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Quantifying gait impairment using an instrumented treadmill in people with multiple sclerosis.

ABSTRACT: Background and Objective. Treadmill gait analysis has been proposed as an attractive alternative for overground walking measuring systems. The purpose of this study was twofold: first to determine spatiotemporal parameters of treadmill gait in patients with multiple sclerosis (MS) and second to examine whether these parameters are associated with specific functional impairments in this cohort. Method. Eighty-seven relapsing-remitting patients diagnosed with MS, 50 women and 37 men, aged 40.9 ± 11.9 with an expanded disability status scale (EDSS) score of 2.7 ± 1.6, participated in this study. Twenty-five apparently healthy subjects, 14 women and 11 men, aged 38.5 ± 9.4, served as controls. Spatiotemporal gait parameters were obtained using the Zebris FDM-T Treadmill (Zebris Medical GmbH, Germany). People with MS demonstrated significantly shorter steps, extended stride time, wider base of support, longer step time, reduced single support phase, and a prolonged double support phase compared to the healthy controls. The EDSS score was significantly correlated with all spatiotemporal gait parameters. Conclusion. The instrumented treadmill may be an effective tool in assessing ambulation capabilities of people with MS.

SUBMITTER: Kalron A

PROVIDER: S-EPMC3708434 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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Quantifying gait impairment using an instrumented treadmill in people with multiple sclerosis.

Kalron Alon A Dvir Zeevi Z Frid Lior L Achiron Anat A

ISRN neurology 20130625

Background and Objective. Treadmill gait analysis has been proposed as an attractive alternative for overground walking measuring systems. The purpose of this study was twofold: first to determine spatiotemporal parameters of treadmill gait in patients with multiple sclerosis (MS) and second to examine whether these parameters are associated with specific functional impairments in this cohort. Method. Eighty-seven relapsing-remitting patients diagnosed with MS, 50 women and 37 men, aged 40.9 ± 1 ...[more]

PMID: 23878746

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Project description:Fatigue is one of the most limiting symptoms in people with multiple sclerosis (pwMS) and can be subdivided into trait and state fatigue. Activity-induced state fatigue describes the temporary decline in motor and/or cognitive performance (motor and cognitive performance fatigability, respectively) and/or the increase in the perception of fatigue (perceived fatigability) in response to motor or cognitive tasks. To the best of our knowledge, the effects of a 6-min walk test (6MWT), which was often used to assess motor performance fatigability in pwMS, on motor-cognitive dual-task performance (i.e., walking + arithmetic task) and prefrontal cortex (PFC) hemodynamics are not well-known. This is of importance, since daily activities are often performed as multitasks and a worse dual-task walking performance is associated with an increased risk of falling. Consequently, we investigated the effect of a fast 6MWT (comfort velocity + 15%) performed on a treadmill on motor-cognitive performance fatigability (spatio-temporal gait parameters/accuracy during the arithmetic task) and perceived fatigability measures (rating of perceived exhaustion; RPE) as well as PFC hemodynamics recorded during dual-task walking in pwMS and healthy controls (HCs). Twenty pwMS (48.3 ± 9.0 years; 13 females/7 males; expanded disability status scale 2.7 ± 1.0, first diagnosis 13.8 ± 8.8 years) and 24 HC with similar age and sex (48.6 ± 7.9 years; 17 females/7 males) were included. Only cognitive performance fatigability (increased error rate) during dual-task walking was found after the fast 6MWT on the treadmill in pwMS. However, the changes in gait parameters did not indicate motor performance fatigability, although both the groups reported perceived fatigability (increased RPE) after the fast 6MWT. Moreover, no change in the PFC activation was detected in both groups. Our results suggest that the intensity and/or duration of the fast 6MWT was not sufficient to induce motor performance fatigability in pwMS. These factors should be addressed by future studies on this topic, which should also consider further parameters, e.g., muscular oxygenation and/or myoelectrical activity, to verify that exercise intensity and/or duration was appropriate to induce motor performance fatigability in pwMS.Clinical trial registerDRKS00021057.

Project description:Despite the emerging use of treadmills integrated with pressure platforms as outcome tools in both clinical and research settings, published evidence regarding the measurement properties of these new systems is limited. This study evaluated the within- and between-day repeatability of spatial, temporal and vertical ground reaction force parameters measured by a treadmill system instrumented with a capacitance-based pressure platform.Thirty three healthy adults (mean age, 21.5?±?2.8 years; height, 168.4?±?9.9 cm; and mass, 67.8?±?18.6 kg), walked barefoot on a treadmill system (FDM-THM-S, Zebris Medical GmbH) on three separate occasions. For each testing session, participants set their preferred pace but were blinded to treadmill speed. Spatial (foot rotation, step width, stride and step length), temporal (stride and step times, duration of stance, swing and single and double support) and peak vertical ground reaction force variables were collected over a 30-second capture period, equating to an average of 52?±?5 steps of steady-state walking. Testing was repeated one week following the initial trial and again, for a third time, 20 minutes later. Repeated measures ANOVAs within a generalized linear modelling framework were used to assess between-session differences in gait parameters. Agreement between gait parameters measured within the same day (session 2 and 3) and between days (session 1 and 2; 1 and 3) were evaluated using the 95% repeatability coefficient.There were statistically significant differences in the majority (14/16) of temporal, spatial and kinetic gait parameters over the three test sessions (P?<?.01). The minimum change that could be detected with 95% confidence ranged between 3% and 17% for temporal parameters, 14% and 33% for spatial parameters, and 4% and 20% for kinetic parameters between days. Within-day repeatability was similar to that observed between days. Temporal and kinetic gait parameters were typically more consistent than spatial parameters. The 95% repeatability coefficient for vertical force peaks ranged between?±?53 and?±?63 N.The limits of agreement in spatial parameters and ground reaction forces for the treadmill system encompass previously reported changes with neuromuscular pathology and footwear interventions. These findings provide clinicians and researchers with an indication of the repeatability and sensitivity of the Zebris treadmill system to detect changes in common spatiotemporal gait parameters and vertical ground reaction forces.

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Quantifying gait impairment using an instrumented treadmill in people with multiple sclerosis.

Publications

Quantifying gait impairment using an instrumented treadmill in people with multiple sclerosis.

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