1. Profiling walking dysfunction in multiple sclerosis: characterisation, classification and progression over time
- Author
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Katja Reuter, Dominik Straumann, Armin Curt, Tim Killeen, Marc Bolliger, Christian Meyer, Michael Linnebank, Linard Filli, Michael Weller, Lilla Lörincz, Christopher S. Easthope, Tabea Sutter, Björn Zörner, University of Zurich, and Filli, Linard
- Subjects
Adult ,Male ,030506 rehabilitation ,medicine.medical_specialty ,Multiple Sclerosis ,Time Factors ,Knee Joint ,lcsh:Medicine ,610 Medicine & health ,Walk Test ,Article ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,10064 Neuroscience Center Zurich ,Treadmill ,Range of Motion, Articular ,Prospective cohort study ,lcsh:Science ,Gait ,Gait Disorders, Neurologic ,1000 Multidisciplinary ,Multidisciplinary ,business.industry ,Multiple sclerosis ,lcsh:R ,Case-control study ,Middle Aged ,medicine.disease ,10040 Clinic for Neurology ,medicine.anatomical_structure ,10076 Center for Integrative Human Physiology ,Gait analysis ,Case-Control Studies ,Disease Progression ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Female ,lcsh:Q ,Ankle ,0305 other medical science ,Range of motion ,business ,human activities ,030217 neurology & neurosurgery - Abstract
Gait dysfunction is a common and relevant symptom in multiple sclerosis (MS). This study aimed to profile gait pathology in gait-impaired patients with MS using comprehensive 3D gait analysis and clinical walking tests. Thirty-seven patients with MS walked on the treadmill at their individual, sustainable speed while 20 healthy control subjects walked at all the different patient’s paces, allowing for comparisons independent of walking velocity. Kinematic analysis revealed pronounced restrictions in knee and ankle joint excursion, increased gait variability and asymmetry along with impaired dynamic stability in patients. The most discriminative single gait parameter, differentiating patients from controls with an accuracy of 83.3% (χ2 test; p = 0.0001), was reduced knee range of motion. Based on hierarchical cluster and principal component analysis, three principal pathological gait patterns were identified: a spastic-paretic, an ataxia-like, and an unstable gait. Follow-up assessments after 1 year indicated deterioration of walking function, particularly in patients with spastic-paretic gait patterns. Our findings suggest that impaired knee/ankle control is common in patients with MS. Personalised gait profiles and clustering algorithms may be promising tools for stratifying patients and to inform patient-tailored exercise programs. Responsive, objective outcome measures are important for monitoring disease progression and treatment effects in MS trials.
- Published
- 2018