased metabolic cost of walking [10], and reduced community mobility [11]. Furthermore, people with MS reduce their walking speed and increase the variability of their gait when they walk while performing a cognitive task more than healthy controls [12], suggesting that they need to devote greater cognitive reserve to walking than do people without MS.…”