Gait Profile Score in multiple sclerosis patients with low disability

doi:10.1016/j.gaitpost.2016.10.013

Gait & Posture

Volume 51, January 2017, Pages 169-173

https://doi.org/10.1016/j.gaitpost.2016.10.013 Get rights and content

Highlights

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Gait abnormalities are subtle in multiple sclerosis patients with low disability.
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GPS fails to identify gait abnormalities in low-disabled multiple sclerosis patients.
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Multiple sclerosis patients showed gait alterations at the ankle and pelvis level.

Abstract

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.

Introduction

Gait impairments are frequent in patients with multiple sclerosis (MS), even in low-disabled patients [1]. Beside the Expanded Disability Status Scale (EDSS) commonly used to assess the disability in MS patients, a global gait score may be used to identify gait impairments and to evaluate treatment strategy. The biomechanical gold-standard to measure gait deviations is the three-dimensional motion analysis system to compute segments and joints kinematics. Recently, gait scores based on lower-limb kinematics (Gait Profile Score (GPS) [2] and Gait Deviation Index (GDI) [3]) have been proposed to make a global examination of gait quality by combining nine kinematic time-series variables in one single value. GPS has been identified as relevant to detect and evaluate gait abnormalities in MS patients [4]. However, its interest has never been studied for low-disabled patients.

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. As subtle gait disorders exist early in MS [1] and GPS was identified as relevant to detect gait abnormalities in MS patients [4], we hypothesize that the GPS will highlight differences between patients and controls.

Section snippets

Participants

Thirty-four relapsing-remitting MS patients (age 36.32 ± 8.72 years; 12 men, 22 women; EDSS 1.19 ± 0.8) were recruited for this study at the University Geneva Hospitals, Switzerland. They were matched with twenty-two healthy controls (HC) (age 36.85 ± 7.87 years; 6 men, 16 women) for age, weight, height, body mass index and gender. The study procedures have been previously reported in detail [5]. Briefly, patients’ inclusion criteria were a diagnosis of relapsing-remitting MS according to the revised

Results

Clinical and gait characteristics of the participants are shown respectively in Table 1 and Table 2. GPS and GVS showed no significant difference between patients and controls (Fig. 1). Patients presented similar spatiotemporal parameters than controls. Concerning kinematic variables, the patients presented significant differences compared to the controls at ankle level with: a reduced maximal dorsiflexion in stance and a reduced maximal plantarflexion in swing; and at pelvis level: a reduced

Discussion

This study aimed to determine if the GPS could detect early gait deviations in low-disabled MS patients. Our findings reject the initial hypothesis that significant differences exist for the GPS between low-disabled MS patients and HC. The results showed no differences for GPS, GVS and common mean values of spatio-temporal data. Only differences were observed for the ankle and pelvis kinematics.

GPS has been previously identified as a suitable index to represent gait deviations in MS patients

Conclusion

This study failed in demonstrating that the biomechanical approach using the GPS is able to identify gait deviations in low-disabled MS patients. In order to identify subtle gait changes in low-disabled MS patients and to help the clinicians in disease and treatment monitoring, future studies should evaluate other methodological approaches.

Conflict of interest statement

We certify that there is no financial and personal relationship with other people or organisations that could inappropriately influence our work.

Acknowledgment

Gilles Allali and Patrice H. Lalive were supported by a grant from the Swiss Multiple Sclerosis Society.

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Citation Excerpt :
A higher GPS/GVS implies a larger deviation from a hypothetical “normal” gait and a greater level of impairment (Baker et al., 2009). GPS and/or GVS have been applied in previous studies involving patients with MS (Andreopoulou et al., 2019; Coghe et al., 2015; Morel et al., 2017; Pau et al., 2014; Pau et al., 2018) and are considered feasible, reliable (Andreopoulou et al., 2019; Pau et al., 2014), and responsive in this population (Pau et al., 2014). The literature on fampridine-induced 3DGA changes in patients with MS, only include two publications on the same study: One demonstrating changes on kinematic variables (Zörner et al., 2016) and one on kinetic variables (Weller et al., 2020).
Fampridine has shown to improve walking speed, motor control, and balance in patients with multiple sclerosis. However, potential fampridine-induced changes in gait quality and underlying mechanisms, evaluated by three-dimensional gait analysis, are poorly examined.
The aim was to examine if two weeks of fampridine treatment would improve gait quality (using Gait Profile Score and Gait Variable Scores from three-dimensional gait analysis) and gait function (using performance-based tests, spatiotemporal parameters, and self-perceived gait function).
14 participants with multiple sclerosis were included (9 women and 5 men, age 53.6 ± 12.8 years, disease duration 21 ± 9.1 years) in this cohort study. Tests were completed prior to fampridine and after 14 (± 1) days of treatment. Three-dimensional gait analyses were completed, and kinematic measures were calculated for overall gait quality using Gait Profile Score, and for joint-specific variables, Gait Variable Scores. Gait function was assessed using spatiotemporal parameters, performance-based tests, and a patient-reported outcome measure. Student’s paired t-test/Wilcoxon signed rank test were used to compare baseline and follow-up variables. Sample size calculation for Gait Profile Score required at least 9 participants.
No fampridine-induced improvements in gait quality were demonstrated. For gait function, improvements were found in performance-based tests (Timed 25-Foot Walk: −11.5%; Six Spot Step Test: −13.9%; 2-Minute Walk Test: 18.2%) and self-perceived gait function (12-itemMS Walking Scale: –35.2%).
Although two weeks of fampridine treatment in patients with multiple sclerosis improved gait function, there was no change in overall kinematic quality of gait.
Trial registration:
This work was collected as a part of a registered clinical trial (MUST): ClinicalTrials.gov NCT03847545
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Citation Excerpt :
Multiple sclerosis (MS) is the most common non-traumatic cause of neurological disability in young adults between 20 and 40 years old (GBD 2016 Neurology Collaborators 2019). Despite the higher frequency of lower limb dysfunction in people with MS (PwMS) (Baert et al., 2018; Givon et al., 2009; Morel et al., 2017; Socie et al., 2013; Gianfrancesco et al., 2011; Elsworth-Edelsten et al., 2017), manifestations of muscle weakness, tremor, sensory deficits and impaired motor control affect also upper limbs (UL) (Lamers et al., 2016; Lamers and Feys, 2014; Bertoni et al., 2015). One key issue is paucity of objective measures assessing UL function.
Upper limbs (UL) dysfunction is frequent in people with Multiple Sclerosis (PwMS). Several objective measures of UL function are proposed; however, their use is mostly confined to assess subjects with mild-to-moderate disability and requires fine motor skills, often impaired in high disability level subjects. Thus, a tool to score UL function in the advanced disease stage is lacking.
The aim of the study is to analyse and compare UL unilateral and bilateral movements of healthy control (HC) and PwMS, at different disability levels, using an instrumented version (Inertial Measurement Unit, IMU) of the 15-seconds finger-to-nose test (FNT). Each movement cycle was segmented in going/adjusting/returning phases. The inter-hand interval (IHI) allowed assessing bilateral coordination (i.e. synchrony) in each phase. The larger IHI, the more severe the bilateral coordination impairment is.
After stratifying PwMS for disability level (PwMS_LOW, Expanded Disability Status Scale, EDSS≤5.5 and PwMS_HIGH, EDSS≥6), the ANOVA on IHI showed significant differences between PwMS and HC (p<0.001) in all phases. However, only the going phase IHI showed significantly higher asynchrony in PwMS_HIGH than PwMS_LOW and HC (p<0.001) and no differences between PwMS_LOW and HC. The going phase IHI seems to be a clinical marker specific for high disability level PwMS.
These findings suggest inertial sensors during FNT could be an easy-to-use method for a more detailed quantitative characterization of UL function in PwMS also in subjects with EDSS greater than 6.
Are there common walking gait characteristics in patients diagnosed with late-onset Pompe disease?
2021, Human Movement Science
Citation Excerpt :
Indices have been developed to provide a summary of the analysis. The Gait Profile Score (GPS; Baker et al., 2009) has been used to assess the quality of gait in individuals in a range of patients (Cimolin & Galli, 2014; Schweizer, Romkes, Coslovsky, & Brunner, 2014) with disorders such as cerebral palsy (Baker et al., 2009; Holmes, Mudge, Wojciechowski, Axt, & Burns, 2018; Tsang et al., 2016), stroke (Devetak et al., 2016), Parkinson's disease (Corona et al., 2016) and multiple sclerosis (Morel et al., 2017). GPS has demonstrated good validity with other measures of gait quality such as the Gillette Gait Index (GDI) (Baker et al., 2009) and allows the decomposition of the GPS into a movement analysis profile to give an indication of which joint angle measures contribute to an elevation in GPS (Baker et al., 2009).
Late-onset Pompe disease (LOPD) is a rare disease, defined as a progressive accumulation of lysosomal glycogen resulting in muscle weakness and respiratory problems. Anecdotally, individuals often have difficulties walking, yet, there is no three-dimensional data supporting these claims. We aimed to assess walking patterns in individuals with LOPD and compare with healthy individuals. Kinematic, kinetic and spatiotemporal data were compared during walking at a self-selected speed between individuals with LOPD (n = 12) and healthy controls (n = 12). Gait profile scores and movement analysis profiles were also determined to indicate gait quality. In comparison with healthy individuals, the LOPD group demonstrated greater thoracic sway (96%), hip adduction angles (56%) and pelvic range of motion (77%) and reduced hip extensor moments (36%). Greater group variance for the LOPD group were also observed. Individuals with LOPD had a slower (15%) walking speed and reduced cadence (7%). Gait profile scores were 37% greater in the LOPD group compared to the healthy group. Proximal muscular weakness associated with LOPD disease is likely to have resulted in a myopathic gait pattern, slower selected walking speeds and deviations in gait patterns. Although individuals with LOPD presented with some common characteristics, greater variability in gait patterns is likely to be a result of wide variability in phenotype spectrum observed with LOPD. This is the first study to examine walking in individuals with LOPD using instrumented gait analysis and provides an understanding of LOPD on walking function which can help orientate physiotherapy treatment for individuals with LOPD.
Validation of the Arm Profile Score in assessing upper limb functional impairments in people with multiple sclerosis
2018, Clinical Biomechanics
Citation Excerpt :
To overcome such limitations, it has recently been proposed to use synthetic indexes to summarize the whole dataset of kinematic data into few (or even only one) scores (Cimolin and Galli, 2014). In the case of MS, such approach has mainly been applied in investigating gait alterations with encouraging results (Morel et al., 2017; Pau et al., 2014, 2015) but, in recent times, researchers have employed it even to investigate UL movements in CP and hemiplegia (Butler and Rose, 2012; Jaspers et al., 2011). Based on the aforementioned considerations, the purpose of the present study was to verify the feasibility of using synthetic quantitative indexes to characterize UL kinematics during a hand to mouth (HTM) functional task in a sample of pwMS, by comparing their values with those of a group of unaffected individuals.
Although upper limb (UL) impairments are widespread in people with Multiple Sclerosis (pwMS), there is limited quantitative evidence concerning their specific features. The aim of this study is to validate a synthetic measure based on kinematic data to define the degree of deviation from a physiologic pattern during the “hand to mouth” (HTM) task.
Twenty pwMS (mean age 51.2 SD 11.1) years, Expanded Disability Status Scale (EDSS) score in the range 2–6.5, underwent a kinematic analysis of the HTM task using a motion capture system. Spatio-temporal parameters and synthetic indexes (Arm Variable Score, AVS and Arm Profile Score, APS) were calculated and compared with those of age-matched healthy individuals. Kinematic data were correlated with the EDSS score and clinical tests such as the Nine Hole Peg Test (NHPT) and hand-grip strength (HGS).
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However, in minimally disabled pwMS, evidence of gait alterations is mixed. While some studies report reduced speed, cadence and stride length and increased duration of the double support [1,3,4], others fail to detect any differences with respect to healthy individuals [5] or find them in few parameters [6]. Given that small, yet clinically meaningful, changes in spatial-temporal parameters of gait appear difficult to assess, researchers have proposed to investigate changes in stride-to-stride fluctuations (i.e. gait variability) which represents an effective marker of gait impairments in neurological disorders [7].
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Upper limb movement analysis during gait in multiple sclerosis patients
2017, Human Movement Science
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.
In this observational study we analyzed the arm movements during gait in 52 outpatients (mean age: 39.7 ± 9.6 years, 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.
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.
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.

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Short communicationGait Profile Score in multiple sclerosis patients with low disability

Highlights

Abstract

Background

Method

Results

Conclusion

Introduction

Section snippets

Participants

Results

Discussion

Conclusion

Conflict of interest statement

Acknowledgment

Gait Posture

Gait Posture

J. Neurol. Sci.

Hum. Mov. Sci.

Comput. Methods Progr. Biomed.

Gait Posture

Gait Posture

Short communication
Gait Profile Score in multiple sclerosis patients with low disability