Spatial and temporal characteristics of gait as outcome measures in multiple sclerosis (EDSS 0 to 6.5)

Abstract

BackgroundGait impairment represents one of the most common and disabling symptom of multiple sclerosis. Quantification of the gait is an important aspect of clinical trials. In order to identify which temporal or spatial parameters of gait could be used as outcome measures in interventional studies of patients with different levels of disability, we evaluated characteristics of these parameters in MS patients across the whole spectrum of mobility from EDSS 0 to 6.5.MethodsThis is a cross-sectional study of spatial and temporal parameters of gait at self selected speed and at fast speed of walking in 284 patients with multiple sclerosis (108 men, mean age 38 years ± SD 10.8 years, range 18–64) divided into seven levels of disability (EDSS 0 to 1.5, EDSS 2.0 to 2.5, EDSS 3.0 to 3.5, EDSS 4.0 to 4.5, EDSS 5.0 to 5.5, EDSS 6.0, EDSS 6.5).ResultsThe velocity of gait decreases with increasing EDSS levels. Hovewer, the spatio-temporal parameters of gait that are involved in this process differ across the EDSS levels. The step length is decreased at higher EDSS levels up to the EDSS 6.0, but was not different between EDSS 6.0 and 6.5. The step time is significantly longer at EDSS 6.0 and 6.5, while the step length remains the same at those levels. The increase in percentage of double support time becomes statistically significant at EDSS 3.0-3.5 and continues to increase until EDSS 6.5. Variability of step time, step length or step width did not show significant difference between studied EDSS levels.ConclusionsThere is no single spatio-temporal parameter of gait (other than velocity of gait) that would show significant differences among all levels of EDSS. The step length reflects shortening of steps at lower EDSS levels (2.0 to 6.0), and percentage of double support time better reflects changes at higher EDSS levels 3.0 – 6.5. Gait variability is not associated with disability in MS and therefore would not be a suitable outcome measure. These observations have to be considered when designing gait experiments with temporal and spatial parameters of gait as outcomes.

Gait characteristics according to pyramidal, sensory and cerebellar EDSS subcategories in people with multiple sclerosis

“…Numerous studies have examined gait characteristics in PwMS [3][4][5][6] confirming that PwMS walk slower with decreased stride lengths [3,4], reduced knee and ankle motion [5] and elevated variability [6] compared to healthy controls. Research studies have also established that gait parameters change throughout the disease process.…”

“…Lizrova- Preiningerova et al (2015) in a cohort of 284 PwMS reported that velocity of gait and step lengths decrease with increasing neurological disability levels [3]. Gait deterioration in MS is generally explained as a consequence of variable neurological deficits such as motor weakness, spasticity, ataxia and sensory disturbance [7,8].…”

Are Modular Activations Altered in Lower Limb Muscles of Persons with Multiple Sclerosis during Walking? Evidence from Muscle Synergies and Biomechanical Analysis

“…The resulting impairments can be relative muscle weakness, sensory deficits, spasticity, and fatigue interfering with different aspects of the walking function such as endurance, muscle coordination, and balance with negative impact on activities of daily living (Cattaneo et al, 2014; Frank and Larimore, 2015; Michailidou et al, 2015). Despite the high prevalence of gait disorder in PwMS, there are relatively few reports describing gait parameters and overall these studies have reported slower walking with shorter stride length and prolonged double support phase, independently of their walking speed (Benedetti et al, 1999; Martin et al, 2006; Givon et al, 2009; Cameron and Wagner, 2011; Kasser et al, 2011; Remelius et al, 2012; Lizrova Preiningerova et al, 2015). It has been suggested that these alterations from speed-matched normative values of healthy persons are part of protective strategies used by PwMS to reduce the risk of falling while walking.…”

Orthotic and therapeutic effect of functional electrical stimulation on fatigue induced gait patterns in people with multiple sclerosis

“…The gait of people with MS compared to healthy individuals is characterised by reduced walking speed [2][3][4][5][6][7], which may be due to decreases in cadence [4,7],stride length [2,3,7] or step length [4,5,7]. Walking speed has been shown to progressively decrease with disease severity in part due to concomitant decreases in step length [8]. Reduced walking speed is also likely a strategy to counter impaired balance, which is common in people with MS [9], by prolonging periods of double support during stance [2,3,7].…”