Magali Laidet

Adapted timed up and go: a rapid clinical test to assess gait and cognition in multiple sclerosis.

Background/Aims: To measure the Timed Up and Go (TUG), imagined TUG (iTUG), and the difference of time between these two tests (delta time) in 20 patients with relapsing-remitting multiple sclerosis (RRMS) and 20 healthy age-matched controls and to examine whether an association with cognitive functions, motor impairment, and behavioral changes can be determined. Methods: The mean ± SD of TUG, iTUG and delta time were used as outcomes. Spatiotemporal gait parameters were recorded by a 12-camera optoelectronic system during straight walking at usual self-selected speed. Cognitive functions were assessed by a standardized neuropsychological examination. Results: Patients performed the TUG slower than the controls (10.00 ± 1.70 s vs. 8.71 ± 1.04 s, p = 0.01, respectively). The TUG was correlated with gait parameters, cognitive functions, and behavior, whereas delta time was correlated only with cognitive functions. Conclusion: TUG represents an interesting test to reveal subtle deficits in RRMS patients with low disability and is related to motor, cognitive, and behavioral functioning. Combining with the TUG, delta time could easily give additional information on specific cognitive functions in the assessment of patients with RRMS.

Gait and Physical Impairments in Patients With Acute Ankle Sprains Who Did Not Receive Physical Therapy

To assess ankle function 4 weeks after conservative management and to examine the correlation of function with gait.

Dual-Task Assessment in Natalizumab-Treated Multiple Sclerosis Patients

Background: To study the 1-year evolution of quantitative dual-task gait parameters in comparison with single-task gait parameters and detailed neuropsychological assessment in patients with multiple sclerosis (MS) treated with natalizumab. Methods: Walking speed, stride length and stride time during a dual task (walking while forward counting, backward counting, semantic fluency, and phonemic fluency), a single walking task, and a detailed neuropsychological assessment were prospectively measured and assessed twice at the 1-year interval in 9 consecutive patients with MS treated with natalizumab. Results: Dual-task-related gait changes (walking speed, stride length and stride time while performing semantic fluency and walking speed, and stride time while performing phonemic fluency) showed a significant improvement after 1 year of treatment with natalizumab. The single walking task and detailed neuropsychological assessment did not present any modification. Conclusions: Dual-task-related gait changes using a cognitive task with a specific executive demand represent an interesting marker of disease-modifying therapy in patients with MS.

Improvement in executive subfunctions following cerebrospinal fluid tap test identifies idiopathic normal pressure hydrocephalus from its mimics

Patients with idiopathic normal pressure hydrocephalus (iNPH) present cognitive deficits that overlap with other neurological conditions such as Parkinsons disease or vascular dementia, therefore mimicking iNPH. This prospective study aimed to compare cognitive performances between iNPH and iNPH mimics before and after cerebrospinal fluid (CSF) tapping.

A combined cognitive and gait quantification to identify normal pressure hydrocephalus from its mimics: The Geneva’s protocol

OBJECTIVES Idiopathic normal pressure hydrocephalus (iNPH) is very prevalent in aging, underdiagnosed, and represents a rare cause of reversible neurological condition. The clinical triad of iNPH - gait, cognitive and urinary symptoms - and its neuroradiological features (i.e. ventriculomegaly) are not specific and found a various neurodegenerative and/or vascular conditions. We present our iNPH standardized protocol at the Geneva University Hospitals involving a multispecialty team of behavioral neurologists, neurosurgeons, neuropsychologists, engineers, and physical therapists. Based on a pragmatic approach, the goal of this protocol is to improve the identification of older patients with iNPH from its mimics (i.e. vascular dementia or other parkinsonian syndromes). PATIENTS AND METHODS We used a novel standardized paradigm with a simultaneous quantification of cognition and gait (dual task gait assessment and mental imagery of locomotion) before and 24h after CSF tapping. RESULTS We assessed 125 patients with suspicion of iNPH (age: 75.9±7.4years; 34.4% female) in 5 years: 54.4% of probable/possible iNPH and 45.6% of mimics. Among the mimics, vascular dementia (24.6%) and patients with multifactorial conditions (19.9%) were the two most common diagnoses. A total of 27 patients with iNPH (39.7%) accepted the neurosurgical shunt procedure. CONCLUSION This report shows that a quantified gait and cognitive assessment - using dual-task paradigms - before and after CSF tapping is feasible among older adults with suspicion of iNPH and that this multidisciplinary approach contributes to the identification of patients with iNPH from its mimics.

Apathy and higher level of gait control in normal pressure hydrocephalus

Apathy represents the most common behavioral disturbance in patients with suspicion of idiopathic normal pressure hydrocephalus (iNPH) and has a major impact on quality of life. However, its impact on gait -the hallmark motor disturbance of iNPH - has never been studied yet. This study aims to evaluate the impact of apathy on higher level of gait control in patients with suspicion of iNPH. Stride time variability (STV), a marker of higher level of gait control, was quantified during usual walking (single task) and during walking while performing simultaneously cognitive tasks (dual task) of counting and verbal fluency. Among 46 patients with suspicion of iNPH (77.6±6.7years; 34.8% women), 30 (65.2%) presented apathy (defined by a score≥14 on the Starkstein apathy scale). Backward counting induced more important worsening of STV (i.e. increasing STV) in apathetic compared to non-apathetic patients (14.8±25.1% versus 9.0±20.4%; p=0.005), while both groups presented similar executive functioning. These findings suggest that apathy contributes to gait disorders in iNPH. Apathy is easy to monitor and should be considered as a target symptom of treatment.

Gait Profile Score in multiple sclerosis patients with low disability

BACKGROUND Gait abnormalities are subtle in multiple sclerosis (MS) patients with low disability and need to be better determined. As a biomechanical approach, the Gait Profile Score (GPS) is used to assess gait quality by combining nine gait kinematic variables in one single value. This study aims i) to establish if the GPS can detect gait impairments and ii) to compare GPS with discrete spatiotemporal and kinematic parameters in low-disabled MS patients. METHOD Thirty-four relapsing-remitting MS patients with an Expanded Disability Status Scale (EDSS) score ≤2 (mean age 36.32±8.72 years; 12 men, 22 women; mean EDSS 1.19±0.8) and twenty-two healthy controls (mean age 36.85±7.87 years; 6 men, 16 women) matched for age, weight, height, body mass index and gender underwent an instrumented gait analysis. RESULTS No significant difference in GPS values and in spatiotemporal parameters was found between patients and controls. However patients showed a significant alteration at the ankle and pelvis level. CONCLUSION GPS fails to identify gait abnormalities in low-disabled MS patients, although kinematic analysis revealed subtle gait alterations. Future studies should investigate other methods to assess gait impairments with a gait score in low-disabled MS patients.

Brain comorbidities in normal pressure hydrocephalus

This cross‐sectional study aims to compare gait changes after the cerebrospinal fluid (CSF) tap test between normal pressure hydrocephalus patients with and without brain comorbidities (NPH+ and NPH− respectively) and then to identify significant contributors to a poor CSF tap test amongst individuals with NPH+.

Does fear of falling predict gait variability in multiple sclerosis

BACKGROUND Behavioural symptoms and gait disorders are very common in patients with multiple sclerosis. OBJECTIVE To evaluate the association between fear of falling and gait instability at one year in patients with multiple sclerosis. METHODS Thirty-five multiple sclerosis patients were included. Fear of falling was assessed by the Fall Efficacy Scale-International and gait variability with stride time variability under single and dual-task conditions at baseline and at one year. RESULTS Baseline fear of falling score was associated with increased stride time variability at one year during dual-task condition even after adjustment on covariates. CONCLUSION Fear of falling is associated with gait variability at one year, especially under dual-task condition.

Upper limb movement analysis during gait in multiple sclerosis patients

PURPOSE Gait disorders in multiple sclerosis (MS) are well studied; however, no previous study has described upper limb movements during gait. However, upper limb movements have an important role during locomotion and can be altered in MS patients due to direct MS lesions or mechanisms of compensation. The aim of this study was to describe the arm movements during gait in a population of MS patients with low disability compared with a healthy control group. METHODS In this observational study we analyzed the arm movements during gait in 52 outpatients (mean age: 39.7±9.6years, female: 40%) with relapsing-remitting MS with low disability (mean EDSS: 2±1) and 25 healthy age-matched controls using a 3-dimension gait analysis. RESULTS MS patients walked slower, with increased mean elbow flexion and decreased amplitude of elbow flexion (ROM) compared to the control group, whereas shoulder and hand movements were similar to controls. These differences were not explained by age or disability. CONCLUSION Upper limb alterations in movement during gait in MS patients with low disability can be characterized by an increase in mean elbow flexion and a decrease in amplitude (ROM) for elbow flexion/extension. This upper limb movement pattern should be considered as a new component of gait disorders in MS and may reflect subtle motor deficits or the use of compensatory mechanisms.