Gait Patterns in Patients with Multiple Sclerosis

Background Limited walking ability is an important problem for patients with multiple sclerosis (MS). A better understanding of how gait impairments lead to limited walking ability may help to develop more targeted interventions. Although gait classifications are available in stroke and cerebral palsy, relevant knowledge in MS is scarce. The purpose of this study is to identify distinctive gait patterns in patients with MS, based on a combined evaluation of kinematics, gait features and muscle activity during walking. Method Eighty-one patients (including 51 women) participated, with an age range of 28-69 years and a median EDSS of 3.0 (range 1.0-7.0). Participants were recruited from the longitudinal study FuPro MS. All patients participated in a 2D video gait analysis, with concurrent measurement of surface electromyography (EMG) and ground reaction forces. A score chart, developed by an expert panel, was used to rate each gait analysis. A single rater performed the scoring. Latent class analysis (LCA) was used to identify gait classes. Results Latent class analysis of the 73 variables determined during gait analysis revealed that nine variables could distinguish classes. Three gait classes were defined, based on heel-rise in terminal-stance, push-off, clearance in initial swing, plantar flexion position mid-swing, pelvic rotation, arm-trunk movement, activity of the m. gastrocnemius in pre-swing, M-wave and the propulsive force. The EDSS score and gait speed worsened in ascending classes. Conclusion Based on a core set of nine variables measured with clinical gait analysis, patients with MS could be divided into three different gait classes. The gait variables of the core set were mainly related to push-off and clearance.