Multiple sclerosis (MS) is an autoimmune disease that is characterized by chronic inflammation and demyelination of the central nervous system (CNS). It can affect any of the nerves in the CNS, meaning that symptoms and rate of progression can vary widely between individuals.
The clinical course of the disease varies widely and ranges from a stable chronic disease to a rapidly developing and debilitating disease. The most common form of the disease is recurrent-remitting multiple sclerosis. However, there are several other forms such as B. primarily progressive and secondary progressive.
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MS can cause sensory, pyramidal, cerebellar and visual symptoms, all of which can impair the ability to walk to different degrees. Gait disorders are arguably one of the most difficult symptoms, and it is estimated that 15 years after diagnosis, half of people living with MS need help walking and 10% need a wheelchair.
Gait disorders in people with MS are poorly characterized despite numerous studies investigating the types of defects found. This is surprising considering that aisle retraining is a large part of neurorehabilitation for people with MS.
A new systematic review was published last week in the journal Diagnostics to summarize the current understanding of MS-related gait disorders in order to facilitate treatment and diagnostic decisions, particularly when classifying gait disorders.
Methods
Pubmed, Web of Science, PEDro and CINAHL were the databases searched and were limited to cross-sectional articles published in English, French or Spanish. The publication date was unlimited and the basis for the search strategy was as follows:
("visual" OR "observational" OR "pattern") AND ("gait" OR "walking movement" OR "walking") AND ("assessment" OR "assessment" OR "test" OR "scale" OR "measurement "" OR "Tool" OR "Analysis" OR "Profiling") AND "Multiple Sclerosis".
To be included in the results, articles had to be cross-sectional studies that used 3-D analysis to assess gait in people over 18 years of age with confirmed MS. If observation instruments were used to assess gait, articles were excluded from the results, as were studies without a control group.
The quality of the studies was assessed using the Critical Review Form-Quantitative Studies scale. In addition to the PRISMA guidelines followed by the authors, the principles of good systematic review practice were followed, including the use of a third consensus reviewer if necessary.
After performing the search and reviewing the results, 12 articles were included in the results. These included a total of 523 participants (342 women and 181 men). All types of MS were included in the results, but some studies did not indicate what type of MS some participants lived with.
Results and clinical implications
In all of the studies included in the review, there were notable differences between control groups and those living with MS. The most noticeable are the walking speed and the stride and stride length. The speed deficit depends on whether the person with MS has mild (41.7 cm / s slower), moderate (87.2 cm / s slower) and severe (115.3 cm / s) forms compared to the control group of MS.
When comparing the technical elements of gait cycles, people with MS have a reduced swing and stance phase, probably due to muscle weakness in the adductors and quads and changes in tone in the hip flexors.
Brief summary of gait disorders in MS
Due to the different position of the lesions caused by the disease process it is difficult to establish a standardized atypical gait pattern .
The most common gait disorder noted is a decrease in speed as stride and stride length
There is a decrease in hip extension in the stance phase probably due to an increased tone on quads or weak extensor muscles
During the swing phase there is a reduction in knee flexion due to weakness or changes in tone
At the ankle there is a d increased dorsiflexion for those with spasticity
Rehabilitation should focus on combating asymmetrical gait features
The muscle weakness also leads to a reduction in the maximum knee flexion during the swing phase and this decreases the more severe the disease is. The same goes for ankle dorsiflexion, but this is likely caused by changes in tone, rather than just weakness alone.
Due to the variable position of the gait disorders of the lesions, the changes that are observed during the progression of the disease can and will often change. There will also be differences between individuals when treating gait changes associated with the disease. The deficits in muscle strength and the increase in tone often lead to asymmetry, and the restoration of gait symmetry should be the goal of gait rehabilitation.
