Relationship Between Gait Speed And Strength Parameters In Multiple Sclerosis
Mevellec E, Lamotte D, Cantalloube S, Amarenco G, Thoumie P
Ann Readapt Med Phys 2003 Mar;46(2):85-90
Hopital Rothschild, Service de Reeducation Neuro-Orthopedique, 33, boulevard de Picpus, 75012 Paris et Inserm U483, France
Recent studies have focused on correlation between strength and Gait parameters in Hemiplegia, suggesting the interest for strength training in patients with Central Nervous System lesions.
The aim of this study was to evaluate this correlation in Multiple Sclerosis (MS) patients with special regard to the different clinical forms including Proprioceptive loss or Cerebellar Ataxia.
Patients And Method
Gait speed and muscular function were performed in 27 patients with moderate affected Gait (EDSS < 6). Gait speed was evaluated with Locometre and peak-torques of quadriceps and hamstrings were evaluated with isokinetic dynamometer.
Patients were separated in three groups related to their deficiency: Spastic group (8 patients), Spastic with Proprioceptive loss (12 patients) and spastic with Cerebellar Ataxia (7 patients). Gait parameters were evaluated in 10 healthy subjects as control group.
Gait speeds (spontaneous and maximal) and peak torques of quadriceps and hamstring were similar in the three groups.
In the whole patients group, Gait speed was reduced and related to hamstring peak torque (r = 0.56 at spontaneous speed and 0.51 at high speed) but not with quadriceps peak torque.
Patients with Proprioceptive loss exhibited not only a higher correlation between Gait speed and hamstring torque (r = 0.76 and 0.65 respectively) than other patients but also with quadriceps torque (r = 0.66 and 0.59 respectively) when patients in other groups did not.
As it was previously pointed out in Hemiplegic patients, MS patients exhibit some correlation between Gait speed and muscle strength, mainly with hamstrings.
These correlations can change in special sensory conditions suggesting that patients with sensory loss use different muscular strategies to maintain Gait speed.
Strength training may therefore be discussed in MS including specific modalities as a function of clinical parameters.
Strength, Postural And Gait Changes Following Rehabilitation In Multiple Sclerosis: A Preliminary Study
Cantalloube S, Monteil I, Lamotte D, Mailhan L, Thoumie P
Ann Readapt Med Phys 2006 May;49(4):143-9
Hôpital Léopold-Bellan, Service de Rééducation Neurologique, 21, rue Vercingétorix, 75014 Paris, France
To evaluate the impact of rehabilitation on Balance, Gait and Strength in inpatients with Multiple Sclerosis (MS).
Twenty-one in patients with MS benefited from a program of rehabilitation with evaluation before and after rehabilitation.
Balance was assessed by stabilometry, walking speed with use of a locometer device and maximal peak torque of knee extensor and flexor with use of an Isokinetic Dynamometer at 60 degrees speed.
The Functional Independence Measure (FIM) was also applied before and after rehabilitation.
After rehabilitation, patients showed significant improvement in Balance with opened and closed eyes, velocity gait, strength of the lower quadriceps and the higher hamstrings and FIM values.
Absolute values of Gait speed and Strength parameters were related as were improvement in velocity speed and the higher hamstrings.
The results are encouraging and confirm the interest and tolerance of a program of rehabilitation among patients with MS.
Gait And Balance Impairment In Early Multiple Sclerosis In The Absence Of Clinical Disability
Martin CL, Phillips BA, Kilpatrick TJ, Butzkueven H, Tubridy N, McDonald E, Galea MP
Mult Scler. 2006 Oct;12(5):620-8
The University of Melbourne, School of PhysioTherapy, Melbourne 3010, Australia
This study evaluated the Gait and Balance performance of two clinically distinct groups of recently diagnosed and minimally impaired Multiple Sclerosis (MS) patients:
(Expanded Disability Status Scale range 0-2.5), compared to control subjects.
Ten MS patients with mild Pyramidal Signs (Pyramidal Functional Systems 1.0), 10 MS patients with no Pyramidal Signs (Pyramidal Functional Systems 0) and 20 age.
And gender-matched control subjects were assessed using laboratory-based Gait analysis and clinical Balance measures.
Both MS groups demonstrated reduced speed and stride length (P < 0.001), and prolonged double limb support (P < 0.02), compared to the control group.
Along with alterations in the timing of ankle muscle activity, and the pattern of ankle motion during walking, which occurred independent of Gait speed.
The Pyramidal MS group walked with reduced speed (P = 0.03) and stride length (P = 0.04), and prolonged double limb support (P =0.01), compared to the Non-Pyramidal group.
Both MS groups demonstrated concomitant Balance Impairment, performing poorly on the Functional Reach Test compared to the control group (P < 0.05).
The identification of incipient Gait and Balance Impairment in MS patients with recent disease onset suggests that motor function may begin to deteriorate in the early stages of the disease, even in the absence of clinical signs of pyramidal dysfunction.