Article

Limited walking ability is an important problem for patients with
multiple sclerosis. A better understanding of how gait impairments lead to
limited walking ability may help to develop more targeted interventions. Although
gait classifications are available in cerebral palsy and stroke, relevant
knowledge in MS is scarce.
The aims of this study were: (1) to
identify distinctive gait patterns in patients with MS based on a combined
evaluation of kinematics, gait features, and muscle activity during walking and
(2) to determine the clinical relevance of these gait patterns. DESIGN: This was
a cross-sectional study of 81 patients with MS of mild-to-moderate severity
(Expanded Disability Status Scale [EDSS] median score=3.0, range=1.0-7.0) and an
age range of 28 to 69 years. METHOD: The patients participated in 2-dimensional
video gait analysis, with concurrent measurement of surface electromyography and
ground reaction forces. A score chart of 73 gait items was used to rate each gait
analysis. A single rater performed the scoring. Latent class analysis was used to
identify gait classes. RESULTS: Analysis of the 73 gait variables revealed that 9
variables could distinguish 3 clinically meaningful gait classes. The 9 variables
were: (1) heel-rise in terminal stance, (2) push-off, (3) clearance in initial
swing, (4) plantar-flexion position in mid-swing, (5) pelvic rotation, (6)
arm-trunk movement, (7) activity of the gastrocnemius muscle in pre-swing, (8)
M-wave, and (9) propulsive force. The EDSS score and gait speed worsened in
ascending classes. LIMITATIONS: Most participants had mild-to-moderate
limitations in walking ability based on their EDSS scores, and the number of
walkers who were severely limited was small. CONCLUSIONS: Based on a small set of
9 variables measured with 2-dimensional clinical gait analysis, patients with MS
could be divided into 3 different gait classes. The gait variables are suggestive
of insufficient ankle push-off.
CI - (c) 2016 American Physical Therapy Association.

Langue : ANGLAIS