scholarly journals Speed but Not Smoothness of Gait Reacts to Rehabilitation in Multiple Sclerosis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Philipp Gulde ◽  
Joachim Hermsdörfer ◽  
Peter Rieckmann
Keyword(s):  
Multiple Sclerosis ◽  
Short Distance ◽  
Walking Speed ◽  
State Of The Art ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Programs ◽  
Therapy Goals ◽  
Movement Smoothness ◽  
Gait Parameters ◽  
Private Specialist

Introduction. Improved gait is one of the leading therapy goals in multiple sclerosis. A plethora of clinical timed trials and state-of-the-art technology-based approaches are available to assess gait performance. Objectives. To examine what aspects of gait react to inpatient rehabilitation in MS and which parameters should be best assessed. Design. In this longitudinal study, we examined the performance of 76 patients with MS to shed further light on factors influencing gait, associations between tests, and the reaction to inpatient rehabilitation during an average time span of 16 d. Setting. Private specialist clinic for inpatient neurorehabilitation. Main Outcome Measures. Clinical walk tests (timed 25-foot walk test at normal pace, maximum pace over 10 m or 6 min) and IMU-based measures of movement smoothness. Results. All gait parameters were strongly intercorrelated (all p < 0.05 ), and a model multiple linear regression for the 6MWT revealed short distance velocity (10 m) and movement smoothness as predictors in a strong model ( R 2 adjusted 0.75, p < 0.01 ). A second model with natural pace on short distance and movement smoothness was almost equally strong ( R 2 adjusted 0.71, p < 0.01 ). Patients improved their walking speed ( p < 0.01 ), but not smoothness ( p = 0.08 – 0.12 ), over the course of rehabilitation. Conclusions. Since we were not able to observe improvements in smoothness of gait, we conclude that rehabilitation programs should be adapted to the patient’s physiological capacities in order to allow for such improvements in smoothness of gait. Externally valid gait capacity (6MWT) could be predicted by a single walk for 10 s at natural pace.

scholarly journals Effects of Rehabilitation on Gait Pattern at Usual and Fast Speeds Depend on Walking Impairment Level in Multiple Sclerosis

2018 ◽  
Vol 20 (5) ◽  
pp. 199-209 ◽  
Author(s):  
Carmela Leone ◽  
Alon Kalron ◽  
Tori Smedal ◽  
Britt Normann ◽  
Inez Wens ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Walking Speed ◽  
Step Length ◽  
Physical Rehabilitation ◽  
Walk Test ◽  
Rehabilitation Treatment ◽  
Gait Parameters ◽  
Patient Reported ◽  
Walking Capacity ◽  
Minute Walk

Abstract Background: Physical rehabilitation can improve walking capacity in persons with multiple sclerosis (MS). However, changes in spatiotemporal gait parameters after rehabilitation are not frequently evaluated, and it is unknown to what extent potential effects depend on baseline disability level. The objective was to investigate the effectiveness of rehabilitation programs on gait parameters at usual and fastest speeds in persons with MS categorized according to walking speed. Methods: This nonrandomized multinational study in “real-world” settings evaluated participants before and after conventional rehabilitation. Outcome measurements included spatiotemporal gait parameters assessed by an electronic walkway (at usual and fastest speeds), walking capacity tests (Timed 25-Foot Walk test, 2-Minute Walk Test, 6-Minute Walk Test), and the patient-reported 12-item Multiple Sclerosis Walking Scale. Patients were allocated into three subgroups based on walking speed (&lt;0.82 m/s and &gt;1.14 m/s) and MS center. Results were calculated for the total group and subgroups. Results: Forty-two persons with MS (26 women; mean ± SD age, 44.6 ± 11.0 years; mean ± SD Expanded Disability Status Scale score, 3.5 ± 1.5) receiving rehabilitation treatment were enrolled. After rehabilitation treatment, the group demonstrated a significant decrease in double support time and an increase in stride length and step length (left leg) at usual and fastest speeds. Velocity and step length (right leg) increased only at usual speed. Subgroup analysis revealed greatest and clinically meaningful improvements in more disabled persons with MS. Conclusions: Physical rehabilitation induced changes in spatiotemporal gait parameters in persons with MS. The magnitude of improvement was greater in participants with more walking impairment.

scholarly journals Searching for the “Active Ingredients” in Physical Rehabilitation Programs Across Europe, Necessary to Improve Mobility in People With Multiple Sclerosis: A Multicenter Study

2019 ◽  
Vol 33 (4) ◽  
pp. 260-270 ◽  
Author(s):  
Alon Kalron ◽  
Peter Feys ◽  
Ulrik Dalgas ◽  
Tori Smedal ◽  
Jennifer Freeman ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Total Duration ◽  
Real Life ◽  
Rehabilitation Program ◽  
Physical Rehabilitation ◽  
Individual Therapy ◽  
Future Research ◽  
Rehabilitation Programs ◽  
Therapy Goals ◽  
Passive Mobilization

Background. Physical rehabilitation programs can lead to improvements in mobility in people with multiple sclerosis (PwMS). Objective. To identify which rehabilitation program elements are employed in real life and how they might affect mobility improvement in PwMS. Methods. Participants were divided into improved and nonimproved mobility groups based on changes observed in the Multiple Sclerosis Walking Scale–12 following multimodal physical rehabilitation programs. Analyses were performed at group and subgroup (mild and moderate-severe disability) levels. Rehabilitation program elements included setting, number of weeks, number of sessions, total duration, therapy format (individual, group, autonomous), therapy goals, and therapeutic approaches. Results. The study comprised 279 PwMS from 17 European centers. PwMS in the improved group received more sessions of individual therapy in both subgroups. In the mildly disabled group, 60.9% of the improved received resistance training, whereas, 68.5% of the nonimproved received self-stretching. In the moderately-severely disabled group, 31.4% of the improved, received aerobic training, while 50.4% of the nonimproved received passive mobilization/stretching. Conclusions. We believe that our findings are an important step in opening the black-box of physical rehabilitation, imparting guidance, and assisting future research in defining characteristics of effective physical rehabilitation.

scholarly journals Effects of normobaric hypoxic endurance training on fatigue in patients with multiple sclerosis: a randomized prospective pilot study

2021 ◽  
Author(s):  
Tobias Zrzavy ◽  
Anna Pfitzner ◽  
Peter Flachenecker ◽  
Paulus Rommer ◽  
Uwe Klaus Zettl
Keyword(s):  
Multiple Sclerosis ◽  
Pilot Study ◽  
Endurance Training ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Program ◽  
Pharmacological Intervention ◽  
Rehabilitation Programs ◽  
Hypoxic Conditions ◽  
Prospective Longitudinal ◽  
Walking Endurance

Abstract Background Fatigue is one of the most frequent symptoms in patients with multiple sclerosis (MS), causing a major impact on quality-of-life. Non-pharmacological intervention strategies involve physical activity, which has been shown to reduce fatigue. Training under normobaric hypoxic conditions is thought to improve the response to endurance training and may, therefore, have an additional benefit over normoxic training conditions in MS patients. Objective To compare the effects of endurance training under hypoxic and normoxic conditions on fatigue, mobility and spasticity in patients with MS during inpatient rehabilitation. Methods Thirty-nine patients with MS were assigned within a randomized prospective longitudinal pilot study to (1) a routine clinical rehabilitation program, (2) a routine clinical rehabilitation program + normoxic endurance training and (3) a routine clinical rehabilitation program + hypoxic endurance training for 14 days. Fatigue (WEIMuS and MFIS), spasticity (MSSS-88) and walking endurance (6MinWT) were assessed at days 0, 7 and 14. Results Fatigue scores improved significantly in all groups, but these improvements were reached faster in the groups which additionally received endurance training (normoxic p = 0.004; hypoxic p = 0.002). Spasticity scores were significantly lower in endurance training groups at the end of the study compared to baseline (normoxic p = 0.048, hypoxic p = 0.012), while only the hypoxic group increased significantly in 6MinWT (p = 0.001). Conclusions Our findings demonstrate that endurance training provides substantial benefit to neurological rehabilitation programs. Endurance training under hypoxic conditions could positively influence walking endurance within a 2-week training intervention and warrants further investigations.

Self-efficacy predicts self-reported health status in multiple sclerosis

2004 ◽  
Vol 10 (1) ◽  
pp. 61-66 ◽  
Author(s):  
A Riazi ◽  
A J Thompson ◽  
J C Hobart
Keyword(s):  
Multiple Sclerosis ◽  
Health Status ◽  
Self Efficacy ◽  
Psychological Impact ◽  
Inpatient Rehabilitation ◽  
Walking Ability ◽  
Rehabilitation Programs ◽  
Reported Health ◽  
Self Reported Health Status ◽  
Challenging Situation

Self-efficacy is a belief that one can competently cope with a challenging situation. If self-efficacy is a strong predicto r of health status in multiple sclerosis (MS), it may be an important area to target in clinical practice, as such beliefs may be modifiable. The aim of this study was to examine the predictive value of self-efficacy on self-reported health status in MS. Eighty-nine people with MS completed the Multiple Sclerosis Self-efficacy Scale (MSSE function and control scales), the Multiple Sclerosis Impact Scale (MSIS-29), and the Multiple Sclerosis Walking Scale (MSWS-12) at two time points: 1) admission to an inpatient rehabilitation unit (n=43) or for steroid treatment for relapses (n=46); and 2) discharge (rehabilitation group) or six weeks later (steroid group). Multiple regression analyses examined whether baseline and changes in self-efficacy predict changes in self-reported health status. Both baseline and changes in self-efficacy were strong and independent predictors of changes in health status (P-values ranged from 0.025 to B-0.001). That is, pretreatment self-efficacy scores and increases in self-efficacy scores from baseline to follow-up (improvement), were significantly associated with decreases (improvement) in perceived walking ability and physical and psychological impact of MS. The findings suggest that self-efficacy predicts improvement in health status and that self-efficacy would be an important domain to measure and manage actively in education and rehabilitation programs.

Deficits in Selective Attention Alter Gait in Frail Older Adults

GeroPsych ◽  
2016 ◽  
Vol 29 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Véronique Cornu ◽  
Jean-Paul Steinmetz ◽  
Carine Federspiel
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Selective Attention ◽  
Dual Task ◽  
Nursing Home Residents ◽  
Gait Rehabilitation ◽  
Rehabilitation Programs ◽  
Gait Parameters ◽  
Growing Body ◽  
Task Conditions

Abstract. A growing body of research demonstrates an association between gait disorders, falls, and attentional capacities in older adults. The present work empirically analyzes differences in gait parameters in frail institutionalized older adults as a function of selective attention. Gait analysis under single- and dual-task conditions as well as selective attention measures were collected from a total of 33 nursing-home residents. We found that differences in selective attention performances were related to the investigated gait parameters. Poorer selective attention performances were associated with higher stride-to-stride variabilities and a slowing of gait speed under dual-task conditions. The present findings suggest a contribution of selective attention to a safe gait. Implications for gait rehabilitation programs are discussed.

Perception of Inpatient Oncologic Rehabilitation in Children, Adolescents and Young Adults Diagnosed with Cancer in Switzerland

2020 ◽  
Vol 232 (06) ◽  
pp. 294-299
Author(s):  
Maria Otth ◽  
Sibylle Denzler ◽  
Sibylle Schmid ◽  
Birgitta Setz ◽  
Katrin Scheinemann
Keyword(s):  
Young Adults ◽  
Cancer Patients ◽  
Peer Group ◽  
Inpatient Rehabilitation ◽  
Cross Sectional Study ◽  
Adolescents And Young Adults ◽  
Cross Sectional ◽  
Rehabilitation Programs ◽  
Specialized Institutions ◽  
Strobe Statement

Abstract Background Inpatient rehabilitation improves physical and psychosocial performance in childhood cancer patients and their families. Two kinds of inpatient rehabilitation are available in specialized institutions in Germany: family-oriented rehabilitation or peer group-oriented rehabilitation for adolescents and young adults (AYA). Our study aimed to find out what Swiss childhood and AYA cancer patients and their families thought about the rehabilitation programs in which they had participated. Patients and methods We conducted a questionnaire-based, cross-sectional study of Swiss childhood and AYA cancer patients and their families whose inpatient rehabilitation stays were scheduled to take place in Germany between May 2012 and March 2019. We analyzed the data descriptively and present our findings in accordance with the STROBE statement. Results Of the 57 eligible families contacted, 38 (67%) responded. Most rated the rehabilitation stay as very good (68%) or good (26%). Nearly all participants emphasized that these programs should be available to all affected patients and their families. Most (80%) thought the program gave them enough valuable information to enable them to cope with daily life after the stay ended. Only one fifth (19%) of the rehabilitation stays were fully funded by the health or disability insurance. Conclusion Participants expressed an overwhelmingly positive opinion about the rehabilitation programs they attended. We are convinced that childhood and AYA cancer patients and their families in Switzerland benefit from these programs and encourage insurances to cover the costs.

scholarly journals Inpatient Rehabilitation: Prediction of Changes in Sensorimotor Performance in Multiple Sclerosis: A Pilot Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2177
Author(s):  
Philipp Gulde ◽  
Joachim Hermsdörfer ◽  
Peter Rieckmann
Keyword(s):  
Multiple Sclerosis ◽  
Time Pressure ◽  
Inpatient Rehabilitation ◽  
Unhealthy Lifestyle ◽  
Rehabilitation Outcomes ◽  
Relapsing Remitting ◽  
Steps Per Day ◽  
Rest Time ◽  
Impacting Factors ◽  
Sensorimotor Performance

Inpatient rehabilitation has been shown to be an effective intervention for sensorimotor performance in multiple sclerosis (MS) patients. So far, predictions of the rehabilitation outcomes are limited. The objective was to predict inpatient rehabilitation outcomes by changes in the Watzmann Severity Scale (WSS), a statistical estimation of the EDSS by sensorimotor capacity. Sensorimotor performance and physical activity during rehabilitation (by actigraphy) were assessed in a sample of 28 MS patients at a facility for neurorehabilitation. Daily changes in the WSS were predicted by a model of multiple linear regression. The resulting model had an R2adjusted of 0.48 (p < 0.01) and revealed five impacting factors (a reduction in the WSS represents an improvement): the number of steps (β-weight = 0.52, p < 0.01), the duration of nocturnal rest time (β-weight = 0.46, p = 0.01), the EDSS at entry (β-weight = 0.38, p = 0.03), a relapsing-remitting MS (β-weight = 0.37, p = 0.03), and the performance in a visuomotor pursuit task with time pressure (β-weight = −0.35, p = 0.04). One standard deviation improvement was predicted when the patient at admission yielded 6600 fewer steps per day, 94 min less rest per night, −2.7 points in the EDSS at entry, a relapsing-remitting MS, and a pursuit task performance that decreased by 2.2 standard deviations. Overall, the patients improved by −0.22 ± 0.51 WSS points during 19.3 ± 4.5 d of inpatient rehabilitation. Different potential explanations of the findings are discussed, one of which proposes that the results reflect an unhealthy lifestyle which, in addition to MS, would explain the higher predicted improvements by rehabilitation tackling both MS and the patients’ lifestyle.

Walking capacities in multiple sclerosis measured by global positioning system odometer

2007 ◽  
Vol 13 (2) ◽  
pp. 220-223 ◽  
Author(s):  
A Créange ◽  
I Serre ◽  
M Levasseur ◽  
D Audry ◽  
A Nineb ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Global Positioning System ◽  
Walking Speed ◽  
Walking Distance ◽  
Expanded Disability Status Scale ◽  
Satellite Technology ◽  
Promising Tool ◽  
Disability Status ◽  
Global Positioning

We used a global positioning satellite technology odometer to determine the maximum objective walking distance capacity (MOWD) of patients with multiple sclerosis (MS). The MOWD correlated with Expanded Disability Status Scale (EDSS) score (r2 =0.41; P < 0.0001), the MSWS-12 scale (r2 = 0.46; P < 0.0001), time to walk 10 m (r2 = 0.51; P < 0.02) and walking speed (r2 =0.75; P < 0.001). Limitation of walking capacities was measurable up to 4550 m, strikingly above the 500-m limit of the EDSS. This objective odometer is a promising tool for evaluation and follow-up of patients with MS. Multiple Sclerosis 2007; 13: 220–223. http://msj.sagepub.com

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