Detecting kinematic gait abnormalities in people with multiple sclerosis using clinically practical measures

Abstract

The effects of multiple sclerosis (MS) on the central nervous system often manifest as abnormalities in gait kinematics. Clinically practical, valid, and reliable measures of gait kinematics are necessary to address research and clinical questions about MS. Wireless flexible electrogoniometry (EG) is a clinically practical measure of joint angles. The GAITRite walkway system is a clinically practical, valid and reliable measure of temporal and spatial gait characteristics. The overall objective of this two-study research project was to explore whether these clinically practical measures of gait kinematics can be used to accurately detect gait abnormalities in people with multiple sclerosis. Study 1 examined the reliability and validity of EG and Study 2 examined the gait kinematics of people with MS (PWMS) using EG and GAITRite. For Study 1, angle at initial contact and total joint excursion were measured by EG at both the knee and ankle while ten healthy adults walked at a self-selected comfortable speed. Measurements were repeated for two testers and two visits to assess reliability. The same variables were measured concurrently with three-dimensional motion analysis (3D) to assess validity. For all variables, reliability was good as indicated by low measurement error and validity was good as indicated by association and agreement of EG with 3D. For Study 2, the same joint angles, along with speed, cadence, step length, stride length, stance duration and double support duration were assessed for six PWMS and six controls without MS. PWMS showed significantly reduced speed, cadence, and ankle excursion and increased stance and double support duration as previously shown with 3D. Spasticity and/or instability may lead to these kinematic gait abnormalities in PWMS; however, reduced velocity may confound this interpretation by affecting the other observed gait abnormalities. Further research about the determinants of gait dysfunction in PWMS is required. EG and GAITRite are clinically practical, valid and reliable measures of gait kinematics and should be included in further clinic-based research to determine which kinematic gait abnormalities are causes and which are effects of the observed decrease in gait speed in PWMS.