Giuseppina Pilloni

Novel characterization of gait impairments in people with multiple sclerosis by means of the gait profile score.

The assessment of gait abnormalities in individuals with multiple sclerosis (MS) represents a key factor in evaluating the effectiveness of rehabilitation treatments. Despite the availability of sophisticated equipment to objectively evaluate the kinematic aspects of gait, there are still some difficulties in processing the large and complex amount of data they produce in the daily clinical routine. On the basis of the above-mentioned considerations we propose a novel characterization of gait kinematics in individuals with MS, based on a single measure (gait profile score, GPS) obtained from a quantitative three-dimensional analysis of gait performed using an opto-electronic system. We also investigated the correlation between GPS and the Expanded Disability Status Scale (EDSS) values. Thirty-four patients suffering from relapsing-remitting MS (13 female, 21 male, mean age 46.7 years) with an EDSS score of ≤6 underwent a gait analysis from which the GPS index was calculated. Their results were compared with those of a control group of healthy age- and gender-matched subjects. The GPS of individuals with MS was found significantly higher with respect to controls (9.12° vs. 5.67°, p<0.001) as the result of kinematic differences in gait patterns referring to pelvic tilt and rotation, hip flexion-extension and rotation, knee flexion-extension and ankle dorsi- and plantar-flexion. A moderate correlation was also found between the EDSS score of the participants and their GPS values (r = 0.63, p < 0.001). The GPS index thus appears suitable to represent gait deviations from physiological patterns in individuals affected by MS and potentially useful in assessing the outcomes related both to rehabilitation programs and pharmacologic/physical therapies.

Are static and functional balance abilities related in individuals with Multiple Sclerosis

BACKGROUND In people with Multiple Sclerosis (pwMS), balance assessment is essential in estimating the risk of falls, monitoring disease progression and verifying the effectiveness of rehabilitative treatment. Clinical tools and instrumental techniques are available for testing static and dynamic balance, but the relationship between such abilities is still not clear. Having information about this link would be important in properly planning the type and number of tests to administer. METHODS One hundred and six pwMS (Expanded Disability Status Scale, EDSS 0-6.5) stratified in three sub-groups (Class 1 EDSS 0-1.5, Class 2 EDSS 2-4 and Class 3 EDSS 4.5-6.5) and 42 healthy controls (HC) participated in the study. All underwent static posturography and instrumented Timed-Up-and-Go (TUG) performed using a wearable inertial sensor. Raw data were processed to extract postural sway features, overall duration of TUG and its main sub-phases (i.e. sit-to-stand, 180° turns and stand-to-sit). RESULTS All sway parameters of pwMS of Classes 2 and 3, as well as total TUG duration and time necessary to perform 180° turns, were found significantly higher than HC and Class 1 participants. However, poor correlations were found between sway and TUG parameters. When pwMS are grouped, small/moderate correlations (in the range 0.20-0.41) were found between all sway parameters and total TUG duration. CONCLUSIONS Static and dynamic balance in pwMS appear scarcely correlated, although both worsen as disability increases. This implies that they should be separately assessed using specific tests to have a complete view of postural control performance in MS.

Texting while walking differently alters gait patterns in people with multiple sclerosis and healthy individuals

BACKGROUND In recent times, increasing safety concerns have been associated with the use of mobile phones by pedestrians. In particular, texting has been shown to significantly alter gait patterns. However, no specific investigations have been performed on people with Multiple Sclerosis (pwMS), who are already characterized by gait dysfunctions caused by the disease. OBJECTIVE To assess the existence of possible alterations in spatio-temporal parameters of gait in pwMS when simultaneously texting on a smartphone and walking. METHODS Fifty-four pwMS (mean age 40.5 ± 10.5) and 40 age-matched unaffected individuals were tested in two conditions: walking, and walking while texting on a smartphone. Spatio-temporal parameters of gait were assessed using a wearable accelerometer located on the lower back. RESULTS Texting induces reduction of gait speed, stride length and cadence in both groups, but such changes were smaller in magnitude in pwMS. An increase of stance and double support and reduction of swing phase were observed in pwMS only. CONCLUSIONS Texting alters gait patterns of pwMS differently from unaffected individuals, probably due to a different prioritization of the task, which appears to take into account the motor and sensory impairments associated with the disease by favoring the motor task.

Smoothness of gait detects early alterations of walking in persons with multiple sclerosis without disability

In people with Multiple Sclerosis (pwMS) with little or no signs of disability, early detection of walking impairments represents a challenging issue, as simple gait metrics (e.g. speed, cadence, stride length, etc.) may not significantly differ from those of healthy individuals. In this study, we aimed to assess the existence of possible differences in spatial-temporal parameters and smoothness of gait measures (assessed through Harmonic Ratio, HR) obtained from trunk accelerations between 50pwMS without disability (Expanded Disability Status Scale score =1) and 50 age-matched healthy controls. The results show no differences in terms of gait velocity, stride length, stance/swing and double support phases duration, while HR in the direction of motion was significantly lower in pwMS (2.92 vs. 3.67, p<0.001), thus indicating a less smooth gait. The study of trunk accelerations through calculation of HR represents a fast, non-intrusive technique that allows early identification of anomalies in gait patterns of pwMS in absence of disability.

Texting While Walking Induces Gait Pattern Alterations in Healthy Older Adults

The use of a mobile phone for texting purposes results in distracted walking which may lead to injuries. In particular, texting while walking has been shown to induce significant alterations in gait patterns. This study aimed to assess whether changes in the main spatio-temporal parameters of gait when simultaneously engaged in texting on a smartphone and walking are different in older adults relative to young and middle- aged individuals. A total of 57 participants divided in three groups (19 older adults aged over 65, 19 young aged 20-40 and 19 middle-aged aged 41-64) were tested in two conditions: walking, and walking while texting on a smartphone. Spatio-temporal parameters of gait were assessed using a wearable accelerometer located on the lower back. The results show that texting induced similar reduction of gait speed, stride length and cadence in all groups. Slight (although significant) alterations of stance, swing and double support phases duration were found only for middle-aged participants. Such findings suggest that modifications of gait patterns due to texting seem unaffected by age, probably due to different perceptions of the cognitive complexity of the task and differential prioritization of its motor and cognitive aspects.

Association between Objectively Measured Physical Activity and Gait Patterns in People with Parkinson’s Disease: Results from a 3-Month Monitoring

Background Although physical activity (PA) is known to be beneficial in improving motor symptoms of people with Parkinsons disease (pwPD), little is known about the relationship between gait patterns and features of PA performed during daily life. Objective To verify the existence of possible relationships between spatiotemporal and kinematic parameters of gait and amount/intensity of PA, both instrumentally assessed. Methods Eighteen individuals affected by PD (10F and 8M, age 68.0 ± 10.8 years, 1.5 ≤ Hoehn and Yahr (H&Y) < 3) were required to wear a triaxial accelerometer 24 h/day for 3 consecutive months. They also underwent a 3D computerized gait analysis at the beginning and end of the PA assessment period. The number of daily steps and PA intensity were calculated on the whole day, and the period from 6:00 to 24:00 was grouped into 3 time slots, using 3 different cut-point sets previously validated in the case of both pwPD and healthy older adults. 3D gait analysis provided spatiotemporal and kinematic parameters of gait, including summary indexes of quality (Gait Profile Score (GPS) and Gait Variable Score (GVS)). Results The analysis of hourly trends of PA revealed the existence of two peaks located in the morning (approximately at 10) and in the early evening (between 18 and 19). However, during the morning time slot (06:00–12:00), pwPD performed significantly higher amounts of steps (4313 vs. 3437 in the 12:00–18:00 time slot, p < 0.001, and vs. 2889 in the 18:00–24:00 time slot, p=0.021) and of moderate-to-vigorous PA (43.2% vs. 36.3% in the 12:00–18:00 time slot, p=0.002, and vs. 31.4% in the 18:00–24:00 time slot, p=0.049). The correlation analysis shows that several PA intensity parameters are significantly associated with swing-phase duration (rho = −0.675 for sedentary intensity, rho = 0.717 for moderate-to-vigorous intensity, p < 0.001), cadence (rho = 0.509 for sedentary intensity, rho = −0.575 for moderate-to-vigorous intensity, p < 0.05), and overall gait pattern quality as expressed by GPS (rho = −0.498 to −0.606 for moderate intensity, p < 0.05) and GVS of knee flexion-extension (rho = −0.536 for moderate intensity, p < 0.05). Conclusions Long-term monitoring of PA integrated by the quantitative assessment of spatiotemporal and kinematic parameters of gait may represent a useful tool in supporting a better-targeted prescription of PA and rehabilitative treatments in pwPD.

Association between brain atrophy and cognitive motor interference in multiple sclerosis

INTRODUCTION Cognitive motor interference (CMI) is performance impairment due to simultaneuous task execution and is measured using the dual task cost (DTC). No pathological feature of MS has to date been associated with CMI. AIM To assess the relationship between brain volumes and CMI, as measured using the DTC, in a cross-sectional study. METHODS A group of persons with MS (pwMS) and an age- and sex-matched healthy control (HC) group underwent 3D gait analysis during using the dual task paradigm. Brain volumes were measured on T1-weighted gradient echo scans using SIENAX software. The relationships between brain volumes and the DTCs of spatial temporal parameters were evaluated using Pearson correlation. A multiple regression model was used to evaluate the ability to predict the DTC of cadence based on brain volume and grey matter (GM) volume. RESULTS Forty-four patients and 16 HCs underwent MRI and gait analysis. The mean expanded disability status scale (EDSS) was 2.4 ± 1.5. Significant relationships between brain volumes and DTC were found only in the pwMS group, with higher rho scores for the DTC of mean velocity, DTC of cadence, and DTC of stride time. A statistically significant regression equation with an R2 value of 0.684 was found using GM and Z-score on the Stroop test as predictors of the DTC of cadence (p < 0.001). CONCLUSION Brain atrophy, especially than in the GM, is a major determinant of DTC, although other pathological markers also contribute to CMI in patients with MS.

Trunk rotation alters postural sway but not gait in female children and early adolescents: Results from a school-based screening for scoliosis

OBJECTIVE The purpose of this study was to assess the influence of trunk rotation (TR) on postural sway and spatial-temporal parameters of gait in children and early adolescents screened at school for the presence of scoliosis. METHODS Two hundred and fifty-five individuals aged 9-14 (141 boys, 114 girls) underwent trunk rotation (TR) assessment by means of angle of trunk rotation (ATR) measurements performed with Bunnells scoliometer. Participants with ATR ≥ 5° formed the TR group whose data were compared with those of a control group (CON) composed of individuals with ATR < 5° matched for age and anthropometric features. Postural sway was calculated on the basis of center of pressure (COP) time series acquired using a pressure plate. Spatial-temporal parameters of gait were derived from trunk accelerations collected by a single inertial sensor located in the low-back region. RESULTS Sway area, sway path, COP velocities in medio-lateral (ML) and antero-posterior (AP) directions and COP displacements in ML direction were found significantly higher in girls with TR, while no differences between the TR and CON groups were detected in boys. Both boys and girls with TR exhibited gait patterns similar to those of their CON schoolmates. CONCLUSIONS These findings suggest that even mild levels of TR may influence balance of female children and early adolescents screened for scoliosis, and thus early interventions including selective and task-oriented exercises appear advisable. In contrast, TR does not appear to influence gait, but further investigations are required to clarify whether different ATR cut-offs may reveal alterations of spatial-temporal parameters.

Sex-dependent and sex-independent muscle activation patterns in adult gait as a function of age

Introduction: Aging leads to poorer neuromuscular control that may impact mobility. However, the specific decades when these changes occur, and whether these time‐based changes are sex‐specific, are unclear. Methods: Adults aged 20–82 years (N = 93, 51 females) walked six gait trials at their preferred speed over a 10‐m platform. Electromyography (EMG) of the rectus femoris (RF), tibialis anterior (TA), and gastrocnemius lateralis (GL) were measured using wireless surface sensors. Root mean square (RMS) and within‐cycle coefficient of variation (CV) values were calculated for several phases of gait. Mixed effect models were conducted to test for Age, Sex, Muscle, and interaction effects, covarying for gait speed and stride length. Results: A significant Age × Sex × Muscle interaction on RMS at the mid‐swing phase was found (p = .036), showing 4.2% higher RF RMS for males (&bgr; = 0.42, p = .008) and 3.3% higher GL RMS for females (&bgr; = 0.33, p = .038) with each of the three decades investigated. Significant Age × Muscle interactions on GL RMS were found at loading, mid‐stance, and over the full gait cycle (ps < .05), with 2.0–4.3% higher values per decade (&bgr; = 0.20–0.43, ps < .05). There was generally higher CV with higher age at mid‐swing and over the full gait cycle (significant Age effects, ps < .05). Females showed higher CV at loading, mid‐stance, and terminal stance (significant Age × Sex effects, ps < .05). Discussion/conclusion: Results suggest sex‐dependent influences of age on muscle recruitment during a few specific phases of gait, and sex‐independent influences of age on the recruitment of the ankle musculature, and on the overall gait cycle. These influences may help explain overall increased instability and fall risk in older adults. HighlightsHealthy aging affects muscle activation sex‐dependently at mid‐swing (MS) of gait.Age‐increase in gastrocnemius lateralis (GL) activity at MS was greater in females.Healthy aging affects EMG signal variability sex‐dependently during stance.Age‐increases in EMG signal variability at stance were greater in females.Healthy aging associated with higher GL activation during gait, independent of sex.

Quantifying gait impairment in individuals affected by Charcot-Marie-Tooth disease: the usefulness of gait profile score and gait variable score

Abstract Background: Gait analysis is a reliable tool to characterise ambulation in Charcot-Marie-Tooth, the obtained are complex data makes its use scarce in clinical practice. The use of synthetic measures may enable the clinician to easily interpret gait kinematics in Charcot-Marie-Tooth. Aims: To test the usefulness of Gait Profile Score as a method to quantify and monitor kinematic gait alterations in Charcot-Marie-Tooth. Methods: A group of patients with Charcot-Marie-Tooth and a control group underwent Gait Analysis. Neurological impairment was evaluated by means of the Charcot Marie Tooth neuropathy score in his original form and in the Rasch Analysis revised form. Differences in Kinematics scores induced by the pathology were assessed using the Mann-Whitney U test. The relationship between gait parameters and Charcot Marie Tooth neuropathy score was assessed by means of the Spearman correlation. Results: Twenty patients were enrolled. Mann-Whitney U test revealed a significant effect of the pathology on Gait Profile Score (p < 0.001). Charcot Marie Tooth neuropathy score was positively correlated with Gait Profile Score (Rho = 0.708, p = 0.001). Conclusion: Gait profile score can differentiate Charcot Marie Tooth from unaffected people and to quantify ambulation impairment, also identifying the joints more affected by the disease. Implications for rehabilitation Physiotherapy and orthotics constitute the sole possible clinical approach for Charcot Marie Tooth, but the clinical scales are scarcely effective for assessing the rehabilitative outcome. Synthetic measures are able to summarize Charcot Marie tooth kinematics in a single score, and Gait Profile Score is able to differentiate patients with Charcot Marie tooth from healthy controls. Gait Profile Score is related to clinical disability as measured by the Charcot Marie tooth neuropathy score.