Gait initiation in multiple sclerosis patients with and without functional loss

Area of Science:

• Neuroscience
• Biomechanics
• Rehabilitation Science

Background:

• Gait initiation (GI) is vital for balance and mobility.
• GI deficits predict falls and postural instability in multiple sclerosis (MS).
• Early-stage MS (EDSS ≤3) GI impairments remain unclear.

Purpose of the Study:

• Investigate anticipatory postural adjustments (APAs).
• Assess posterior center of pressure (COPap) displacement.
• Examine spatiotemporal variability during GI in early MS patients with and without functional loss.

Main Methods:

• Prospective cross-sectional study of 44 participants (31 MS patients, 13 healthy).
• Groups: Early MS without functional loss (EDSS 0-1.5), early MS with functional loss (EDSS 2-3), and healthy controls.
• Recorded electromyography (EMG) of tibialis anterior (TA) and gastrocnemius medialis (GM), COPap displacement, and spatiotemporal parameters over 40 walks.

Main Results:

• MS patients showed smaller APAs and COPap displacement than controls.
• Patients with functional loss had the most significant impairments.
• Increased stride width variability in MS patients without functional loss; increased stride length, time, and double support time variability in those with functional loss.

Conclusions:

• Early MS impairs both postural and locomotor phases of GI, more so with functional loss.
• Even without functional loss, MS patients have gait difficulties and fall risk.
• Rehabilitation is recommended for MS patients, regardless of apparent functional loss.