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Brain Sciences
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Gait Pathology in Multiple Sclerosis: Functional Assessments and Therapeutic Interventions
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Gait Pathology in Multiple Sclerosis: Functional Assessments and Therapeutic Interventions

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Sensory and Motor Neuroscience".

Deadline for manuscript submissions: closed (15 December 2021) | Viewed by 26954

Special Issue Editors

Dr. Linard Filli

E-Mail Website
Guest Editor
Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
Interests: gait; locomotion; neurorehabilitation; neural plasticity; neural control of movements; multiple sclerosis; spinal cord injury
Dr. Björn Zörner

E-Mail Website
Guest Editor
Balgrist University Hospital, Zurich, Switzerland
Interests: spinal cord; spinal cord injury; cerebrovascular diseases; gait disturbances

Special Issue Information

Dear Colleagues,

Walking dysfunction and impaired mobility is frequent among people with multiple sclerosis (PwMS) and represents a major burden for them. Given the high incidence of gait disorder in PwMS, restoration of walking function is a main objective in this field of research. Advanced assessments of gait function including both quantitative (i.e., measuring gait performance) and qualitative (i.e., assessing gait patterns) functional outcomes are increasingly used to track disease progression, to guide treatment decisions and to quantify the efficacy of therapeutic interventions in an objective and sensitive fashion. Moreover, instrumented gait analysis using state-of-the-art technology is able to shed some light onto the neural mechanisms underlying gait pathology in MS.

Treatment options for MS-related ambulatory impairments are currently limited to physical therapy and symptomatic treatments (e.g., anti-spastic agents). Advanced functional outcomes might assist the selection and development of tailored therapeutic interventions, thereby enhancing walking performance in PwMS.

This Special Issue of Brain Sciences is dedicated to highlighting current research advancements in the field of MS-related gait dysfunction and rehabilitation. Authors are invited to submit cutting-edge original research and reviews broaching the topics of gait impairment profiling, novel rehabilitative strategies, refinement of functional outcome measures, neural mechanisms underlying walking abnormalities and related areas.  

Dr. Linard Filli
Dr. Björn Zörner
Guest Editors

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Keywords

  • Gait dysfunction
  • Multiple sclerosis
  • Functional assessment
  • Treatments
  • Neurorehabilitation
  • Neural movement control

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Published Papers (6 papers)

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Research

11 pages, 1698 KiB  
Article
Intensive Neurorehabilitation and Gait Improvement in Progressive Multiple Sclerosis: Clinical, Kinematic and Electromyographic Analysis
by Su-Chun Huang, Simone Guerrieri, Gloria Dalla Costa, Marco Pisa, Giulia Leccabue, Lorenzo Gregoris, Giancarlo Comi and Letizia Leocani
Brain Sci. 2022, 12(2), 258; https://doi.org/10.3390/brainsci12020258 - 12 Feb 2022
Cited by 8 | Viewed by 3233
Abstract
Background: Gait deficit is a hallmark of multiple sclerosis and the walking capacity can be improved with neurorehabilitation. Technological advances in biomechanics offer opportunities to assess the effects of rehabilitation objectively. Objective: Combining wireless surface electromyography and wearable inertial sensors to assess and [...] Read more.
Background: Gait deficit is a hallmark of multiple sclerosis and the walking capacity can be improved with neurorehabilitation. Technological advances in biomechanics offer opportunities to assess the effects of rehabilitation objectively. Objective: Combining wireless surface electromyography and wearable inertial sensors to assess and monitor the gait pattern before and after an intensive multidisciplinary neurorehabilitation program (44 h/4weeks) to evaluate rehabilitation efficiency. Methods: Forty people with progressive multiple sclerosis were enrolled. Wireless wearable devices were used to evaluate the gait. Instrumental gait analysis, clinical assessment, and patient report outcome measures were acquired before and after the neurorehabilitation. Spatiotemporal gait parameters, the co-activation index of lower limb muscles, and clinical assessments were compared pre- and post-treatment. Results: Significant improvements after intensive neurorehabilitation were found in most of the clinical assessments, cadence, and velocity of the instrumental gait analysis, paralleled by amelioration of thigh co-activation on the less-affected side. Subjects with better balance performance and higher independence at baseline benefit more from the neurorehabilitation course. Conclusions: Significant improvements in gait performance were found in our cohort after an intensive neurorehabilitation course, for both quantitative and qualitative measures. Integrating kinematic and muscle activity measurements offers opportunities to objectively evaluate and interpret treatment effects. Full article
(This article belongs to the Special Issue Gait Pathology in Multiple Sclerosis: Functional Assessments and Therapeutic Interventions)
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14 pages, 1044 KiB  
Article
Impact of Moderate Individually Tailored Physical Activity in Multiple Sclerosis Patients with Fatigue on Functional, Cognitive, Emotional State, and Postural Stability
by Justyna Redlicka, Ewa Zielińska-Nowak, Anna Lipert and Elżbieta Miller
Brain Sci. 2021, 11(9), 1214; https://doi.org/10.3390/brainsci11091214 - 15 Sep 2021
Cited by 6 | Viewed by 3939
Abstract
Multiple sclerosis (MS) is a chronic disease, with fatigue syndrome as one of the main symptoms. The aim of this study was to demonstrate that moderate physical activity (MPA) may have a beneficial effect on postural stability, balance, and clinical parameters. The research [...] Read more.
Multiple sclerosis (MS) is a chronic disease, with fatigue syndrome as one of the main symptoms. The aim of this study was to demonstrate that moderate physical activity (MPA) may have a beneficial effect on postural stability, balance, and clinical parameters. The research group consisted of 137 randomized patients hospitalized at the Department of Neurological Rehabilitation, Medical University of Lodz. Finally, 76 patients were qualified who were divided into two groups—high fatigue (HF) and low fatigue (LF). Participants were assessed twice: before and after a 4-week MPA program using: the Expanded Disability Status Scale (EDSS), the Fatigue Severity Scale (FSS), the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), and the Geriatric Depression Scale (GDS), and stabilometric platform tests were performed. Results obtained after the 4-week MPA program showed a positive effect of the MPA with differences between LF and HF groups. The MPA was more effective in MS patients with LF in cognitive functions, functional status, and postural stability but among HF patients in an emotional state, especially in MS patients below 65 years, although in total, both groups benefited from the MPA. Full article
(This article belongs to the Special Issue Gait Pathology in Multiple Sclerosis: Functional Assessments and Therapeutic Interventions)
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11 pages, 690 KiB  
Article
Motor Imagery of Walking in People Living with and without Multiple Sclerosis: A Cross-Sectional Comparison of Mental Chronometry
by Douglas A. Wajda, Tobia Zanotto and Jacob J. Sosnoff
Brain Sci. 2021, 11(9), 1131; https://doi.org/10.3390/brainsci11091131 - 26 Aug 2021
Cited by 3 | Viewed by 2650
Abstract
Motor imagery represents the ability to simulate anticipated movements mentally prior to their actual execution and has been proposed as a tool to assess both individuals’ perception of task difficulty as well as their perception of their own abilities. People with multiple sclerosis [...] Read more.
Motor imagery represents the ability to simulate anticipated movements mentally prior to their actual execution and has been proposed as a tool to assess both individuals’ perception of task difficulty as well as their perception of their own abilities. People with multiple sclerosis (pwMS) often present with motor and cognitive dysfunction, which may negatively affect motor imagery. In this cross-sectional study, we explored differences in motor imagery of walking performance between pwMS (n = 20, age = 57.1 (SD = 8.6) years, 55% female) and age- and sex-matched healthy controls (n = 20, age = 58.1 (SD = 7.0) years, 60% female). Participants underwent mental chronometry assessments, a subset of motor imagery, which evaluated the difference between imagined and actual walking times across four walking tasks of increasing difficulty (i.e., large/narrow-width walkway with/without obstacles). Raw and absolute mental chronometry (A-MC) measures were recorded in single- (ST) and dual-task (DT) conditions. In ST conditions, pwMS had higher A-MC scores across all walking conditions (p ≤ 0.031, η2 ≥ 0.119), indicating lower motor imagery ability compared to healthy controls. During DT, all participants tended to underestimate their walking ability (3.38 ± 6.72 to 5.63 ± 9.17 s). However, after physical practice, pwMS were less able to adjust their imagined walking performance compared to healthy controls. In pwMS, A-MC scores were correlated with measures of balance confidence (ρ = −0.629, p < 0.01) and the self-reported expanded disability status scale (ρ = 0.747, p < 0.01). While the current study revealed that pwMS have lower motor imagery of walking performance compared to healthy individuals, further work is necessary to examine how the disassociation between mental chronometry and actual performance relates to quality of life and well-being. Full article
(This article belongs to the Special Issue Gait Pathology in Multiple Sclerosis: Functional Assessments and Therapeutic Interventions)
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20 pages, 697 KiB  
Article
Using Machine Learning Algorithms for Identifying Gait Parameters Suitable to Evaluate Subtle Changes in Gait in People with Multiple Sclerosis
by Katrin Trentzsch, Paula Schumann, Grzegorz Śliwiński, Paul Bartscht, Rocco Haase, Dirk Schriefer, Andreas Zink, Andreas Heinke, Thurid Jochim, Hagen Malberg and Tjalf Ziemssen
Brain Sci. 2021, 11(8), 1049; https://doi.org/10.3390/brainsci11081049 - 7 Aug 2021
Cited by 23 | Viewed by 4415
Abstract
In multiple sclerosis (MS), gait impairment is one of the most prominent symptoms. For a sensitive assessment of pathological gait patterns, a comprehensive analysis and processing of several gait analysis systems is necessary. The objective of this work was to determine the best [...] Read more.
In multiple sclerosis (MS), gait impairment is one of the most prominent symptoms. For a sensitive assessment of pathological gait patterns, a comprehensive analysis and processing of several gait analysis systems is necessary. The objective of this work was to determine the best diagnostic gait system (DIERS pedogait, GAITRite system, and Mobility Lab) using six machine learning algorithms for the differentiation between people with multiple sclerosis (pwMS) and healthy controls, between pwMS with and without fatigue and between pwMS with mild and moderate impairment. The data of the three gait systems were assessed on 54 pwMS and 38 healthy controls. Gaussian Naive Bayes, Decision Tree, k-Nearest Neighbor, and Support Vector Machines (SVM) with linear, radial basis function (rbf) and polynomial kernel were applied for the detection of subtle walking changes. The best performance for a healthy-sick classification was achieved on the DIERS data with a SVM rbf kernel (κ = 0.49 ± 0.11). For differentiating between pwMS with mild and moderate disability, the GAITRite data with the SVM linear kernel (κ = 0.61 ± 0.06) showed the best performance. This study demonstrates that machine learning methods are suitable for identifying pathologic gait patterns in early MS. Full article
(This article belongs to the Special Issue Gait Pathology in Multiple Sclerosis: Functional Assessments and Therapeutic Interventions)
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19 pages, 1488 KiB  
Article
Improving Digital Patient Care: Lessons Learned from Patient-Reported and Expert-Reported Experience Measures for the Clinical Practice of Multidimensional Walking Assessment
by Maria Scholz, Rocco Haase, Katrin Trentzsch, Heidi Stölzer-Hutsch and Tjalf Ziemssen
Brain Sci. 2021, 11(6), 786; https://doi.org/10.3390/brainsci11060786 - 14 Jun 2021
Cited by 10 | Viewed by 3242
Abstract
Background: Walking assessment (WA) enables meaningful patient mobility assessment. In this context, patient satisfaction with WA can influence assessment compliance and indirectly affect outcomes. One opportunity to assess patient satisfaction is patient-reported and expert-reported experience measures (PREM). Research on PREMs and WA in [...] Read more.
Background: Walking assessment (WA) enables meaningful patient mobility assessment. In this context, patient satisfaction with WA can influence assessment compliance and indirectly affect outcomes. One opportunity to assess patient satisfaction is patient-reported and expert-reported experience measures (PREM). Research on PREMs and WA in daily clinical multiple sclerosis (MS) practice does not exist yet. Methods: We surveyed people with MS about their experience and assessed healthcare professionals’ experience via an interview after patients completed WA. Results: Gait parameters were related to perceived difficulty and strain during performance. Less impaired patients perceived the WA to be less difficult and exhausting but were less likely to use WA results for themselves. Men and patients with higher impairment would perform WA more frequently. A good workflow, a fully performed WA with standardized testing, fully functional measurement systems, support and safeguarding by staff in case of falls, direct feedback after the testing, and patients’ motivation are identified by the experts as necessary factors for a successful WA. Conclusions: As patients’ experience has an impact on patients’ outcomes, long-term monitoring of PREMs should become an integral part of the healthcare service to identify and avoid problems early. Full article
(This article belongs to the Special Issue Gait Pathology in Multiple Sclerosis: Functional Assessments and Therapeutic Interventions)
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20 pages, 2668 KiB  
Article
Transcutaneous Spinal Cord Stimulation Enhances Walking Performance and Reduces Spasticity in Individuals with Multiple Sclerosis
by Ursula S. Hofstoetter, Brigitta Freundl, Peter Lackner and Heinrich Binder
Brain Sci. 2021, 11(4), 472; https://doi.org/10.3390/brainsci11040472 - 8 Apr 2021
Cited by 38 | Viewed by 8023
Abstract
Gait dysfunction and spasticity are common debilitating consequences of multiple sclerosis (MS). Improvements of these motor impairments by lumbar transcutaneous spinal cord stimulation (tSCS) have been demonstrated in spinal cord injury. Here, we explored for the first time the motor effects of lumbar [...] Read more.
Gait dysfunction and spasticity are common debilitating consequences of multiple sclerosis (MS). Improvements of these motor impairments by lumbar transcutaneous spinal cord stimulation (tSCS) have been demonstrated in spinal cord injury. Here, we explored for the first time the motor effects of lumbar tSCS applied at 50 Hz for 30 min in 16 individuals with MS and investigated their temporal persistence post-intervention. We used a comprehensive protocol assessing walking ability, different presentations of spasticity, standing ability, manual dexterity, and trunk control. Walking ability, including walking speed and endurance, was significantly improved for two hours beyond the intervention and returned to baseline after 24 h. Muscle spasms, clonus duration, and exaggerated stretch reflexes were reduced for two hours, and clinically assessed lower-extremity muscle hypertonia remained at improved levels for 24 h post-intervention. Further, postural sway during normal standing with eyes open was decreased for two hours. No changes were detected in manual dexterity and trunk control. Our results suggest that transcutaneous lumbar SCS can serve as a clinically accessible method without known side effects that holds the potential for substantial clinical benefit across the disability spectrum of MS. Full article
(This article belongs to the Special Issue Gait Pathology in Multiple Sclerosis: Functional Assessments and Therapeutic Interventions)
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