Measuring Gait Stability in People with Multiple Sclerosis Using Different Sensor Locations and Time Scales

The evaluation of local divergence exponent (LDE) has been proposed as a common gait stability measure in people with multiple sclerosis (PwMS). However, differences in methods of determining LDE may lead to different results. Therefore, the purpose of the current study was to determine the effect of different sensor locations and LDE measures on the sensitivity to discriminate PwMS. To accomplish this, 86 PwMS and 30 healthy participants were instructed to complete a six-minute walk wearing inertial sensors attached to the foot, trunk and lumbar spine. Due to possible fatigue effects, the LDE short (~50% of stride) and very short (~5% of stride) were calculated for the remaining first, middle and last 30 strides. The effect of group (PwMS vs. healthy participants) and time (begin, mid, end) and the effect of Expanded Disability Status Scale (EDSS) and time were assessed with linear random intercepts models. We found that perturbations seem to be better compensated in healthy participants on a longer time scale based on trunk movements and on a shorter time scale (almost instantaneously) according to the foot kinematics. Therefore, we suggest to consider both sensor location and time scale of LDE when calculating local gait stability in PwMS.

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Quantifying six-minute walk induced gait deterioration with inertial sensors in multiple sclerosis subjects

Gait & Posture ◽

10.1016/j.gaitpost.2016.07.184 ◽

2016 ◽

Vol 49 ◽

pp. 340-345 ◽

Cited By ~ 17

Author(s):

Matthew M. Engelhard ◽

Sriram Raju Dandu ◽

Stephen D. Patek ◽

John C. Lach ◽

Myla D. Goldman

Keyword(s):

Multiple Sclerosis ◽

Inertial Sensors ◽

Minute Walk

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Phototest for neurocognitive screening in multiple sclerosis

Dementia & Neuropsychologia ◽

10.1590/s1980-57642016dn10100003 ◽

2016 ◽

Vol 10 (1) ◽

pp. 12-18

Author(s):

Joana Pinto ◽

Emanuela Lopes ◽

Gerly Gonçalves ◽

Ângela Silva ◽

Carnero-Pardo ◽

...

Keyword(s):

Multiple Sclerosis ◽

Neurological Disorders ◽

Area Under The Curve ◽

Naming Task ◽

Cognitive Test ◽

Neurocognitive Impairments ◽

Disability Status ◽

Different Types ◽

Fatigue Severity ◽

Healthy Participants

Multiple Sclerosis (MS) is one of the most common neurological disorders. Cognitive dysfunction is considered a clinical marker of MS, where approximately half of patients with MS have cognitive impairment. Objective : The Phototest (PT) is a brief cognitive test with high diagnostic sensitivity, accuracy and cost-effectiveness for detecting cognitive deterioration. Our aim was to test the utility of the PT as a neurocognitive screening instrument for MS. Methods : The study enrolled 30 patients with different types of MS from an outpatient clinic as well as 19 healthy participants. In conjunction with the PT, the Montreal Cognitive Assessment (MoCA), Barthel Index (BI), Expanded Disability Status Scale (EDSS), and Fatigue Severity Scale (FSS) were administered. Results : The MS group obtained significantly lower results on all domains of the PT, except for the naming task. The PT showed good concurrent validity with the MoCA. In direct comparison to the MoCA, PT showed a greater area under the curve and higher levels of sensitivity and specificity for MS neurocognitive impairments. A cut-off score of 31 on the Phototest was associated with sensitivity of 100% and specificity of 76.7%. Conclusion : The PT is a valid, specific, sensitive and brief test that is not dependent on motor functions. The instrument could be an option for neurocognitive screening in MS, especially in identifying cases for further neuropsychological assessment and intervention.

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Personality Functioning in Patients with a Progressive Course of Multiple Sclerosis

Psychological Reports ◽

10.2466/02.09.15.19.pr0.107.5.629-646 ◽

2010 ◽

Vol 107 (2) ◽

pp. 629-646 ◽

Cited By ~ 3

Author(s):

Rita Lorio ◽

Giuseppe Moressa ◽

Francesca Meneghello ◽

Silvia Salcuni ◽

Alessandro Zennaro ◽

...

Keyword(s):

Multiple Sclerosis ◽

Self Esteem ◽

Control Group ◽

Rorschach Test ◽

State Trait Anxiety Inventory ◽

Personality Functioning ◽

Self Image ◽

Disability Status ◽

Healthy Participants ◽

Progressive Course

This study intended to describe general personality functioning in patients with a progressive course of multiple sclerosis. 55 consecutive rehabilitation inpatients with progressive course of multiple sclerosis were assessed with a multimethod test battery: the Expanded Disability Status Scale, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Rosenberg Self-esteem Scale, and the Rorschach Test administered and scored with Comprehensive System. The control group comprised 55 healthy participants with similar sociodemographic characteristics. Specific differences were found for both cognitive and affective aspects, as the patients with progressive course of multiple sclerosis had less positive self-image, less effective mediation processing, and an affective approach to reality. Present data illustrated the usefulness of examining patients with a progressive course of multiple sclerosis to identify abilities and difficulties in cognitive and affective patterns, and support better adaptation to relationships and the environment.

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Effect of time of day on walking capacity and self-reported fatigue in persons with multiple sclerosis: a multi-center trial

Multiple Sclerosis Journal ◽

10.1177/1352458511419881 ◽

2011 ◽

Vol 18 (3) ◽

pp. 351-357 ◽

Cited By ~ 35

Author(s):

P Feys ◽

D Gijbels ◽

A Romberg ◽

C Santoyo ◽

B Gebara ◽

...

Keyword(s):

Multiple Sclerosis ◽

Time Of Day ◽

Diurnal Change ◽

Walk Test ◽

Expanded Disability Status Scale ◽

Time Points ◽

Walking Capacity ◽

Disability Status ◽

6 Minute Walk Test ◽

Minute Walk

Background: Many persons with multiple sclerosis (PwMS) report increased fatigue in the afternoon and evening compared with the morning. It is commonly accepted that physical capacity also decreases as time of day progresses, potentially influencing the outcomes of testing. Objective: The objective of this article was to determine whether self-reported fatigue level and walking capacity are influenced by time of day in PwMS. Methods: A total of 102 PwMS from 8 centers in 5 countries, with a diverse level of ambulatory dysfunction (Expanded Disability Status Scale [EDSS] <6.5), participated. Patients performed walking capacity tests and reported fatigue level at three different time points (morning, noon, afternoon) during 1 day. Walking capacity was measured with the 6-Minute Walk Test (6MWT) and the 10-m walk test performed at usual and fastest speed. Self-reported fatigue was measured by the Rochester Fatigue Diary (RFD). Subgroups with mild (EDSS 1.5–4.0, n = 53) and moderate (EDSS 4.5–6.5, n = 49) ambulatory dysfunction were formed, as changes during the day were hypothesized to depend on disability status. Results: Subgroups had different degree of ambulatory dysfunction ( p < 0.001) but reported similar fatigue levels. Although RFD scores were affected by time of day with significant differences between morning and noon/afternoon ( p < 0.0001), no changes in walking capacity were found in any subgroup. Additional analyses on subgroups distinguished by diurnal change in self-reported fatigue failed to reveal analogous changes in walking capacity. Conclusions: Testing of walking capacity is unaffected by time of day, despite changes in subjective fatigue.

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Wearable inertial sensors are highly sensitive in the detection of gait disturbances and fatigue at early stages of multiple sclerosis

BMC Neurology ◽

10.1186/s12883-021-02361-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Roy Müller ◽

Daniel Hamacher ◽

Sascha Hansen ◽

Patrick Oschmann ◽

Philipp M. Keune

Keyword(s):

Multiple Sclerosis ◽

Inertial Sensors ◽

Linear Trend ◽

Significant Linear Trend ◽

Subjective Fatigue ◽

Gait Parameters ◽

Highly Sensitive ◽

Wearable Inertial Sensors ◽

Gait Disturbances ◽

Healthy Participants

Abstract Background The aim of the current study was to examine multiple gait parameters obtained by wearable inertial sensors and their sensitivity to clinical status in early multiple sclerosis (MS). Further, a potential correlation between gait parameters and subjective fatigue was explored. Methods Automated gait analyses were carried out on 88 MS patients and 31 healthy participants. To measure gait parameters (i.e. walking speed, stride length, stride duration, duration of stance and swing phase, minimal toe-to-floor distance), wearable inertial sensors were utilized throughout a 6-min 25-ft walk. Additionally, self-reported subjective fatigue was assessed. Results Mean gait parameters consistently revealed significant differences between healthy participants and MS patients from as early as an Expanded Disability Status Scale (EDSS) value of 1.5 onwards. Further, MS patients showed a significant linear trend in all parameters, reflecting continuously deteriorating gait performance throughout the test. This linear deterioration trend showed significant correlations with fatigue. Conclusions Wearable inertial sensors are highly sensitive in the detection of gait disturbances, even in early MS, where global scales such as the EDSS do not provide any clinical information about deviations in gait behavior. Moreover, these measures provide a linear trend parameter of gait deterioration that may serve as a surrogate marker of fatigue. In sum, these results suggest that classic timed walking tests in routine clinical practice should be replaced by readily and automatically applicable gait assessments, as provided by inertial sensors.

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The Two-Minute Walk Test in Persons with Multiple Sclerosis: Correlations of Cadence with Free-Living Walking Do Not Support Ecological Validity

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17239044 ◽

2020 ◽

Vol 17 (23) ◽

pp. 9044

Author(s):

Viktoria Karle ◽

Verena Hartung ◽

Keti Ivanovska ◽

Mathias Mäurer ◽

Peter Flachenecker ◽

...

Keyword(s):

Multiple Sclerosis ◽

Ecological Validity ◽

Walk Test ◽

Free Living ◽

Walking Capacity ◽

Disability Status ◽

Intensity Category ◽

Walking Performance ◽

The Relationship ◽

Minute Walk

The two-minute walk test (2MWT) is a frequently used walking capacity test in persons with multiple sclerosis (pwMS). However, less is known about its relevance with regards to walking capacity during free-living walking performance. Therefore, the ecological validity of the 2MWT was tested by 1. computing free-living minutes with the same intensity (cadence) as during the 2MWT and 2. investigating the relationship between 2MWT cadence and minutes with the same cadence during free-living walking. 20 pwMS aged 44.2 ± 12.2 (Expanded Disability Status Scale (EDSS) score of 3.1 ± 1.4) performed a 2MWT and wore an accelerometer for seven days. The number of pwMS reaching 100%, 90%, 80% or 70% of 2MWT cadence for at least one minute a day and minutes/day with at least 100%, 90%, 80% and 70% of 2MWT cadence during free-living walking was calculated. Six participants reached 100% of the 2MWT cadence for at least one minute/day during free-living walking. A total of 80% 2MWT cadence was the first intensity category that was reached by all participants during free-living walking. No significant correlation was found between cadence in the 2MWT and minutes in which this cadence was reached during free-living walking. Ecological validity with regard to walking intensity could not be confirmed in our study sample.

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Comparing Two Conditions of Administering the Six-Minute Walk Test in People with Multiple Sclerosis

International Journal of MS Care ◽

10.7224/1537-2073.2013-014 ◽

2014 ◽

Vol 16 (1) ◽

pp. 48-54 ◽

Cited By ~ 11

Author(s):

Brian M. Sandroff ◽

Lara A. Pilutti ◽

Deirdre Dlugonski ◽

Yvonne C. Learmonth ◽

John H. Pula ◽

...

Keyword(s):

Multiple Sclerosis ◽

Walk Test ◽

Total Distance ◽

Disability Status ◽

Quasi Experimental ◽

Physiological Demands ◽

Metabolic Unit ◽

6 Minute Walk Test ◽

Different Levels ◽

Minute Walk

Objective: This quasi-experimental study was conducted to determine whether differences existed in the total distance walked and energy expended between two conditions of administering the 6-Minute Walk test (6MW) across different levels of disability in people with multiple sclerosis (MS). Methods: The sample comprised 160 individuals with MS. One group of participants (n = 82) completed a 6MW while wearing a portable metabolic unit (K4b2, Cosmed, Italy) in a square hallway with four corridors and performing 90° turns. Another group (n = 78) completed a 6MW while wearing the same metabolic unit in a single corridor and performing 180° turns. Main outcome measures included total distance walked (in feet) and oxygen consumption (in milliliters per minute) expressed as 30-second averages for 1 minute before the 6MW and over the entire 6MW. Disability status was assessed using the Patient-Determined Disease Steps scale. Results: Participants undertaking the 6MW in a single corridor (1412 ft) walked 37 ft (2.7%) farther than those undertaking the test in a square hallway (1375 ft), but this difference was not statistically significant (F = 0.45, P = .51). Those completing the 6MW in a single corridor expended more energy than those completing the 6MW in the square hallway with four corridors (F = 3.41, P < .01). Conclusions: Either protocol is acceptable, but researchers should be aware of the additional physiological demands when administering the 6MW in a single corridor with 180° turns.

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Relationship between Expanded Disability Status Scale scores and the presence of temporomandibular disorders in patients with multiple sclerosis

European Journal of Dentistry ◽

10.4103/ejd.ejd_91_17 ◽

2018 ◽

Vol 12 (01) ◽

pp. 144-148 ◽

Cited By ~ 2

Author(s):

Lucas Senra Correa Carvalho ◽

Osvaldo José Moreira Nascimento ◽

Luciane Lacerda Franco Rocha Rodrigues ◽

Andre Palma Da Cunha Matta

Keyword(s):

Multiple Sclerosis ◽

Temporomandibular Disorders ◽

Control Group ◽

Expanded Disability Status Scale ◽

Exact Test ◽

Disability Status ◽

Relapsing Remitting ◽

Scale Scores ◽

Axis I ◽

Relapsing Remitting Multiple Sclerosis

ABSTRACTObjectives: The objectives of this study were to assess the prevalence of temporomandibular disorders (TMDs) in patients with relapsing-remitting multiple sclerosis (MS) and to investigate whether an association exists between the presence of TMD symptoms and the degree of MS-related disability. Materials and Methods: In all, 120 individuals were evaluated: 60 patients with a diagnosis of relapsing-remitting MS and 60 age- and sex-matched controls without neurological impairments. A questionnaire recommended by the European Academy of Craniomandibular Disorders for the assessment of TMD symptoms was administered. For those who answered affirmatively to at least one of the questions, the RDC/TMD Axis I instrument was used for a possible classification of TMD subtypes. The Expanded Disability Status Scale (EDSS) was the measure of the degree of MS-related disability. Statistical Analysis Used: Fisher’s exact test was used to analyze the data. ANOVA was used to detect significant differences between means and to assess whether the factors influenced any of the dependent variables by comparing means from the different groups. Results: The prevalence of TMD symptoms in patients with MS was 61.7% versus 18.3% in the control group (CG). A diagnosis of TMD was established for 36.7% in the MS group and 3.3% in the CG (P = 0.0001). There were statistically significant differences between degrees of MS-related disability and the prevalence of TMD (P = 0.0288). Conclusions: The prevalence of both TMD and TMD symptoms was significantly greater in the MS group. EDSS scores and TMD prevalence rates were inversely related.

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Determinants of therapeutic lag in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458520981300 ◽

2021 ◽

pp. 135245852098130

Author(s):

Izanne Roos ◽

Emmanuelle Leray ◽

Federico Frascoli ◽

Romain Casey ◽

J William L Brown ◽

...

Keyword(s):

Multiple Sclerosis ◽

Expanded Disability Status Scale ◽

Disability Progression ◽

Delayed Onset ◽

Disease Characteristics ◽

Disability Status ◽

Male Sex ◽

Pre Treatment ◽

Patient Subgroups

Background: A delayed onset of treatment effect, termed therapeutic lag, may influence the assessment of treatment response in some patient subgroups. Objectives: The objective of this study is to explore the associations of patient and disease characteristics with therapeutic lag on relapses and disability accumulation. Methods: Data from MSBase, a multinational multiple sclerosis (MS) registry, and OFSEP, the French MS registry, were used. Patients diagnosed with MS, minimum 1 year of exposure to MS treatment and 3 years of pre-treatment follow-up, were included in the analysis. Studied outcomes were incidence of relapses and disability accumulation. Therapeutic lag was calculated using an objective, validated method in subgroups stratified by patient and disease characteristics. Therapeutic lag under specific circumstances was then estimated in subgroups defined by combinations of clinical and demographic determinants. Results: High baseline disability scores, annualised relapse rate (ARR) ⩾ 1 and male sex were associated with longer therapeutic lag on disability progression in sufficiently populated groups: females with expanded disability status scale (EDSS) < 6 and ARR < 1 had mean lag of 26.6 weeks (95% CI = 18.2–34.9), males with EDSS < 6 and ARR < 1 31.0 weeks (95% CI = 25.3–36.8), females with EDSS < 6 and ARR ⩾ 1 44.8 weeks (95% CI = 24.5–65.1), and females with EDSS ⩾ 6 and ARR < 1 54.3 weeks (95% CI = 47.2–61.5). Conclusions: Pre-treatment EDSS and ARR are the most important determinants of therapeutic lag.

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