Gait Re-education in Multiple Sclerosis(MS)
Introduction[edit | edit source]
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[1]. 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[2].
Individuals with MS mainly present with the following symptoms;
- Muscle weakness,
- Sensory disturbances,
- Spasticity, and
- Ataxic movement patterns[3].
Characteristics of the gait patterns of individuals with MS[edit | edit source]
Individuals with MS often present with gait ataxia[4], which may increase their risk of falling and affect their independence with locomotive tasks.
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[5].
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[5].
Physiotherapy Management[edit | edit source]
Early detection of gait abnormalities. targeted rehabilitation interventions to address the underlying primary gait restrictions that cause gait impairments and not the compensatory patterns[5].
1. Tone & Spasticity[edit | edit source]
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2. Range of motion (ROM)[edit | edit source]
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.
3. Strength[edit | edit source]
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4. Balance & Coordination[edit | edit source]
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5. Treadmill training[edit | edit source]
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6. Hydrotherapy[edit | edit source]
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7. Robotic-assisted gait training[edit | edit source]
- ↑ Sospedra M, Martin R. Immunology of multiple sclerosis. Annu. Rev. Immunol.. 2005 Apr 23;23:683-747.
- ↑ National Multiple Sclerosis Society. Who gets MS (epidemiology)
- ↑ Straudi S, Fanciullacci C, Martinuzzi C, Pavarelli C, Rossi B, Chisari C, Basaglia N. The effects of robot-assisted gait training in progressive multiple sclerosis: a randomized controlled trial. Multiple Sclerosis Journal. 2016 Mar;22(3):373-84
- ↑ Kelleher KJ, Spence W, Solomonidis S, Apatsidis D. The characterisation of gait patterns of people with multiple sclerosis. Disability and rehabilitation. 2010 Jan 1;32(15):1242-50.
- ↑ 5.0 5.1 5.2 Psarakis M, Greene DA, Cole MH, Lord SR, Hoang P, Brodie M. Wearable technology reveals gait compensations, unstable walking patterns and fatigue in people with multiple sclerosis. Physiological measurement. 2018 Jul 13;39(7):075004.
