Quantitative Changes in Gait Parameters after Cycling among Multiple Sclerosis Patients withAtaxia:APilot Study

Abstract

Introduction: Cerebellar ataxia is a common symptom of multiple sclerosis (MS), particularly in progressive forms, where gait and balance problems are the most debilitating symptoms. Exercise training is a critical component of rehabilitation in managing equilibrium dysfunction, and stationary bicycling is a safe, feasible, and effective method to reduce the symptom. Clinical walking performance tests are typically used to assess gait in these patients. However, gait analysis technologies are more sensitive and accurate at detecting subtle and subclinical changes. The purpose of this study was to determine the changes in gait parameters in MS patients with ataxic gait after using a stationary bicycle.
 Materials and Methods: Ten secondary progressive MS patients with ataxic gait and a mean expanded disability status scale (EDSS) of four were recruited. The participants cycled on a stationary bike. Gait analysis was performed before and after 12 sessions of cycling. It included spatiotemporal and balance parameter measurements.
 Results: Gait analysis showed statistically significant changes in spatiotemporal parameters, including speed (P=0.02, r=-0.51), and stride length (P=0.01, r=-0.63). Of balance-related indices, the mediolateral (ML) center of pressure (COP) displacement, anterior and posterior COP overshoot, and COP velocity changes were statistically remarkable after the intervention respectively. (P=0.01, r=-0.63), (P=0.02, r=-0.51), (P=0.03, r=-0.49), (P=0.01, r=-0.54).
 Conclusion: Gait analysis is applicable to track changes following rehabilitation in individuals with MS. The results indicate that using a stationary bicycle can improve some spatiotemporal and COP-related parameters.

Rehabilitation on cerebellar ataxic patients with multiple sclerosis: A systematic review

“…There were a total 6 non‐pharmacological interventional studies regarding the rehabilitation of CerA in MS patients (Ali et al, 2020; Keser et al, 2013; Klatt et al, 2019; Rahimibarghani et al, 2022; Salcı et al, 2017; Scheidler et al, 2018). Of those 3 were RCTs and the interventions included two task‐oriented training (TT) protocols (physiotherapy exercises based on mundane kinematic individual actions in order to perform those more efficiently) (Ali et al, 2020; Salcı et al, 2017) and a functional rehabilitation training approach (Scheidler et al, 2018).…”

“…Of those 3 were RCTs and the interventions included two task‐oriented training (TT) protocols (physiotherapy exercises based on mundane kinematic individual actions in order to perform those more efficiently) (Ali et al, 2020; Salcı et al, 2017) and a functional rehabilitation training approach (Scheidler et al, 2018). The remaining 3 were pilot studies, with a sample size range between 10 and 20 participants and included a combination of NDT‐Bobath and conventional physiotherapy protocol (Keser et al, 2013), a robotic and visual biofeedback reeducation protocol (Klatt et al, 2019) and a functional rehabilitation technique (Rahimibarghani et al, 2022) (Table 1). A total of 145 MS patients were included in all 6 studies.…”

“…Rahimibarghani and colleagues (Rahimibarghani et al, 2022) investigated, in a pilot study, the effects of cycling on gait parameters on 10 Secondary Progressive MS (SPMS) patients with CerA. Statistical analysis revealed significant gait improvement regarding stability, speed and stride length ( p < .001).…”

“…The diagnostic criteria used ranged from 2001(Keser et al, 2013) to 2010 (The periodic health examination, 1979). Given the fact that the MS diagnostic criteria have evolved, throughout the years, to become more sensitive and time efficient, the use of outdated ones automatically makes the MS patients stratified diagnostically heterogeneous and incomparable(McDonald et al, 2001;Polman et al, 2011).In addition, in 3 studies(Klatt et al, 2019;Rahimibarghani et al, 2022;Salcı et al, 2017) there were no MS diagnostic criteria were applied and the sample stratification was performed based on a biased neurological examination or on the EDSS score. Finally, none of the pilot studies has provided any data on a future RCT study and there was no follow-up data in any of the study protocols included.…”