Persons With Multiple Sclerosis Research Articles

Is diet associated with physical capacity and fatigue in persons with multiple sclerosis? –Results from a pilot study

BackgroundDiet may have immunomodulatory effects in persons with multiple sclerosis (PwMS) and studies suggest that diet may be considered a complementary treatment to control the progression of the disease. The role of nutrition in MS and related symptoms have been reported by several studies but remains controversial. ObjectiveTo explore the association between dietary intake and physical capacity and fatigue in PwMS. MethodsAn explorative cross-sectional pilot study was conducted, in which 23 ambulatory PwMS were enrolled. Dietary intake was assessed using a 4-day food record. Outcome variables included a 6-Minute Walk Test (6MWT), a VO2max test, and self-reported questionnaires assessing fatigue severity (Fatigue Severity Scale, FSS) and impact (Modified Fatigue Impact Scale, MFIS). Associations between variables were determined using simple and multiple regression analyses. ResultsIn the simple but not the multiple (adjusted for sex and age) regression analyses the carbohydrate intake (% of total energy intake) was positively associated with physical capacity (i.e. the 6MWT and VO2max test), whereas fat intake (% of total energy intake) was inversely associated with physical capacity. In the multiple regression analyses the absolute intake of ω-3 and vitamin D showed trends towards a positive association with the MFIS physical subscale and VO2max, respectively. ConclusionAlthough not consistent across analyses, these findings suggest that better physical capacity most often is associated with a diet rich in carbohydrates and reduced fat content. Further research and randomized controlled trials are required to fully assess the role and the efficacy of diet quality and content on physical capacity in PwMS.

Pain-related illness intrusiveness is associated with lower activity engagement among persons with multiple sclerosis

BackgroundPain can interfere with the daily functioning of persons with multiple sclerosis (PwMS). Furthermore, beliefs about pain and activity engagement are reliably associated with persons’ experience of chronic pain. This study aimed to explore the extent to which different aspects of PwMS’ activity engagement is related to pain-related illness intrusiveness, and whether certain coping and support systems mediate that relationship. MethodsParticipants (N = 161) were PwMS with at least mild pain who were recruited electronically through the North American Research Committee on MS (NARCOMS). Pain-related illness intrusiveness was measured using a modified version of the Illness Intrusiveness Ratings Scale (IIRS). Activity engagement was assessed with Section III of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Correlations analyses were followed by multiple hierarchical regressions, with disability and depression symptom severity as covariates. Exploratory mediation analyses were then conducted with the subscales of the MS Resiliency Scale (MSRS). ResultsPain-related illness intrusiveness was significant correlated with activities away from home (r = −0.37, p < .001), social activities (r = −0.26, p = .001), and household chores (r = −0.16, p < 0.05). After controlling for covariates, pain-related illness intrusiveness exclusively remained a significant predictor of activities away from home. Coping strategies from MSRS mediated the effect of pain-related illness intrusiveness on activities away from home (b = −0.01, p < .05), which represents a relatively small effect (R2med = 0.07). ConclusionsThese findings highlight the influence that PwMS’ pain experience can have on engagement in activities away from home and the indirect effects of positive coping strategies on that relationship.

Associations Among Sensory Processing Patterns, Trait Anxiety, and Physical Quality of Life in Multiple Sclerosis

(1) To identify associations among sensory processing patterns, trait anxiety, and physical quality of life (QOL) among persons with multiple sclerosis (PwMS). (2) To identify whether sensory processing patterns predict physical QOL after controlling for demographics, disability, and trait anxiety.

Serum neurofilament light chain level associations with clinical and cognitive performance in multiple sclerosis: A longitudinal retrospective 5-year study

Background: A limited number of studies investigated associations between serum neurofilament light chain (sNfL) and cognition in persons with multiple sclerosis (PwMS). Objective: To assess cross-sectional and longitudinal associations between sNfL levels, clinical, and cognitive performance in PwMS and age-matched healthy controls (HCs). Materials: One hundred twenty-seven PwMS (85 relapsing–remitting MS/42 progressive MS), 20 clinically isolated syndrome patients, and 52 HCs were followed for 5 years. sNfL levels were measured using the single-molecule array (Simoa) assay and quantified in picograms per milliliter. Expanded Disability Status Scale (EDSS), walking, and manual dexterity tests were obtained. At follow-up, Brief International Cognitive Assessment for MS (BICAMS) was utilized. Cognitively impaired (CI) status was derived using HC-based z-scores. Age-, sex-, and education-adjusted analysis of covariance (ANCOVA) and regression models were used. Multiple comparison–adjusted values of q < 0.05 were considered significant. Results: In PwMS, sNfL levels were cross-sectionally associated with walking speed (r = 0.235, q = 0.036), manual dexterity (r = 0.337, q = 0.002), and cognitive processing speed (CPS; r =−0.265, q = 0.012). Baseline sNfL levels predicted 5-year EDSS scores (r = 0.25, q = 0.012), dexterity (r = 0.224, q = 0.033), and CPS (r =−0.205, q = 0.049). CI patients had higher sNfL levels (27.2 vs. 20.6, p = 0.016) and greater absolute longitudinal sNfL increase when compared with non-CI patients (4.8 vs. 0.7, p = 0.04). Conclusion: Higher sNfL levels are associated with poorer current and future clinical and cognitive performance.

Demographic, Disease, and Clinical Factors Related to Pain Catastrophizing Among Persons with Multiple Sclerosis

Pain catastrophizing, a maladaptive cognitive approach to the experience of chronic pain characterized by rumination, magnification, and helplessness, has been found to be highly predictive of poor physical and emotional functioning. This study aimed to characterize pain catastrophizing among persons with multiple sclerosis (PwMS) and explore its relationships with demographic, disease-related, and clinical variables.

Decrease in Secondary Neck Vessels in Multiple Sclerosis: A 5-year Longitudinal Magnetic Resonance Angiography Study.

Studies have previously shown greater arterial and venous extracranial vascular changes in persons with multiple sclerosis (PwMS) when compared to healthy controls (HCs). To determine the change in the number and size of secondary neck vessels in PwMS and HCs over a 5-year follow-up period. Both at baseline and follow-up, 83 PwMS and 25 HCs underwent magnetic resonance angiography (MRA) imaging and analysis. The number and cross-sectional area (CSA) of all secondary neck vessels (excluding the common/internal carotid, vertebral artery, and internal jugular vein) measured at levels from C2-T1 were determined by semi-automated edge detection/ contouring software. The longitudinal change in the number and CSA of the secondary neck vessels from the PwMS and HCs were analyzed by non-parametric Wilcoxon repeated measure. Benjamini-Hochberg procedure adjusted for false discovery rate (FDR). For over 5 years, PwMS demonstrated a consistent longitudinal decrease in both the number of secondary neck vessels (Z-change between -3.3 and -5.4, q=0.001) and their CSA (Zchange between -2.9 and -5.2, q=0.004). On the contrary, the HCs did not demonstrate a significant longitudinal change in secondary neck vessels over the follow-up period. Due to the longitudinal decrease, the PwMS showed a lower number of secondary neck vessels when compared to HCs measured at follow-up (p<0.029, except for C4 with trending p=0.071). The PwMS changes were also corroborated within each MS phenotype. PwMS demonstrate a significant mid-term decrease in the number and the size of the secondary neck vessels. The clinical relevance of these findings and the effect on intracranial blood flow are currently unknown.

Lipoprotein(a) Levels Are Associated with the Size of Extracranial Arteries in Multiple Sclerosis

Background: Hyperlipidemia is associated with worse clinical and radiological outcomes in persons with multiple sclerosis (PwMS) and studies show greater MS extracranial arterial vessel pathology. Objective: The aim of this study was to determine the effect of lipid profile measures on extracranial arterial vessels in PwMS and healthy controls (HCs). Methods: Non-contrast magnetic resonance angiography was conducted on 104 PwMS and 41 HCs. The cross-sectional area (CSA) of the common carotid artery (CCA) and vertebral artery (VA) was measured using a semi-automated edge-detection/contouring method at cervical levels C4-C7. The lipid profile was obtained at the time of the scan. Repeated measures analyses adjusted for age, gender, and body mass index were used. Results: In PwMS, age was associated with CCA CSA (F = 7.65, η² = 0.083, p = 0.007) and lipoprotein(a) [Lp(a)] with VA CSA (F = 13.4, η² = 0.13, p < 0.001). These associations were not present in HCs. PwMS with Lp(a) ≥30 and ≥50 mg/dL, and within the highest Lp(a) quartile had significantly larger CCA and VA when compared to those with lower Lp(a) threshold values. Total cholesterol and low- and high-density lipoprotein cholesterol were not associated with CCA or VA CSA. Conclusions: Lp(a) levels are associated with CSA of major extracranial arterial vessels in PwMS but not in HCs. The clinical and pathological significance of these associations, if any, remains unknown.

Next Steps in Wearable Technology and Community Ambulation in Multiple Sclerosis.

Walking impairments are highly prevalent in persons with multiple sclerosis (PwMS) and are associated with reduced quality of life. Walking is traditionally quantified with various measures, including patient self-reports, clinical rating scales, performance measures, and advanced lab-based movement analysis techniques. Yet, the majority of these measures do not fully characterize walking (i.e., gait quality) nor adequately reflect walking in the real world (i.e., community ambulation) and have limited timescale (only measure walking at a single point in time). We discuss the potential of wearable sensors to provide sensitive, objective, and easy-to-use assessment of community ambulation in PwMS. Wearable technology has the ability to measure all aspects of gait in PwMS yet is under-studied in comparison with other populations (e.g., older adults). Within the studies focusing on PwMS, half that measure pace collected free-living data, while only one study explored gait variability in free-living conditions. No studies explore gait asymmetry or complexity in free-living conditions. Wearable technology has the ability to provide objective, comprehensive, and sensitive measures of gait in PwMS. Future research should investigate this technology's ability to accurately assess free-living measures of gait quality, specifically gait asymmetry and complexity.

Evaluation of Power Production Asymmetry during Cycling in Persons with Multiple Sclerosis.

Lower limb asymmetries have been observed in persons with multiple sclerosis (PwMS), and have been associated with mobility impairment. An incremental cycling test was performed on a cycle ergometer to determine peak power output (PPO) and peak oxygen consumption (VO2peak). Then, participants cycled at 50%, 60%, and 70% of their PPO to assess the contribution of each lower limb to power production. Two-way repeated measures ANOVA was used to detect group × intensity differences in power production asymmetry. Eight PwMS and six healthy individuals (Non-MS) completed the study. No statistically significant (p > 0.05) group × intensity interactions or main effects were present when examining between-limb differences in power production. The current data do not indicate a statistically significant difference in power production asymmetry between groups and exercise intensities. Previous research has established a 10% difference between contralateral limbs as a threshold for asymmetry. The average asymmetry in power production in PwMS exceeded the 10% threshold at all measured outputs, suggesting the presence of asymmetry in power production.

Serum neurofilament light chain levels associations with gray matter pathology: a 5-year longitudinal study.

BackgroundGray matter (GM) pathology is closely associated with physical and cognitive impairment in persons with multiple sclerosis (PwMS). Similarly, serum neurofilament light chain (sNfL) levels are related to MS disease activity and progression.ObjectivesTo assess the cross–sectional and longitudinal associations between sNfL and MRI–derived lesion and brain volume outcomes in PwMS and age–matched healthy controls (HCs).Materials and MethodsForty‐seven HCs and 120 PwMS were followed over 5 years. All subjects underwent baseline and follow–up 3T MRI and sNfL examinations. Lesion volumes (LV) and global, tissue–specific and regional brain volumes were assessed. sNfL levels were analyzed using single molecule array (Simoa) assay and quantified in pg/mL. The associations between sNfL levels and MRI outcomes were investigated using regression analyses adjusted for age, sex, baseline disease modifying treatment (DMT) use and change in DMT over the follow‐up. False discovery rate (FDR)–adjusted q‐values <0.05 were considered significant.ResultsIn PwMS, baseline sNfL was associated with baseline T1‐, T2‐ and gadolinium‐LV (q = 0.002, q = 0.001 and q < 0.001, respectively), but not with their longitudinal changes. Higher baseline sNfL levels were associated with lower baseline deep GM (β = −0.257, q = 0.017), thalamus (β = −0.216, q = 0.0017), caudate (β = −0.263, q = 0.014) and hippocampus (β = −0.267, q = 0.015) volumes. Baseline sNfL was associated with longitudinal decline of deep GM (β = −0.386, q < 0.001), putamen (β = −0.395, q < 0.001), whole brain (β = −0.356, q = 0.002), thalamus (β = −0.272, q = 0.049), globus pallidus (β = −0.284, q = 0.017), and GM (β = −0.264, q = 0.042) volumes. No associations between sNfL and MRI–derived measures were seen in the HCs.ConclusionHigher sNfL levels were associated with baseline LVs and greater development of GM atrophy in PwMS.

"I battle pain every single day": Pain-related illness intrusiveness among persons with multiple sclerosis.

Pain has been identified as a highly prevalent and common correlate of physical and emotional dysfunction among persons with multiple sclerosis (PwMS). Yet, it remains unknown how PwMS experience the intrusiveness of pain relative to other challenges associated with living with MS. This study aimed to determine the extent to which PwMS experience pain as a particularly intrusive problem among the totality of their experience of MS-related challenges and to examine how cognitive and affective factors, including resiliency, are associated with PwMS's pain-related illness intrusiveness. Participants (N = 161) were PwMS with at least mild pain who were recruited through the North American Research Committee on Multiple Sclerosis Registry for this cross-sectional study. Participants completed the Illness Intrusiveness Ratings Scale twice regarding their (a) MS and (b) pain. Multiple regression analyses were run to evaluate the relationship between MS- and pain-related illness intrusiveness, as well as the cognitive and affective predictors of the latter. Controlling for level of disease severity, pain-related illness intrusiveness was a significant predictor of MS-related illness intrusiveness (p < .001). Depressive symptom severity was the strongest predictor of pain-related illness intrusiveness (p < .001), followed by pain catastrophizing (p < .001). The relationship between pain-related illness intrusiveness and pain catastrophizing was mediated (med) by coping strategies (Rmed2 = .15) and support from family and friends (Rmed2 = .07), with the latter mediating pain-related illness intrusiveness's relationship with depressive symptom severity (Rmed2 = .10). (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Continuous 12 min walking to music, metronomes and in silence: Auditory-motor coupling and its effects on perceived fatigue, motivation and gait in persons with multiple sclerosis

BackgroundIn Persons with Multiple Sclerosis (PwMS), coupling walking to beats/pulses in short bursts is reported to be beneficial for cadence and perceived fatigue. However it is yet to be investigated if coupling and its effects can be sustained for longer durations, required for task-oriented training strategy in PwMS. AimsTo investigate if PwMS compared to healthy controls (HC) sustain synchronization for 12 min when walking to music and metronome, and its effects on perceived physical and cognitive fatigue, motivation and gait compared to walking in silence. MethodsParticipants walked for 12 min in three conditions (music, metronome and silence). The tempo of the auditory conditions was individualized. Auditory-motor coupling and spatio-temporal gait parameters were measured during walking. The visual analogue scale was used for perceived fatigue, and the Likert scale for motivation. Results27 PwMS and 28 HC participated. All participants synchronized to both stimuli, yet PwMS synchronized better to music. Overall, participants had lower cadence, speed and stride length when over time all conditions, with an exception of HC, with increasing cadence during the music condition. PwMS perceived less cognitive fatigue, no difference in perceived physical fatigue and a higher motivation walking to music compared to metronomes and silence. Conclusion12 min of uninterrupted walking was possible in PwMS in all conditions, while better synchronization, low perception of cognitive fatigue and high motivation occurred with music compared to other conditions. Coupling walking to music could offer novel paradigms for motor task-oriented training in PwMS.

Effects Of A Cooling Vest On Dual-task Performance And Fatigability In Persons With Multiple Sclerosis

Fatigue and heat sensitivity are commonly reported symptoms in persons with multiple sclerosis (PwMS). PwMS also often have difficulty performing concurrent cognitive and motor tasks that presents as a dual-task decrement. Heat sensitivity along with a dual-task decrement may hinder activities of daily living and quality of life for PwMS. Though using a cooling vest could help decrease heat sensitivity, it is currently unknown if it improves dual-tasking performance in PwMS. PURPOSE: To examine the effects of a cooling vest on cognitive-motor dual-task cost (DTC) and fatigability in PwMS. METHODS: 5 PwMS participated in two sessions that were at least 1 week apart. During one session participants wore a sham cooling vest and the other session an actual cooling vest. During each session participants completed a Timed 25-Foot Walk Test (T25FWT), 6 Minute Walk Test (6MWT), T25FWT while performing Serial 3’s, and a 6MWT while narrating a story. The type of vest and order of tests was randomized for each participant. Total times for T25FWT and total distances for 6MWT were recorded. DTC, defined as the percent change between single- and dual-task performance, was calculated. Fatigability, defined as the difference between the averages of the first two and the last two lap times of the 6MWT, was calculated. Paired samples t-tests were used to compare DTC during cooling and non-cooling sessions and fatigability during single- and dual-task conditions within each session. RESULTS: The mean DTC during the 6MWT for cooling and non-cooling was -4.1% and -6.5%, respectively. The DTC during the T25FWT for cooling was 7.3% and 11.5% for non-cooling. The mean distance walked during 6MWT dual-task increased from 275.5m without cooling to 285.6m with cooling. There was a trend towards significant difference between single- and dual-task fatigability during 6MWT for non-cooling session (Single: 1.6±7.6m; Dual: 6.2±5.3m; p=.051), but not for cooling session (Single: 0.7±3.8m; Dual: 12±16.4m; p=.082). CONCLUSION: Preliminary results with lower DTC and no significant difference between single- and dual-task fatigability when using a cooling vest suggests that a cooling vest may have a benefit PwMS while dual-tasking during endurance activities. Further research with a larger sample size is needed to confirm these findings.

Altered visual and somatosensory feedback affects gait stability in persons with multiple sclerosis

Persons with multiple sclerosis (PwMS) often report problems due to sensory loss and have an inability to appropriately reweight sensory information. Both of these issues can affect individual’s ability to maintain stability when walking under challenging conditions. The purpose of the current study was to determine how gait stability is adapted when walking under challenging sensory conditions where vision and somatosensation at the feet is manipulated. 25 healthy adults and 40 PwMS (15 fallers, 25 non-fallers) walked on a treadmill at their preferred normal walking speed under 3 conditions: normal walking, altered vision using goggles that shifted visual field laterally, and altered somatosensation using shoes with compliant foam soles. Inertial measurement united recorded acceleration at the lumbar and right ankle, and acceleration variability measures were calculated including root mean square (RMS), range, sample entropy (SaEn), and Lyapunov exponents (LyE). A gait stability index (GSI) was calculated using each of the four variability measures as the ratio of lumbar acceleration variability divided by foot acceleration variability in the frontal and sagittal planes. The sagittal and frontal GSIRMS were larger in the somatosensory condition compared to the normal and visual conditions (p < 0.001). The frontal GSISaEn was greater in the visual condition compared to the somatosensory condition (p = 0.021). The frontal and sagittal GSILyE was greater in the somatosensory condition compared to the normal and visual conditions (p < 0.002). The current study showed that HC, MS non-fallers and MS fallers largely adapted to altered sensory feedback during walking in a similar manner. However, MS faller subjects may be more reliant on visual feedback compared to MS non-fallers and HC subjects.

Walking to Music and Metronome at Various Tempi in Persons With Multiple Sclerosis: A Basis for Rehabilitation

Background. Mobility dysfunctions are prevalent in persons with multiple sclerosis (PwMS), thus novel rehabilitation mechanisms are needed toward functional training. The effect of auditory cueing is well-known in Parkinson’s disease, yet the application of different types of auditory stimuli at different tempi has not been investigated yet. Objectives. Investigating if PwMS, compared with healthy controls (HC), can synchronize their gait to music and metronomes at different tempi during walking and the effects of the stimuli on perceived fatigue and gait. Additionally, exploring if cognitive impairment would be a factor on the results. Methods. The experimental session consisted of 2 blocks, music and metronomes. Per block, participants walked 3 minutes per tempi, with instructions to synchronize their steps to the beat. The tempi were 0%, +2%, +4% +6%, +8%, +10% of preferred walking cadence (PWC). Results. A total of 28 PwMS and 29 HC participated. On average, participants were able to synchronize at all tempi to music and metronome. Higher synchronization was obtained for metronomes compared with music. The highest synchronization for music was found between +2% and +8% of PWC yet pwMS perceived less physical and cognitive fatigue walking to music compared with metronomes. Cognitive impaired PwMS (n = 9) were not able to synchronize at tempi higher than +6%. Conclusion. Auditory-motor coupling and synchronization was feasible in HC and PwMS with motor and cognitive impairments. PwMS walked at higher tempi than their preferred walking cadence, and lower fatigue perception with music. Coupling walking to music could be a promising functional walking training strategy.

An ecological measure to screen executive functioning in MS: the Picture Interpretation Test (PIT) 360\xb0

Executive functions are crucial for performance of everyday activities. In Multiple Sclerosis (MS), executive dysfunctions can be apparent from the early onset of the disease. Technology-based time-efficient and resource-saving tools for early evaluation of executive functions using an ecological approach are needed to assess functional performance in real-life. The aim was to compare the efficiency of the Picture Interpretation Test 360° (PIT 360°) with traditional measures on executive dysfunction in Persons with Multiple Sclerosis (PwMS) and Healthy Controls (HC). Participants were 31 patients with Relapsing-Remitting MS (mean age = 44.323 ± 13.149; mean Expanded Disability Status Scale = 2) and 39 HC (mean age = 39.538 ± 15.728). All were tested with standard neuropsychological tests of executive functions, PIT 360°, and measures of user experience. While standard neuropsychological tests failed to differentiate between PwMS and HC group, the PIT 360° was successful in detecting executive dysfunction in PwMS. All participants reported the PIT 360° to be an engaging tool and endorsed positive reactions to their experience. Overall, the PIT 360° is a quick, sensitive, and ecological tool that captures real-world executive dysfunction in PwMS. This engaging measure is sensitive for the detection of executive deficits since the early phases of the disease.

Assessing the effects of post-acute rehabilitation services on health care outcomes for people with multiple sclerosis

BackgroundThe impact of post-acute rehabilitative services provided in skilled nursing facilities (SNF) on a particularly vulnerable, disabled subgroup, namely persons with multiple sclerosis (PwMS), is unknown. ObjectiveThe objectives of this study were to (1) describe the use of post-acute rehabilitative services in SNFs, and (2) examine the association between the use of physical and occupational therapy (PT/OT) and (a) successful community discharge and (b) functional improvement for PwMS. MethodsWe retrospectively selected PwMS newly admitted to a SNF from the hospital between January 2008 and September 2012. Using the Minimum Data Set (MDS), we examined the receipt of PT/OT and categorized the receipt as high and low intensity PT/OT according to median hours/week. We assessed the association of high vs. low PT/OT with successful discharge to the community and functional improvement using propensity-matched logistic regression. ResultsA total of 26,412 PwMS had valid OT/PT values in the MDS during the study period, among which 24,410 (92.4%) used PT/OT for some time in the SNF. Median PT/OT use was 9.7 h/week. Use of rehabilitation services was higher in patients with less cognitive and functional impairment. Overall, two-thirds (67.3%) of the propensity matched cohorts for Objective 2a (n = 8204/group) were successfully discharged to community; and one-third (33.6%) of the matched cohort for Objective 2b (n = 6803/group) had improved function. Higher PT/OT therapy was associated with successful discharge [odds ratio (OR) 1.20; 95% CI 1.12–1.28] and functional improvement (OR 1.21; 95% CI 1.13–1.30). ConclusionPwMS used post-acute rehabilitation services at SNFs for a median of ∼10 h/week. Those who used more rehabilitative services in the post-acute care setting were more likely to be successfully discharged to the community and experience functional improvement after adjustment for major confounders.

A Survey of Assistive Technologies for Assessment and Rehabilitation of Motor Impairments in Multiple Sclerosis

Multiple sclerosis (MS) is a disease that affects the central nervous system, which consists of the brain and spinal cord. Although this condition cannot be cured, proper treatment of persons with MS (PwMS) can help control and manage the relapses of several symptoms. In this survey article, we focus on the different technologies used for the assessment and rehabilitation of motor impairments for PwMS. We discuss sensor-based and robot-based solutions for monitoring, assessment and rehabilitation. Among MS symptoms, fatigue is one of the most disabling features, since PwMS may need to put significantly more intense effort toward achieving simple everyday tasks. While fatigue is a common symptom across several neurological chronic diseases, it remains poorly understood for various reasons, including subjectivity and variability among individuals. To this end, we also investigate recent methods for fatigue detection and monitoring. The result of this survey will provide both clinicians and researchers with valuable information on assessment and rehabilitation technologies for PwMS, as well as providing insights regarding fatigue and its effect on performance in daily activities for PwMS.

Gait quantification in multiple sclerosis: A single-centre experience of systematic evaluation

Gait disorders can be disabling in persons with multiple sclerosis (PMS). Different gait parameters have been used to evaluate gait disorders according to the International classification of functioning. Some authors have reported a direct relation between evaluations over short distances and long-term outcomes. This relationship is of interest for the purposes of clinical research, as it enables short-distance evaluations to be used as a primary endpoint for trials. However, these endpoints are not always particularly relevant for PMS, and furthermore, all evaluations do not present the same metrological characteristics, especially with regards to reproducibility. However, it is essential to have good reproducibility in order to be able to test the effect of a therapeutic strategy on walking parameters in PMS. Using a range of walk tests (timed 25-foot walk in different conditions, namely comfortable walking, fast walking and dual-task walking; the Timed Up and Go test; the 6minute walk test) associated with neuromotor analysis of the lower limbs, we describe the advantages and limitations of gait evaluation in MS. Based on clinical experience accumulated over 4 years, we propose a minimum set of measurements to be used in clinical practice and also for research purposes.

How much does balance and muscle strength impact walking in persons with multiple sclerosis? - A cross-sectional study

IntroductionDespite the multitude of rehabilitation interventions targeting gait impairments in persons with multiple sclerosis (PwMS), only little is known about the relative association of muscle strength and balance on different gait outcomes. AimTo determine the relative association of balance and muscle strength to three gait performance outcomes in PwMS. Method90 PwMS were enrolled in this cross-sectional study (72% women; mean age=49.8 ± 10.5 years; mean EDSS=3.7 ± 1.3. Spearman correlation and multivariate linear regression analysis were used to determine associations between three (dependent) gait outcomes (six-minute walk test (6MW), Timed 25-Foot Walk (T25FW), and Six Spot Step Test (SSST)). Explanatory variables were maximal muscle strength of the knee extensors, kneeflexors, plantarflexors and dorsiflexors, static balance (postural sway), functional balance (Mini-BESTest) and age and gender. ResultsStatic balance (r = 0.30 to 0.53; p<.05) and muscle strength of the knee extensors, knee flexors, plantarflexors and dorsiflexors (r = 0.28 to 0.47; p<.05) were weakly related to all gait performance outcomes, while functional balance showed strong relationships (r = 0.70 to 0.83; p<.05). Multivariate regression models including postural sway, muscle strength, and age and gender accounted for 32–39% of the variability in the 6MW, T25FW, and SSST. In 6MW and T25FW, with standardized beta coefficients for postural sway and muscle strength ranging from -0.34 to -0.37 (SE=0.09) and 0.18 to 0.35 (SE=0.10 to 0.12), respectively. For SSST, significant associations were only observed for balance. ConclusionsBalance and muscle strength are significantly associated with gait performance during fast walking, whereas only balance was associated with more complex walking tasks.