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Gait impairment in multiple sclerosis

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  #1  
Old 3rd May 2011, 01:59 PM
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Default Gait impairment in multiple sclerosis

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Quantifying gait impairment in multiple sclerosis using GAITRite™ technology.
Sosnoff JJ, Weikert M, Dlugonski D, Smith DC, Motl RW.
Gait Posture. 2011 Apr 29. [Epub ahead of print]
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This pilot study investigated the validity of the functional ambulatory profile (FAP) score from the GAITRite™ electronic pathway in persons with multiple sclerosis (PwMS) who had onset of walking impairment. Thirteen PwMS who had Expanded Disability Status Scale (EDSS) scores of 4.0-6.0 performed four trials on GAITRite™ pathway, and completed a multidimensional walking assessment including performance tests (timed 25 foot walk; T25FW, timed up and go; TUG), self reports of walking ability (Multiple Sclerosis Walking Scale-12; MSWS-12) and function (Late Life Function and Disability Inventory; LL-FDI), and free-living walking behavior (accelerometry). The FAP score correlated strongly with neurological disability (EDSS, ρ=-0.81), walking performance (T25FW, ρ=-0.82; TUG, ρ=-0.88) and self-reported walking function (LL-FDI, ρ=0.81), and moderately with self-reported walking impairment (MSWS-12, ρ=0.49) and free-living walking behavior (accelerometry, ρ=0.52). This suggests that the FAP score is a valid marker of gait impairment in PwMS who have onset of walking impairment.
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Old 3rd May 2011, 02:03 PM
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Default Re: Gait impairment in multiple sclerosis

Related threads:
Other threads tagged with multiple sclerosis
Foot orthoses and multiple sclerosis
Multiple Sclerosis and Toenails
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Old 21st June 2011, 12:09 PM
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Default Re: Gait impairment in multiple sclerosis

Relationship between foot sensation and standing balance in patients with multiple sclerosis.
Citaker S, Gunduz AG, Guclu MB, Nazliel B, Irkec C, Kaya D.
Gait Posture. 2011 Jun 15. [Epub ahead of print]
Quote:
The aims of the present study were to investigate the relationship between the foot sensations and standing balance in patients with Multiple Sclerosis (MS) and find out the sensation, which best predicts balance. Twenty-seven patients with MS (Expanded Disability Status Scale 1-3.5) and 10 healthy volunteers were included. Threshold of light touch-pressure, duration of vibration, and distance of two-point discrimination of the foot sole were assessed. Duration of static one-leg standing balance was measured. Light touch-pressure, vibration, two-point discrimination sensations of the foot sole, and duration of one-leg standing balance were decreased in patients with MS compared with controls (p<0.05). Sensation of the foot sole was related with duration of one-leg standing balance in patients with MS. In the multiple regression analysis conducted in the 27 MS patients, 47.6% of the variance in the duration of one-leg standing balance was explained by two-point discrimination sensation of the heel (R(2)=0.359, p=0.001) and vibration sensation of the first metatarsal head (R(2)=0.118, p=0.029). As the cutaneous receptors sensitivity decreases in the foot sole the standing balance impairs in patients with MS. Two-point discrimination sensation of the heel and vibration sensation of the first metatarsal head region are the best predictors of the static standing balance in patients with MS. Other factors which could be possible to predict balance and effects of sensorial training of foot on balance should be investigated.
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Old 8th March 2012, 01:02 PM
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Default Re: Gait impairment in multiple sclerosis

Morphofunctional aspects of lower limb in multiple sclerosis.
Neamţu MC, Rusu L, Marin M, Avramescu T, Rusu PF, Neamţu OM, Iancău M.
Rom J Morphol Embryol. 2012;53(1):117-20.
Quote:
Gait, as an expression of the locomotive system, needs a complex biomechanical analysis, which allows the description of multiple sclerosis (MS) specific patterns, MS patients having a polymorphism of motion patterns. The studied group consisted of 13 MS patients with gait disorders, average age of the group was of 36 years. The evaluation of the subjects comprises: clinical evaluation (anamnesis, neurological examination), paraclinical evaluation (MRI), functional evaluation, neuro-physiologic evaluation and biomechanical evaluation. Biomechanical examination was completed using the force and pressure-measuring platform of plantar pressure distribution Footscan Scientific Version, RSscan. The studied parameters were: contact area, active contact area, heel rotation, foot balance, foot angle. The evaluated zones during a gait cycle were: the heel, medial foot, antefoot. Although the analysis of contact area in the lateral foot did not show any significant differences between the right and the left foot, it nonetheless underlined a major difference in the expression of maximum and minimum values, which meant that MS patients with clinically detectable gait disorders had a tendency to increase contact area to maintain balance. Examining the foot positions in relation to the movement direction and to the foot vertical axis, we noticed the existence of certain elements indicating an orientation tendency of the foot. This tendency had to be related to neutral position (corresponding to anatomical position) of the foot. We also noticed a foot deviation in abduction, associated with visible pronation and decrease of the contact area corresponding to medial plantar zone.
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Old 20th March 2012, 03:25 PM
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Default Re: Gait impairment in multiple sclerosis

Quantifying gait abnormalities in persons with multiple sclerosis with minimal disability.
Sosnoff JJ, Sandroff BM, Motl RW.
Gait Posture. 2012 Mar 17
Quote:
Abnormalities in gait kinematics in persons with multiple sclerosis (PwMS) who have mild disability have been noted using motion capture systems. However, it is not clear if these abnormalities can be detected with clinically feasible technology. This investigation examined if the spatiotemporal markers of gait including variability metrics can distinguish between PwMS with minimal disability and controls with clinically feasible technology. 43 PwMS with minimal disability and 43 healthy controls completed four walking trials along a 26 foot long pressure sensitive pathway (GAITRite). Spatiotemporal markers of gait including variability metrics were determined. Statistical analysis revealed that PwMS walked slower, with fewer, shorter, wider steps and spent a greater percentage of a gait cycle in double support than controls. Additionally, PwMS had greater variability in the time between steps, single support percent and step width than controls. Collectively, the results highlight that PwMS, in the absence of clinical gait impairment, have subtle but detectable differences in gait and that these alterations can be detected with clinically feasible technology. The current results raise the possibility of targeting walking deviations earlier in disability progression in PwMS.
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Old 1st April 2012, 01:45 AM
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Default Re: Gait impairment in multiple sclerosis

Perceived impact of spasticity is associated with spatial and temporal parameters of gait in multiple sclerosis.
Balantrapu S, Sandroff BM, Sosnoff JJ, Motl RW.
ISRN Neurol. 2012;2012:675431
Quote:
Background. Spasticity is prevalent and disabling in persons with multiple sclerosis (MS), and the development of the Multiple Sclerosis Spasticity Scale-88 (MSSS-88) provides an opportunity for examining the perceived impact of spasticity and its association with gait in this population.

Purpose. This study examined the association between the perceived impact of spasticity and spatio-temporal parameters of gait in persons with MS.

Methods. The sample included 44 adults with MS who completed the MSSS-88 and 4 walking trials on a 26-foot GAITRite(TM) electronic walkway for measurement of spatio-temporal components of gait including velocity, cadence, base of support, step time, single support, double support, and swing phase.

Results. The overall MSSS-88 score was significantly associated with velocity (r = -0.371), cadence (r = -0.306), base of support (r = 0.357), step time (r = 0.305), single leg support (r = -0.388), double leg support (r = 0.379), and swing phase (r = -0.386).

Conclusions. The perceived impact of spasticity coincides with alterations of the spatio-temporal parameters of gait in MS. This indicates that subsequent interventions might target a decrease in spasticity or its perceived impact as an approach for improving mobility in MS.
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Old 9th May 2012, 12:39 PM
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Default Re: Gait impairment in multiple sclerosis

Gait Impairments in Persons With Multiple Sclerosis Across Preferred and Fixed Walking Speeds.
Remelius JG, Jones SL, House JD, Busa MA, Averill JL, Sugumaran K, Kent-Braun JA, Van Emmerik RE.
Arch Phys Med Rehabil. 2012 Mar 7.
Quote:
OBJECTIVES:
To investigate (1) whether previously observed changes in gait parameters in individuals with multiple sclerosis (MS) are the result of slower preferred walking speeds or reflect adaptations independent of gait speed; and (2) the changes in spatiotemporal features of the unstable swing phase of gait in people with MS.

DESIGN:
Cross-sectional study assessing changes in gait parameters during preferred, slow (0.6m/s), medium (1.0m/s), and fast (1.4m/s) walking speeds.

SETTING:
Gait laboratory with instrumented walkway and motion capture system.

PARTICIPANTS:
MS group with mild to moderate impairment (n=19, 16 women) with a median Expanded Disability Status Scale score of 3.75 (range, 2.5-6), and a sex- and age-matched control group (n=19).

INTERVENTIONS:
Not applicable.

MAIN OUTCOME MEASURES:
Gait speed, stride length, stride width, cadence, dual support time, swing time, and timing of swing foot and body/head center of mass during swing phase.

RESULTS:
Individuals with MS walked at slower preferred speeds with longer dual support times compared with controls. In fixed-speed conditions, dual support times were longer and swing times were shorter in MS compared with controls. Stride width was wider for all speed conditions in the MS group. In fixed-speed conditions, the MS group positioned their head and body centers of mass closer to the anterior base of support boundary when entering the unstable equilibrium of the swing phase.

CONCLUSIONS:
Longer dual support time is part of a gait strategy in MS that is apparent even when controlling for the confounding effect of slower preferred speed. However, a gait strategy featuring longer dual support times may have limitations if potentially destabilizing swing dynamics exist, which especially occur at walking speeds other than preferred for people with MS.
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Old 25th May 2012, 02:07 PM
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Default Re: Gait impairment in multiple sclerosis

Foot placement patterns of female rollator users with multiple sclerosis in the community.
Chee JN, Gage WH, McIlroy WE, Zabjek KF.
Disabil Rehabil. 2012 May 24.
Quote:
Purpose: The objective of this study was to investigate the relationship between medio-lateral foot placement characteristics and environmental context when individuals with Multiple Sclerosis (MS) walk with a rollator (four-wheeled walker).

Method: Ten women diagnosed with MS, who used rollators regularly, participated in this study. First, a rollator-based technique of calculating step width (SW) was validated in this patient population by comparing the output of an instrumented rollator (iWalker) to a laboratory-based Vicon Motion Capture System. Secondly, the iWalker-based technique was used to calculate the participants' SW and SW variability as they used the iWalker in four common outdoor community environments.

Results: There was a strong level of agreement between the iWalker and Vicon SW calculations, with an intra-class correlation coefficient of 0.993 and a root-mean-square difference of 0.71 cm. Furthermore, SW variability (P = 0.002), but not SW (P = 0.288), was influenced by the walking environment (i.e. between the in-lab vs. up-ramp and up-ramp vs. down-ramp conditions).

Conclusions: Foot placement variability appears to be influenced by the walking environment of MS patients. Therefore, an enhanced understanding of walker-user interactions in relation to the environment must be established in order to improve mobility
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Old 26th May 2012, 11:44 AM
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Default Re: Gait impairment in multiple sclerosis

Effect of wearing a dorsiflexion assist orthosis on mobility, perceived fatigue and exertion during the six-minute walk test in people with multiple sclerosis: a randomised cross-over protocol.
McLoughlin JV, Barr CJ, Sturnieks D, Lord SR, Crotty M.
BMC Neurol. 2012 May 25;12(1):27.
Quote:
BACKGROUND:
Fatigue in combination with gait and balance impairments can severely limit daily activities in people with multiple sclerosis (PWMS). Generalised fatigue has a major impact on walking ability, with moderately disabled PWMS experiencing difficulty in walking extended distances. Localised motor fatigue in the ankle dorsiflexors can lead to foot drop, further reducing functional ambulation. The aim of this study is to evaluate the effect of a simple dynamic dorsiflexion assist orthosis on walking-induced fatigue, gait, balance and functional mobility in PWMS.

METHODS:
A randomised cross-over trial will be conducted with 40 community dwelling PWMS with mild to moderate mobility disability. Participants will initially be screened for disease severity, balance, strength, depression and fatigue at the South Australian Motion Analysis Centre. On two non-consecutive occasions, within two weeks, participants will undergo either the 6-minute walk test (6MWT) or the 6MWT while wearing a dorsiflexion ankle orthosis (with a randomised condition order). Distance walked, perceived exertion, perceived fatigue and the physiological cost of walking (the primary outcome measures) will be compared between the two walking conditions. Additional pre- and post-6MWT assessments for the two conditions will include tests of strength, reaction time, gait and balance.

DISCUSSION:
This study will increase our understanding of motor fatigue on gait and balance control inPWMS and elucidate the effect of a Dynamic Ankle Orthosis on fatigue-related balance and gait in PWMS. It will also examine relationships between mobility and balance performance with perceived fatigue levels in this group
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Old 8th June 2012, 12:24 PM
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Default Re: Gait impairment in multiple sclerosis

A corrected version of the Timed-25 Foot Walk Test with a dynamic start to capture the maximum ambulation speed in multiple sclerosis patients.
Phan-Ba R, Calay P, Grodent P, Delrue G, Lommers E, Delvaux V, Moonen G, Nagels G, Belachew S.
NeuroRehabilitation. 2012 Jan 1;30(4):261-6.
Quote:
Background: No clinical test is currently available and validated to measure the maximum walking speed (WS) of multiple sclerosis (MS) patients. Since the Timed 25-Foot Walk Test (T25FW) is performed with a static start, it takes a significant proportion of the distance for MS patients to reach their maximum pace. Objectives: In order to capture the maximum WS and to quantify the relative impact of the accelerating phase during the first meters, we compared the classical T25FW with a modified version (T25FW<formula>^{+}</formula>) allowing a dynamic start after a 3 meters run-up.

Methods: Sixty-four MS patients and 30 healthy subjects performed successively the T25FW and the T25FW<formula>^{+}</formula>.Results: The T25FW<formula>^{+}</formula> was performed faster than the T25FW for the vast majority of MS and healthy subjects. In the MS population, the mean relative gain of speed due to the dynamic start on T25FW<formula>^{+}</formula> was independent from the EDSS and from the level of ambulation impairment. Compared to healthy subjects, the relative difference between dynamic versus static start was more important in the MS population even in patients devoid of apparent gait impairment according to the T25FW.

Conclusion: The T25FW<formula>^{+}</formula> allows a more accurate measurement of the maximum WS of MS patients, which is a prerequisite to reliably evaluate deceleration over longer distance tests. Indirect arguments suggest that the time to reach the maximum WS may be partially influenced by the cognitive impairment status. The maximum WS and the capacity of MS patients to accelerate on a specific distance may be independently regulated and assessed separately in clinical trials and rehabilitation programs.
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Old 29th June 2012, 12:20 PM
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Default Re: Gait impairment in multiple sclerosis

Assessing walking disability in multiple sclerosis.
Kieseier BC, Pozzilli C.
Mult Scler. 2012 Jul;18(7):914-24.
Quote:
Most patients with multiple sclerosis (MS) eventually experience walking disability. The objective of this review was to evaluate the clinical utility of measures specific for walking in MS. Walking assessments had high reliability and were correlated with related measures, including the 12-item multiple sclerosis walking scale (MSWS-12). Shorter timed walking tests (Timed 25-foot Walk (T25FW), 10-metre Timed Walk, 30-metre Timed Walk) measure overall walking disability and are best suited for clinical settings, whereas longer timed or distance tests (100-metre Timed Walk, 6-minute Walk Test, 2-minute Walk Test) are better for the assessment of walking fatigability, distance limitations and functional capacity. The MSWS-12 measures different, but related, aspects of walking than the objective tests. The T25FW is the best characterised objective measure of walking disability and can be used across a wide range of walking disabilities. Additional work is needed to fully characterise the other objective walking assessments in MS.
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  #12  
Old 22nd August 2012, 03:39 PM
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Default Re: Gait impairment in multiple sclerosis

Walking speed, rather than Expanded Disability Status Scale, relates to long-term patient-reported impact in progressive MS.
Bosma L, Kragt J, Polman C, Uitdehaag B.
Mult Scler. 2012 Aug 20.
Quote:
OBJECTIVE:
To study the relationships between 1-2 year changes in well-known physician-rated measurements (Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9HPT)) and the long-term (≥ 5 years) outcome in patient-reported outcome (PRO) measures (Multiple Sclerosis Impact Scale (MSIS-29), Multiple Sclerosis Walking Scale (MSWS-12)) that reflect the patient-perceived impact of disease, in progressive MS.

METHODS:
We selected all progressive patients having at least two complete visits within 1-2 years, from a larger cohort of prospectively-followed MS patients. These were invited for another visit, at least 5 years later, consisting of another series of similar examinations, plus 2 PRO scales: the MSIS-29 and MSWS-12. We explored associations between early changes in physician-rated measurements and the long-term outcome as per the PRO measures.

RESULTS:
In this study,134 patients fulfilled the selection criteria. We found that early change in T25FW was the only physician-rated change that was significantly related to long-term physical impact experienced by the patient, as was assessed by MSIS-29 (Kruskal-Wallis test: χ(2)=7.8, p=0.020). Early T25FW change, and to a lesser degree early 9HPT change, were significantly related to the reported long-term walking limitations, as assessed by MSWS-12 (Kruskal-Wallis test: χ(2)=13.8 and p=0.001 for T25FW, χ(2)=6.5 and p=0.038 for 9HPT). None of the early physician-rated changes were related to the long-term psychological impact experienced by the patient.

CONCLUSION:
Early changes on physician-rated scales do have long-term impact in terms of potentially predictive value of outcomes for groups of patients in progressive MS, regarding walking limitations and more global physical impact. Surprisingly, early change in T25FW, rather than early change in EDSS, was significantly associated with longer-term patient-reported disease impact. Our study data support the value of using early physician-rated examinations in clinical trials in progressive MS.
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Old 20th September 2012, 02:52 PM
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Default Re: Gait impairment in multiple sclerosis

Social and economic burden of walking and mobility problems in multiple sclerosis.
Pike J, Jones E, Rajagopalan K, Piercy J, Anderson P.
BMC Neurol. 2012 Sep 18;12(1):94.
Quote:
BACKGROUND:
Multiple sclerosis (MS) is a chronic progressive neurological disease and the majority of patients will experience some degree of impaired mobility. We evaluated the prevalence, severity and burden of walking and mobility problems (WMPs) in 5 European countries.

METHODS:
This was a cross-sectional, patient record-based study involving 340 neurologists who completed detailed patient record forms (PRF) for patients (>18 years) attending their clinic with MS. Patients were also invited to complete a questionnaire (PSC). Information collected included demographics, disease characteristics, work productivity, quality of life (QoL; EuroQol-5D and Hamburg Quality of Life Questionnaire Multiple Sclerosis [HAQUAMS]) and mobility (subjective patient-reported and objectively measured using the timed 25 foot walk test [T25FW]). Relationships between WMPs and disease and other characteristics were examined using Chi square tests. Analysis of variance was used to examine relationships between mobility measures and work productivity.

RESULTS:
Records were available for 3572 patients of whom 2171 also completed a PSC. WMPs were regarded as the most bothersome symptom by almost half of patients who responded (43%; 291/683). There was a clear, independent and strong directional relationship between severity of WMPs (subjective and objective) and healthcare resource utilisation. Patients with longer T25FW times (indicating greater walking impairment) were significantly more likely to require additional caregiver support (p < 0.0001), visit a variety of healthcare professionals including their primary care physicians (p = 0.0044) and require more long-term non-disease modifying drugs (p = 0.0001). A similar pattern was observed when subjective reporting of the severity of WMPs was considered. Work productivity was also markedly impacted by the presence of WMPs with fewer patients working full time and a reduction in weekly working hours as T25FW times and the subjective severity of WMPs increased.

CONCLUSIONS:
In Europe, WMPs in MS represent a considerable personal and social burden both financially and in terms of quality of life. Interventions to improve mobility could have significant benefits for patients and society as a whole.
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Old 26th September 2012, 05:08 AM
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Default Re: Gait impairment in multiple sclerosis

Robot-assisted gait training in multiple sclerosis patients: a randomized trial.
Schwartz I, Sajin A, Moreh E, Fisher I, Neeb M, Forest A, Vaknin-Dembinsky A, Karusis D, Meiner Z.
Mult Scler. 2012 Jun;18(6):881-90.
Quote:
BACKGROUND:
Preservation of locomotor activity in multiple sclerosis (MS) patients is of utmost importance. Robotic-assisted body weight-supported treadmill training is a promising method to improve gait functions in neurologically impaired patients, although its effectiveness in MS patients is still unknown.

OBJECTIVE:
To compare the effectiveness of robot-assisted gait training (RAGT) with that of conventional walking treatment (CWT) on gait and generalized functions in a group of stable MS patients.

METHODS:
A prospective randomized controlled trial of 12 sessions of RAGT or CWT in MS patients of EDSS score 5-7. Primary outcome measures were gait parameters and the secondary outcomes were functional and quality of life parameters. All tests were performed at baseline, 3 and 6 months post-treatment by a blinded rater.

RESULTS:
Fifteen and 17 patients were randomly allocated to RAGT and CWT, respectively. Both groups were comparable at baseline in all parameters. As compared with baseline, although some gait parameters improved significantly following the treatment at each time point there was no difference between the groups. Both FIM and EDSS scores improved significantly post-treatment with no difference between the groups. At 6 months, most gait and functional parameters had returned to baseline.

CONCLUSIONS:
Robot-assisted gait training is feasible and safe and may be an effective additional therapeutic option in MS patients with severe walking disabilities.
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Old 17th October 2012, 07:05 PM
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Default Re: Gait impairment in multiple sclerosis

The impact of slower walking speed on activities of daily living in patients with multiple sclerosis.
Yildiz M.
Int J Clin Pract. 2012 Nov;66(11):1088-94.
Quote:
Aims:  To identify the relevance and impact of walking speed (WS) over a short distance on activities of daily living (ADLs) in patients with multiple sclerosis (MS).

Methods:  An internet-administered survey of MS patients in four countries was distributed to 605 individuals in 2010. Participants had MS for > 5 years and must have reported difficulty walking as a result of MS. The impact of MS on walking and the effects of WS on ADLs were assessed based upon responses (scored on a scale of 1-10) to five questions and categorised post hoc as: high (8-10), moderate (4-7) or low (1-3) impact/importance.

Results:  Of the participants who completed the survey (n = 112), 60% were female patients, 63% were aged ≥ 45 years, and 55% had relapsing-remitting MS. Approximately, half of participants reported a high impact of MS on their general walking ability (46%) and their ability to increase WS over a short distance (55%). Up to 53% of participants reported avoiding ADLs because of concerns about WS; within this cohort, older male patients and patients with secondary-progressive MS were highly represented.

Discussion:  These results, which highlight the importance of WS to patients with MS and emphasise the impact of WS on health-related quality of life and ADLs, underscore the importance of clinical measures of WS, such as the timed 25-foot walk, in assessing walking in MS patients.

Conclusion:  Walking speed over a short distance has a significant impact on ADLs for patients with MS.
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Old 12th November 2012, 05:54 PM
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Default Re: Gait impairment in multiple sclerosis

Footfall Placement Variability and Falls in Multiple Sclerosis
Michael J. Socie, Brian M. Sandroff, John H. Pula, Elizabeth T. Hsiao-Wecksler, Robert W. Motl, Jacob J. Sosnoff
Annals of Biomedical Engineering; November 2012
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Gait variability (i.e., fluctuations in walking) provides unique information about the control of movement and is associated with falls. This investigation examined the association between gait variability and falls in persons with multiple sclerosis (MS) and healthy controls. Traditional distributional metrics of gait variability (i.e., coefficient of variation (CV)) and a novel metric based on Fourier series analysis of footfall placement variability were determined for 41 individuals with MS and 20 age- and sex-matched controls. Spatiotemporal parameters of gait were collected using a 7.9 m electronic walkway that recorded individual footfalls during steady state comfortable walking. Persons with MS were divided into two groups based on fall history (non-fallers and recurrent fallers). Overall, persons with MS had greater gait variability than controls as indexed by CV and Fourier-based variability (p’s < 0.05). Moreover, recurrent fallers with MS had greater Fourier-based variability than non-fallers with MS (p = 0.025), whereas there was no difference in MS groups in traditional gait variability metrics (p > 0.05). These observations highlight that footfall placement variability is related to fall status in MS. Future work determining the sensitivity of footfall placement variability to dysfunction is warranted.
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Old 14th November 2012, 02:09 PM
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Default Re: Gait impairment in multiple sclerosis

Gait variability and disability in multiple sclerosis
Michael J. Socie, Robert W. Motl, John H. Pula, Jacob J. Sosnoff
Gait & Posture; Article in Press
Quote:
Gait variability is clinically relevant in some populations, but there is limited documentation of gait variability in persons with multiple sclerosis (MS). This investigation examined average and variability of spatiotemporal gait parameters in persons with MS and healthy controls and subsequent associations with disability status. 88 individuals with MS (age 52.4±11.1) and 20 healthy controls (age 50.9±8.7) performed two self-paced walking trials on a 7.9-m electronic walkway to determine gait parameters. Disability was indexed by the Expanded Disability Status Scale (EDSS) and ranged between 2.5 and 6.5. Gait variability was indexed by standard deviation (SD) and coefficient of variation (CV=SD/mean) of step time, step length, and step width. Average gait parameters were significantly correlated with EDSS (ρ=0.756–0.609) and were significantly different in individuals with MS compared to controls (p≤0.002). Also, step length (p<0.001) and step time (p<0.001) variability were both significantly greater in MS compared to controls. EDSS was positively correlated with step length variability and individuals with MS who used assistive devices to walk had significantly greater step length variability than those who walked independently (p's<.05). EDSS was correlated with step time and length variability even when age was taken into account. Additionally, Fisher's z test of partial correlations revealed that average gait parameters were more closely related to disability status than gait variability in individuals with MS. This suggests that focusing on average gait parameters may be more important than variability in therapeutic interventions in MS.
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Highlights

► Persons with multiple Sclerosis have greater gait variability than controls.
► Gait variability is associated with disability in persons with multiple sclerosis.
► Average spatiotemporal gait parameters are more closely related to disability than variability metrics.
Abstract
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Old 18th December 2012, 11:38 AM
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Default Re: Gait impairment in multiple sclerosis

Accelerometry as a measure of walking behavior in multiple sclerosis.
Motl RW, Pilutti L, Sandroff BM, Dlugonski D, Sosnoff JJ, Pula JH.
Acta Neurol Scand. 2012 Dec 13.
Quote:
OBJECTIVE:
Accelerometry has been identified as a possible ecologically valid and objective approach for measuring community ambulation in multiple sclerosis (MS). This study provides a validation of accelerometer output based on associations with Expanded Disability Status Scale (EDSS), Patient Determined Disease Steps (PDDS) Scale, and Multiple Sclerosis Walking Scale-12 (MSWS-12) scores, timed 25-foot walk (T25FW) and 6-min walk (6MW) performance, oxygen cost (O(2) cost) of walking, and spatial and temporal parameters of gait.

MATERIALS AND METHODS:
256 persons with MS completed the PDDS and MSWS-12, underwent an examination for the generation of an EDSS score, undertook two T25FW tests and a 6MW while wearing a portable metabolic unit for measuring the O(2) cost of walking, completed two trials of comfortable walking on a GAITRite electronic walkway for measuring spatial and temporal parameters of gait, and then wore an Actigraph accelerometer during the waking hours of a 7-day period.

RESULTS:
The accelerometer output was significantly correlated with EDSS (ρ = -0.522), PDDS (ρ = -0.551), and MSWS-12 (ρ = -0.617) scores, T25FW (ρ = -0.595) and 6MW (ρ = 0.630) performance, and O(2) cost of walking (ρ = -0.457). Regarding gait parameters, the accelerometer output was significantly correlated with velocity (ρ = 0.420), cadence (ρ = 0.349), step time (ρ = -0.353), step length (ρ = 0.395), double support (ρ = -0.424), and single support (ρ = 0.400).

CONCLUSION:
We provide comprehensive evidence from a large sample of persons with MS that further supports accelerometry as a measure of walking behavior.
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Old 15th February 2013, 03:29 PM
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Default Re: Gait impairment in multiple sclerosis

Quantification of gait kinematics and walking ability of people with multiple sclerosis who are new users of functional electrical stimulation.
Scott SM, van der Linden ML, Hooper JE, Cowan P, Mercer TH.
J Rehabil Med. 2013 Feb 14.
Quote:
Objective: To assess whether the application of Functional Electrical Stimulation improves gait kinematics and walking ability in people with multiple sclerosis who experience foot drop.

Design: Acute open labelled comparative observation trial.

Participants: Twelve people (3 females, 9 males, EDSS 2-4) with relapsing remitting multiple sclerosis (47.8 years (standard deviation 6.6)) who were new users of functional electrical stimulation. Methods: Gait kinematics were recorded using 3D gait analysis. Walking ability was assessed through the 10-m walk test and the 6-min walk test. All assessments were performed with and without the assistance of functional electrical stimulation. The effect of functional electrical stimulation was analysed using paired t-tests.

Results: Ankle dorsiflexion at initial contact (p = 0.026), knee flexion at initial contact (p = 0.044) and peak knee flexion during swing (p = 0.011) were significantly greater whilst walking with Functional Electrical Stimulation. The increased peak dorsiflexion in swing of nearly 4 degrees during functional electrical stimulation assisted walking approached significance (p = 0.069). The 10-m walk time was significantly improved by functional electrical stimulation (p = 0.004) but the 6 min walk test was not.

Conclusion: The acute application of functional electrical stimulation resulted in an orthotic effect through a change in ankle and knee kinematics and increased walking speed over a short distance in people with multiple sclerosis who experience foot drop.
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Old 22nd February 2013, 02:28 PM
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Default Re: Gait impairment in multiple sclerosis

Repeatability of the timed 25-foot walk test for individuals with multiple sclerosis.
Larson RD, Larson DJ, Baumgartner TB, White LJ.
Clin Rehabil. 2013 Feb 20
Quote:
Objective:The purpose of this study was to determine if there is a practice effect present in the timed 25-foot walk in ambulatory individuals with multiple sclerosis.

Design:Thirty six people (30 women and 6 men) diagnosed with relapsing remitting multiple sclerosis participated in two testing sessions, one week apart. Each participant performed two sequential trials of the timed 25-foot walk test per session and the walk performance was measured with a laser timing system.

Results:We observed improvements in walking speed between the two trials of session one (trial one: 6.42 (0.09) vs. trail two: 5.97 (0.08) seconds, p < 0.001). Within session two, performance remained stable (trial three: 5.71 (0.07) vs. trial four: 5.63 (0.07) seconds, p > 0.05). We also observed a significant improvement in walking speed when averages of the two trials were compared across sessions (session 1: 6.19 (0.09) vs. session 2: 5.67 (0.07) seconds, p < 0.01).

Conclusions:Based on our results, familiarization of the timed 25-foot walk test improves stability of walk performance scores in ambulatory individuals with relapsing remitting multiple sclerosis.
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Old 8th March 2013, 06:26 PM
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Default Re: Gait impairment in multiple sclerosis

Gait Variability and Multiple Sclerosis
Michael J. Socie and Jacob J. Sosnoff
Multiple Sclerosis International Volume 2013 (2013), (full text review article)
Quote:
Gait variability, that is, fluctuations in movement during walking, is an indicator of walking function and has been associated with various adverse outcomes such as falls. In this paper, current research concerning gait variability in persons with multiple sclerosis (MS) is discussed. It is well established that persons with MS have greater gait variability compared to age and gender matched controls without MS. The reasons for the increase in gait variability are not completely understood. Evidence indicates that disability level, assistive device use, attentional requirement, and fatigue are related to gait variability in persons with MS. Future research should address the time-evolving structure (i.e., temporal characteristics) of gait variability, the clinical importance of gait variability, and underlying mechanisms that drive gait variability in individuals with MS.
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Old 16th March 2013, 01:18 PM
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Default Re: Gait impairment in multiple sclerosis

Correlation analysis of visual analogue scale and measures of walking ability in multiple sclerosis patients.
Filipović Grčić P, Matijaca M, Bilić I, Džamonja G, Lušić I, Caljkušić K, Capkun V.
Acta Neurol Belg. 2013 Mar 14.
Quote:
Walking limitation assessment in multiple sclerosis patients (MSPs) is a demanding task, especially in the clinical setting. The aim of this study is to correlate the visual analogue scale (VAS), a simple method for measuring subjective experience, with measures of walking ability used in clinical research of MS. The study included 82 ambulatory MSPs who have resided in the local community. The applied measures of walking ability were the following: the single-item and patient-rated Walking Ability Visual Analogue Scale (WA-VAS), the Expanded Disability Status Scale (EDSS), the 25-foot walk test (25FWT), the Six Spot Step Test (SSST), the 2 min timed walk (2 min TW), the Multiple Sclerosis Walking Scale-12 (MSWS-12), and step activity monitor accelerometer (SAM) during 7 day period. The SAM analysis included the average daily step count, the average steps/min of the highest 1 min of a day, and the average steps/min of the highest continuous 60 min of a day. The WA-VAS scores significantly and strongly correlated with EDSS (ρ = 0.679, P < 0.001), 25FWT (ρ = 0.606, P < 0.001), SSST (ρ = 0.729, P < 0.001), 2 min TW (ρ = -0.643, P < 0.001), MSWS-12 (ρ = 0.746, P < 0.001), average daily step count (ρ = -0.507, P < 0.001), average steps/min of the highest 1 min of a day (ρ = -0.544, P < 0.001), and average steps/min of the highest continuous 60 min of a day (ρ = -0.473, P < 0.001). Correlations between WA-VAS and measures of walking ability used in clinical research of MS were satisfactory. The results obtained in this research indicate that the WA-VAS could be an instrument for simple measurement of walking limitations in MSPs in the clinical setting.
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Old 29th March 2013, 07:14 AM
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Default Re: Gait impairment in multiple sclerosis

Timed 25-Foot Walk: Direct evidence that improving 20% or greater is clinically meaningful in MS.
Hobart J, Blight AR, Goodman A, Lynn F, Putzki N.
Neurology. 2013 Mar 27.
Quote:
OBJECTIVE:
In this study, we used data from clinical trials of dalfampridine (fampridine outside the United States) to re-examine the clinical meaningfulness of Timed 25-Foot Walk (T25FW) changes.

METHODS:
Pooled data were analyzed from 2 phase III randomized placebo-controlled clinical trials of dalfampridine in multiple sclerosis (MS) (n = 533). Walking speed (T25FW) and patient-reported walking ability (MS Walking Scale-12 [MSWS-12]) were measured, concurrently, multiple times before and during treatment. We examined T25FW speed variability within and between visits, correlations of T25FW speed with MSWS-12 score, and changes in MSWS-12 (mean scores, effect sizes) associated with percent T25FW changes.

RESULTS:
T25FW speed variability was small (within- and between-visit averages = 7.2%-8.7% and 14.4%-16.3%). Correlations between T25FW and MSWS-12 values were low (-0.20 to -0.30), but relatively stronger between their change values (-0.33 to -0.41). Speed improvements of >20%, and possibly 15%, were associated with clinically meaningful changes in self-reported walking ability using MSWS-12 change score and effect size criteria.

CONCLUSIONS:
This study builds on existing research and provides direct evidence that improvements in T25FW speed of ≥20% are meaningful to people with MS. The dalfampridine data enabled examinations previously not possible, including spontaneous and induced speed changes, speed change anchored to change in self-reported walking ability, and a profile of speed changes. Results support the T25FW as a clinically meaningful outcome measure for MS clinical trials.
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Old 2nd April 2013, 02:34 PM
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Default Re: Gait impairment in multiple sclerosis

From latest LER:
Kickboxing: A creative approach to improving balance in patients with MS
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Old 23rd April 2013, 03:59 AM
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Default Re: Gait impairment in multiple sclerosis

A Feasibility Study to Investigate the Effect of Functional Electrical Stimulation and Physiotherapy Exercise on the Quality of Gait of People With Multiple Sclerosis.
Taylor P, Barrett C, Mann G, Wareham W, Swain I.
Neuromodulation. 2013 Apr 19.
Quote:
OBJECTIVE:
To examine the effect of Functional Electrical Stimulation (FES) for dropped foot and hip instability in combination with physiotherapy core stability exercises.

METHODS:
Twenty-eight people with secondary progressive multiple sclerosis and unilateral dropped foot participated in a randomized crossover trial. Group1 received FES for correction of dropped foot for six weeks with the addition of hip extension for a further six weeks. In weeks 12-18, FES was continued with the addition of eight sessions of core stability physiotherapy with home-based exercise. FES and home-based exercise were continued until weeks 19-24. Group 2 received the same physiotherapy intervention over the first 12 weeks, adding FES in the second 12 weeks.

RESULTS:
FES improved walking speed and Rivermead Observational Gait Analysis (ROGA) score, whereas physiotherapy did not. Adding gluteal stimulation further improved ROGA score. Both interventions reduced falls, but adding FES to physiotherapy reduced them further. FES had greater impact on Multiple Sclerosis Impact Scale, MSIS-29.

CONCLUSION:
The intervention was feasible. FES for dropped foot may improve mobility and quality of life and may reduce falls. Adding gluteal stimulation further improved gait quality. Adding physiotherapy may have enhanced the effect of FES, but FES had the dominant effect.
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Old 4th May 2013, 06:51 AM
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Default Re: Gait impairment in multiple sclerosis

Validity of the Dynamic Gait Index in People With Multiple Sclerosis.
Forsberg A, Andreasson M, Nilsagård YE.
Phys Ther. 2013 May 2.
Quote:
BACKGROUND:
Evaluation of walking capacity and risk of falls in people with multiple sclerosis (PwMS) are often performed in rehabilitation. The Dynamic Gait Index (DGI) evaluates walking during different tasks, but the feasibility in identifying persons at risk of falls needs to be further investigated.

OBJECTIVE:
1) investigate construct validity of the DGI: known-groups, convergent, discriminant; 2) the accuracy of predicting falls and establishing a cut-off point to identify fallers.

DESIGN:
A multi-centre, cross-sectional study.

METHODS:
A convenience sample of 81 PwMS with subjective gait and balance impairment but still able to walk 100 meters (comparable with EDSS 1-6). Mean age was 49 years, 76% were women. The 25-foot Timed Walk test, Timed Up and Go test, Four Square Step Test, Timed sit-to-stand test, MS Walking scale, Multiple Sclerosis Impact Scale (MSIS), and self-reported falls during the previous two months were used for validation, establishing cut-off point for identifying fallers and to investigate predictive values.

RESULTS:
Significantly lower DGI scores (p≤0.001) was found for participants reporting falls (n=31). High sensitivity (87%) in identifying fallers was found with cut-off score ≤19. The positive predictive value was 50% and the negative predictive value 87%. The convergent validity was moderate to strong (rho=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 MSIS.

LIMITATIONS:
The sample included ambulatory persons participating in a randomized controlled trial investigating balance training.

CONCLUSIONS:
The DGI is a valid measure of dynamic balance during walking for ambulatory persons with MS. With the cut-off point of ≤19, sensitivity was high in identifying persons at risk of falls.
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Old 22nd July 2013, 06:25 PM
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Default Re: Gait impairment in multiple sclerosis

Gait characteristics of multiple sclerosis patients in the absence of clinical disability

Leandro Alberto Calazans Nogueira et al
Disability and Rehabilitation August 2013, Vol. 35, No. 17 , Pages 1472-1478
Quote:
Purpose: Motor deficits in lower extremities and gait abnormalities are a major feature of the multiple sclerosis (MS) patients. Patients with minimal clinical disability have subtle gait changes. The aim of this study was to analyze the gait characteristics of MS patients in the absence of clinical disability.

Method: A case–control study was carried out with 12 MS patients and 12 matched healthy controls. The subjects underwent a clinical neurological evaluation to determine their disability level (EDSS ≤ 1.5). Then, the subjects were referred for completion self-report questionnaires (gait, perceived balance confidence, physical activity and fatigue), gait clinical trials, and 3D kinematic analysis.

Results: MS patients showed more impairment of perceived fatigue, perceived of walking impact and perceived balance confidence, despite having no disability. Gait characteristics showed no differences when they were determined by clinical observation. The 3D kinematic analysis of gait showed slight but significant changes in ankle movement.

Conclusion: MS patients with no clinical disability have discrete changes in gait that can be evidenced by perceived impact on walking and kinematic evaluation, mainly of ankle movement. Moreover, there is a decrease in perceived balance confidence and an increase in perceived fatigue, which are correlated despite having different origins.
Quote:
Implications for Rehabilitation

Multiple sclerosis patients showed changes in gait pattern even with no clinical disability.

The reduction of plantar flexion movement at toe off may be the first compensatory strategy on early phases of disease.

Fatigue, higher walking impact, and less balance confidence are early symptoms of Multiple Sclerosis.
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Old 9th August 2013, 12:02 PM
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Default Re: Gait impairment in multiple sclerosis

Gait Disorders in Multiple Sclerosis
Bethoux, Francois MD
CONTINUUM: Lifelong Learning in Neurology: August 2013 - Volume 19 - Issue 4, Multiple Sclerosis - p 1007-1022
Quote:
Purpose of Review: Ambulation, and more broadly mobility, is frequently affected by multiple sclerosis (MS). The purpose of this review is to present recent developments regarding the impact, outcome measures, and management of gait disorders in MS.Recent Findings: Recently published surveys have confirmed the high prevalence of walking limitations in MS and their impact on the functional status and quality of life of MS patients and their families. Validated clinical outcome measures include the Timed 25-Foot Walk, 6-Minute Walk, and Multiple Sclerosis Walking Scale-12. Further characterization of gait disorders is allowed by gait analysis systems, as well as pedometers and oscillometers that measure walking in the patient’s daily life. A growing body of evidence demonstrates the benefits of various rehabilitation interventions on walking performance. Dalfampridine, an extended-release formulation of 4-aminopyridine, is the first symptomatic medication indicated to improve walking in patients with MS. Newer assistive devices, such as the hip flexion assist device and functional electrical stimulation devices, show promising results in preliminary studies. Various treatments for spasticity can be used without compromising ambulation, but their ability to enhance gait needs to be further assessed.Summary: Gait disorders need to be identified and managed early in the course of MS, using a multimodal approach that needs to be adjusted over time based on the results of periodic assessments.
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Old 2nd September 2013, 02:52 PM
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Default Re: Gait impairment in multiple sclerosis

From Lower Extremity Review:
MS and gait: Assessment facilitates opportunity
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Old 16th September 2013, 03:06 PM
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Default Re: Gait impairment in multiple sclerosis

Delayed Recovery of Leg Fatigue Symptoms Following a Maximal Exercise Session in People With Multiple Sclerosis
Helen Dawes et al
Neurorehabil Neural Repair September 11, 2013
Quote:
Background. Fatigue is a chronic symptom for people with multiple sclerosis (PwMS). Objective. Symptoms of fatigue were investigated during and following a single exercise session.

Methods. In all, 58 PwMS and 15 healthy, low-active controls performed a cycle ergometer incremental exercise test to voluntary exhaustion. Physiological intensity (expired air and heart rate), perceived breathlessness, and leg fatigue (Rating of Perceived Exertion [RPE] CR-10 Scale) were measured during and for 10 minutes following exercise. Measures of baseline disability (Barthel Index), activity (Physical Activity Scale for the Elderly), vitality (Subjective Vitality Scale), and general fatigue (Fatigue Severity Scale [FSS]) were recorded.

Results. PwMS had reduced exercise capacity (P = .00 to .01), but sensations of breathlessness and leg fatigue were the same at voluntary exercise termination in both groups (P = .09). PwMS with fatigue (FSS ≥ 4) exhibited reduced exercise capacity (P = .03 to .05) but reached the same physiological intensity, breathlessness, and leg fatigue symptoms at test termination as nonfatigued peers (P = .16 to .59). During recovery, there was no difference in observed means between groups, except for leg RPE, which was higher in the MS group (P = .047) and higher at 3 and 5 minutes after exercise in the fatigued MS group (P = .02). Physiological markers and breathlessness recovered at the same rate in both groups (P = .33 to .67).

Conclusion. Monitoring leg fatigue symptoms during and through recovery from physical activities may help guide participation in physical activities for PwMS, particularly in people managing high levels of fatigue.
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