Examining the gait pattern in terms of spatio-temporal, kinematic and kinetic parameters during gait initiation in MS patients

Abstract

MS is an autoimmune disease of the central nervous system (1). Postural balance impairment is frequently depicted as one of the initial symptoms of MS and one of the most impairing MS symptoms (2, 3). the gait impairment is one of the most common indications of MS and influences the quality of life (4). Although investigation of the quiet stance is critical for analyzing the balance impairments, more challenging situations such as gait initiation (GI) may give a deeper knowledge into understanding of the mechanisms of dynamic postural control (5). Therefore, the aim of this study was to evaluate the gait pattern in terms of spatio-temporal, kinematic and kinetic parameters during the gait initiation phase in people with MS. What are the influencing factors on the gait pattern in gait initiation phase in MS patients? Search in PubMed, Cochrane, Science of Direct, Web of science, Scopus, and Google scholar Databases from 2019 to December 2022 was conducted. Studies were included if: individuals with multiple sclerosis disease, examination the gait initiation phase, and assessment of center of pressure(COP), anticipatory postural adjustments (APA), spatio-temporal, kinematic and kinetic parameters and muscular synergies as outcome measure were evaluated. Included studies were independently reviewed by two authors for their quality evaluation using modified Downs and Black checklist. Since meta-analysis was not possible, studies were descriptively presented. Ten articles were selected for final analysis. A total of 231 MS patients and 132 healthy subjects were included with ages ranging from 18 to 76 years old. The findings of studies showed COP position at gait initiation was more anterior and net muscular moments for each joint were significantly different during the APA phase with smoother variations in patients with MS than healthy participants. A lower amount of muscle activity during APA were reported. The first step was shorter in MS patients compared to healthy people. Gait initiation in the early stage of MS could be a useful measure to characterize balance. These results suggest that it is possible to use the gait initiation evaluation as an effective method for the rehabilitation treatment of these patients.