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The purpose of this study is to investigate the impact of ankle foot orthoses (AFOs) on the spatial and temporal gait parameters, electromyography (EMG), walking endurance, and quality of life in select individuals living with MS. The hypotheses of the study are: 1. Individuals who are fit with an AFO will demonstrate improvements in spatial and temporal gait parameters 2. Individuals who are fit with an AFO will demonstrate improvements in walking endurance. 3. Individuals who are fit with an AFO will demonstrate improvements in muscle firing profiles/EMG measures. 4. Individuals who are fit with an AFO will demonstrate improvements in quality of life.
The aim of this study was to compare the intra-limb coordination during treadmill walking performed by
persons with Multiple Sclerosis (MS) and healthy adults. Twelve healthy adults (male = 5, female = 7) and
twelve age and gender matched MS patients (male = 5, female = 7) were selected non-randomly. All
participants walked on a treadmill for 20 strides on two occasions. The mean absolute relative phase was used to
compare 4 stages of the gait cycle (heel contact, mid stance, toe off, and mid swing) between the two groups.
Dependent variables were relative phase and angular position in the knee and ankle joints. Hotelling’s T2 test
and Cross-correlation coefficient were used to analysis the multiple sets of data. The shape of angle-angle plot
showed significant between-group differences in the patterns of gait (T2 = 35.02, F = 35.02, p < 0.05, η2 = 0.97).
Analysis of variance results showed that there were significant differences between the relative phase of the two
groups on heel contact (F = 13.09, p < 0.05, η2 = 0.65) and mid stance (F = 15.12, p < 0.05, η2 = 0.68) stages.
Cross-correlation function results showed that in the healthy group, there were no significant relationships
between the angular positions of two joints in the different stages, whereas in the MS group there was a
significant inverse relationship (CCF = -0.45, p < 0.05) between the angular positions of two joints. In
conclusion, the results of this study showed that in people with MS, intra-limb coordination patterns during
walking are different from healthy people
Background Evaluation of walking capacity and risk of falls in people with multiple sclerosis often are performed in rehabilitation. The Dynamic Gait Index (DGI) evaluates walking during different tasks, but the feasibility in identifying people at risk for falls needs to be further investigated.
Objective The objective of this study was to investigate (1) the construct validity (known groups, convergent, and discriminant) of the DGI and (2) the accuracy of predicting falls and establishing a cutoff point to identify fallers.
Design This trial was a multicenter, cross-sectional study.
Methods A convenience sample was composed of 81 people with multiple sclerosis with subjective gait and balance impairment who were able to walk 100 m (comparable to Expanded Disability Status Scale 1–6). Mean age of the participants was 49 years; 76% were women. The 25-Foot Timed Walk Test, Timed “Up & Go” Test, Four Square Step Test, Timed Sit-to-Stand Test, MS Walking Scale, Multiple Sclerosis Impact Scale, and self-reported falls during the previous 2 months were used for validation, to establish cutoff points for identifying fallers, and to investigate predictive values.
Results Significantly lower DGI scores (P≤.001) were found for participants reporting falls (n=31). High sensitivity (87%) in identifying fallers was found, with a cutoff score ≤19. The positive predictive value was 50%, and the negative predictive value was 87%. The positive likelihood ratio was 1.77, and the negative likelihood ratio was 0.26. The convergent validity was moderate to strong (ρ=0.58–0.80), with the highest correlation coefficient found for the 25-Foot Timed Walk Test. Discriminant validity was shown with low correlation for the psychological subscale of the Multiple Sclerosis Impact Scale.
Limitations The sample included ambulatory people participating in a randomized controlled trial investigating balance training.
Conclusions The DGI is a valid measure of dynamic balance during walking for ambulatory people with multiple sclerosis. With the cutoff point of ≤19, sensitivity was high in identifying people at risk of falls.
Cognitive processing speed has minimal influence on the construct validity of Multiple Sclerosis Walking Scale-12 scores.
Motl RW, Cadavid D, Sandroff BM, Pilutti LA, Pula JH, Benedict RH. J Neurol Sci. 2013 Sep 24.
The Multiple Sclerosis Walking Scale-12 (MSWS-12) has been a commonly used patient reported outcome for measuring walking impairment in research involving multiple sclerosis (MS).
We examined the possibility that cognitive processing speed (CPS) influences the association between MSWS-12 scores and other measures of ambulation (i.e., construct validity).
96 MS patients completed the MSWS-12, underwent a neurological examination for generating an Expanded Disability Status Scale (EDSS) score, and completed the Symbol Digit Modalities Test (SDMT), Timed 25-Foot Walk (T25FW), 4 trials on the GAITRite™ for generating the functional ambulatory profile (FAP) score, and Six-minute Walk (6MW).
The SDMT was significantly correlated with MSWS-12 scores (r=-.428) and T25FW (r=-.459), 6MW (r=.512), FAP (r=.275), and EDSS (r=-.404) scores. There were statistically significant correlations between MSWS-12 and T25FW (r=.568), 6MW (r=-.680), FAP (r=-.595), and EDSS (r=.737) scores. Lastly, four separate hierarchical linear regression analyses indicated that, after controlling for age, gender, disease duration, and clinical course, T25FW, 6MW, FAP, and EDSS scores individually were significant correlates of MSWS-12 scores, and the associations (i.e., standardized beta-coefficients) were still statistically significant with minimal attenuation when controlling for SDMT scores.
There was minimal evidence that CPS influenced the construct validity of MSWS-12 scores.
Predicting falls in people with multiple sclerosis: fall history is as accurate as more complex measures.
Cameron MH, Thielman E, Mazumder R, Bourdette D. Mult Scler Int. 2013;2013:496325.
Background. Many people with MS fall, but the best method for identifying those at increased fall risk is not known. Objective. To compare how accurately fall history, questionnaires, and physical tests predict future falls and injurious falls in people with MS.
Methods. 52 people with MS were asked if they had fallen in the past 2 months and the past year. Subjects were also assessed with the Activities-specific Balance Confidence, Falls Efficacy Scale-International, and Multiple Sclerosis Walking Scale-12 questionnaires, the Expanded Disability Status Scale, Timed 25-Foot Walk, and computerized dynamic posturography and recorded their falls daily for the following 6 months with calendars. The ability of baseline assessments to predict future falls was compared using receiver operator curves and logistic regression.
Results. All tests individually provided similar fall prediction (area under the curve (AUC) 0.60-0.75). A fall in the past year was the best predictor of falls (AUC 0.75, sensitivity 0.89, specificity 0.56) or injurious falls (AUC 0.69, sensitivity 0.96, specificity 0.41) in the following 6 months.
Conclusion. Simply asking people with MS if they have fallen in the past year predicts future falls and injurious falls as well as more complex, expensive, or time-consuming approaches
The relationship between fear of falling to spatiotemporal gait parameters measured by an instrumented treadmill in people with multiple sclerosis
Alon Kalronemail address, Anat Achiron Gait & Posture; Article in Press
People with multiple sclerosis (MS) identify mobility limitations as one of the greatest challenges of this disease. Continued loss of mobility and falls are among their greatest concerns for the future. Our objective was to determine if fear of falling is associated with spatial and temporal gait parameters in persons with MS, when measured by an instrumented treadmill. This observational case control study was performed at the MS Center, Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel. Sixty-eight relapsing-remitting patients diagnosed with MS, 38 women, aged 40.9 (S.D.=11.9), participated in this investigation. Twenty-five healthy subjects, 14 women, aged 39.5 (S.D.=9.4) served as controls gait controls. Gait spatiotemporal parameters were obtained using the Zebris FDM-T Treadmill (Zebris® Medical GmbH, Germany). The Falls Efficacy Scale International was used to assess the level of concern relating to falls. Forty-one people with MS were classified as highly fearful of falling. Twenty-seven patients were slightly concerned. Highly fearful of falling patients walked slower had a shorter step length, a wider base of support and prolonged double support phase compared to slightly concerned patients. Fearful patients also demonstrated elevated variability of the center of pressure (CoP) trajectory compared to slightly concerned MS patients. Fear of falling and spatiotemporal gait alterations in people with MS are linked. Additionally, variability of the CoP during walking appears to be connected with the level of concern.
•Fear of falling is related to spatial and temporal gait parameters in people with MS.
•Fearful patients demonstrated a larger variability of the CoP trajectory during gait.
•CoP variability in the lateral plane was significantly correlated to fear of falling.