Gait Re-education in Multiple Sclerosis(MS)
- 1 Introduction
- 2 Characteristics of the gait patterns of individuals with MS
- 3 Physiotherapy Management
- 4 References
Multiple Sclerosis (MS) is an autoimmune disorder which causes chronic inflammation that affects the central nervous system (CNS). It can lead to severe disability as it affects motor-, sensory -, automatic- and neurocognitive function. About 1 million individuals suffer from MS in the USA alone and seem to be more common in individuals between 20-50 years of age. Women are also 3 times more likely to develop MS than men.
Individuals with MS mainly present with the following symptoms;
Characteristics of the gait patterns of individuals with MS
The severity is dependent on the extent of impairments present. These impairments may often lead to compensatory gait patterns such as;
- Reduced gait speed
- Swing phase: Circumduction and vaulting during swing phase in order to ensure toe-clearance
- Stance phase: Hyperextension of the knee in order to compensate for reduced passive ankle dorsiflexion range of motion (ROM)
- Lateral sway of trunk
- Uncoordinated movements
- Reduced gait stability and balance
- Head sway
These compensatory gait patterns are commonly due to underlying weakness and restricted joint ROM and contractures.
Common outcome measures such as the timed-up-and-go or the six-minute walk test (6MWT) are great to assess functional mobility but are limited when assessing the quality of gait. Assessing the quality of the individual’s gait pattern is highly dependent on the observer.
Early detection of gait abnormalities. targeted rehabilitation interventions to address the underlying primary gait restrictions that cause gait impairments and not the compensatory patterns.
1. Tone & Spasticity
- Passive sustained stretches
- Joint compressions and weight-bearing
- Strengthening synergistic muscles
2. Range of motion (ROM)
One of the main reasons for the presence of ataxic gait patterns among individuals with MS is due to contractures in the ankle joints. By maintaining or improving joint ROM, compensatory patterns may be prevented.
- Passive ROM movement conducted by the physiotherapist.
- Active & active-assisted ROM exercises conducted by physiotherapist and individual with MS.
By improving trunk and general lower limb strength, especially active dorsiflexion, compensatory patterns may be prevented. Resistance training is also proven to effectively improve gait patterns among individuals with MS.
- Isometric-, eccentric- and concentric strengthening exercises.
- Resistance training (elastic bands, weights).
4. Balance & Coordination
Improving balance and coordination is essential for safe and independent mobility.
5. Sensory & proprioceptive retraining
Sensory and proprioceptive retraining is important in order to effectively improve balance and reduce the risk of falling.
- Brush therapy (using different textures and lightly brush over affected and unaffected surfaces on the skin).
- Mirror therapy (4 to 6 times per day).
- Recognizing and discriminating different shapes and sizes of objects.
6. Treadmill training
Body-weight supported treadmill training (BWSTT) is also proven to effectively improve gait among individuals with MS.
Hydrotherapy is proven to effectively treat pain among individuals with MS as well as ROM, strengthening and functional training among individuals suffering from neurological conditions such as MS.
8. Robotic-assisted gait training
More and more research is indicating the effectiveness of robotic-assisted gait training especially because it improves endurance and balance. It's also proven to reduce depression and therefore improve quality of life (QoL)
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