Abstract
Gait deficit is a hallmark of multiple sclerosis (MS) and the walking capacity can be improved with rehabilitation. Technological advances in biomechanics offer opportunities to assess the effects of rehabilitation objectively. Here we employed wearable sensors to measure electromyography (EMG) and body acceleration during walking and to evaluate the changes in walking pattern after rehabilitation. Forty patients with MS (PwMS, mean EDSS: 5.51 ± 1) were enrolled. Ten-meter-walking-test (10MWT) were performed before and after rehabilitation. Clinical symptoms were assessed with self-reported questionnaires. An accelerator attached on the waist and 8 electrodes (BTS bioengineering, Italy) attached on bilateral thighs (Rectus and Biceps Femoris, RF-BF) and legs (Tibialis anterior and gastrocnemius, TA-GM) for measuring body acceleration and EMG recording. Time, cadence (pace/minutes), step-length and coactivation index(CoI) between antagonistic pairs pre- and post-rehabilitation were calculated on more and less affected side (MA/LA) for statistics. The time (p < 0.001) and cadence (p = 0.01) of 10MWT were significantly improved after rehabilitation. Though not statistically significant, CoI of RF-BF reduced in both sides post treatment (MA pre: 22.51 ± 10.10 v.s. post: 18.72 ± 7.14; LA pre: 20.35 ± 7.34 v.s. post: 17.45 ± 4.64). Further, reduced CoI of RF-BF pair on MA side correlated with less walking time in 10MWT (r = 0.43), while the reduction on LA sides correlated with less fatigue (r = 0.38, fatigue evaluated with Fatigue Severity Scale). Our results showed that the improvements of walking capacity after rehabilitation in PwMS may be related to reduced coactivation of the distal muscle. Combining objective assessments of EMG and accelerators allows us to better evaluate the effects of rehabilitation of gait and may benefit in future personalized rehabilitation program.
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