Ankle Kinematics and Temporal Gait Characteristics over the Duration of a 6-Minute Walk Test in People with Multiple Sclerosis Who Experience Foot Drop.

Marietta L Van Der Linden,Judy Scopes,Thomas H Mercer,Georgia Andreopoulou,Julie E Hooper

doi:10.1155/2018/1260852

Marietta L Van Der Linden, Judy Scopes + Show 3 more

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https://doi.org/10.1155/2018/1260852

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Abstract

Foot drop is a common gait impairment in people with MS (pwMS) but in some foot drop may only occur after a period of prolonged walking and may be a sign of motor fatigability. The purpose of the study was to explore whether, for pwMS, an adapted six-minute walk test (6minWT) would result in an increase in foot drop as measured using electrogoniometry. Sagittal ankle kinematics were recorded for fifteen participants (10 females and 5 males, aged 37-64) with MS (EDSS 4-6) throughout the 6minWT. Ankle kinematics and temporal stride parameters were compared between the first and last 10 gait cycles of the 6minWT. Peak dorsiflexion in swing was significantly reduced at the end of the 6minWT compared to the start, with six of the fifteen participants having a decrease of two degrees or more. Statistically significant changes in temporal stride parameters suggested a decrease in walking speed. Our results suggest that with the protocol used in this study it is feasible to identify patients who experience increased foot drop as a result of a prolonged exercise task.

Highlights

Multiple sclerosis (MS) is an autoimmune disease characterized by inflammation and progressive destruction of the central nervous system (CNS)
The aim of the present study was to investigate whether an adapted 6-minute walking test (6minWT) protocol would result in a decrease in ankle dorsiflexion as an outcome of motor fatigability in people with MS (pwMS) with clinically diagnosed foot drop
We found an average decrease in dorsiflexion of 1.5 degrees which was statistically significant and that 6 of the 15 participants showed a clinically significant decrease of 2 degrees or more

Summary

Introduction

Multiple sclerosis (MS) is an autoimmune disease characterized by inflammation and progressive destruction of the central nervous system (CNS). Heesen et al [3] reported that gait function was most frequently rated as the most important domain by people with MS (pwMS) Both the prevalence and severity of gait impairments have been found to correlate with the duration of the disease, some studies have identified walking characteristics that are affected in people with mild MS [4, 5]. In pwMS foot drop may be a sign of increased motor fatigability [7] In this case, foot drop may not manifest itself when the patient is performing a short walk test (e.g., 10 meters) in the clinic but will only occur after a certain period of prolonged walking the duration of which varies among individuals. In a qualitative study on the experiences of assistive technology (Functional Electrical Stimulation and Ankle Foot Orthosis) to treat foot drop, some participants commented that they only used these when going out for longer walks [8]

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