Abstract
Gait impairments in persons with multiple sclerosis (pwMS) leading to decreased ambulation and reduced walking endurance remain poorly understood. Our objective was to assess gait asymmetry (GA) and bilateral coordination of gait (BCG), among pwMS during the six-minute walk test (6MWT), and determine their association with disease severity. We recruited 92 pwMS (age: 46.6 ± 7.9; 83% females) with a range of clinical disability, who completed the 6MWT wearing gait analysis system. GA was assessed by comparing left and right swing times, and BCG was assessed by the phase coordination index (PCI). Several functional and subjective gait assessments were performed. Results show that gait is more asymmetric and less coordinated as the disease progresses (p < 0.0001). Participants with mild MS showed significantly better BCG as reflected by lower PCI values in comparison to the other two MS severity groups (severe: p = 0.001, moderate: p = 0.02). GA and PCI also deteriorated significantly each minute during the 6MWT (p < 0.0001). GA and PCI (i.e., BCG) show weaker associations with clinical MS status than associations observed between functional and subjective gait assessments and MS status. Similar to other neurological cohorts, GA and PCI may be important parameters to assess and target in interventions among pwMS.
Highlights
Gait impairments in persons with multiple sclerosis leading to decreased ambulation and reduced walking endurance remain poorly understood
It was previously reported that walking velocity in persons with multiple sclerosis (pwMS) was reduced when in vivo diffusion tensor imaging (DTI) of the cervical spinal cord reveals myelin and tissue injury within posterior columns (PC) and lateral corticospinal tracts (CST)[16]
Since CST injury in pwMS is asymmetric[17], we hypothesize that Multiple sclerosis (MS) will be associated with increased gait asymmetry, since asymmetric lesions in the spinal white matter lesions have been shown to correspond to asymmetric motor function[18]
Summary
Gait impairments in persons with multiple sclerosis (pwMS) leading to decreased ambulation and reduced walking endurance remain poorly understood. Our objective was to assess gait asymmetry (GA) and bilateral coordination of gait (BCG), among pwMS during the six-minute walk test (6MWT), and determine their association with disease severity. Gait parameters, e.g. cadence, step-length, step-time, are impaired as compared to those measured in abled bodied individuals[1,2,3,4] This gait deterioration has been demonstrated as a decline in the ability to walk long distances, based on the 6-min or 500-m walk tests[5,6]. The control of right-left stepping, or bilateral coordination of gait (BCG), is hypothesized to be mediated by central pattern generators (CPGs) within lumbrosacral spinal locomotor c enters[13]. It is hypothesized that MS is characterized by impaired BCG
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