Assistive Devices and Spatiotemporal Parameters of Gait in Persons With MS

Background: Gait disturbance is commonly reported by patients with multiple sclerosis (MS) and results in mobility limitations, which in turn have a significant impact on the patients’ functional status and quality of life. Spatiotemporal (ST) parameters of gait are increasingly assessed to characterize gait deviations in MS. Assistive devices and orthoses are frequently recommended and prescribed, but there is little information on the effect of walking aides on ST gait parameters, both at slow (preferred) and fast (but safe) pace. 

Objectives: the goal of our study was to assess immediate changes in ST parameters of gait with and without several types of walking aides (cane, walker, hip flexion assist device (HFAD) and ankle foot orthosis (AFO)), at slow and fast pace.   

Methods: a retrospective chart review was conducted on all adult patients with MS who underwent gait analysis using the GAITRite® electronic walkway during an outpatient visit at our MS center between 1/1/2010 and 11/20/2012. The gait parameters analyzed included velocity, step length, single and double support, step width, and the functional ambulation profile (FAP) score.  Patients were instructed to walk first at their usual pace, then at fast (but safe) pace, with and without a walking aide, as deemed appropriate by the treating clinician. Rest periods were provided between tests.

Results: 156 subjects were included in the analysis. Demographic characteristics were as follows: mean (sd) age 49.8 (10.3) years, 67% women, disease duration 14.0 +/- 9.1 years, and 54% presented with a relapsing-remitting disease course. There was a statistically significant improvement in most gait parameters between slow and fast pace (with the exception of step width) when all subjects were assessed with their usual walking aide. A comparison of subgroups based on the level of support needed (none, unilateral, bilateral) showed significant differences in most gait parameters (with the exception of step width) at slow or fast pace, but the change in gait parameters between slow and fast pace was not significantly different between subgroups. Although some immediate improvements in gait parameters were noted when testing patients with and without walking aide (particularly with the HFAD), the changes did not reach statistical significance, and the differences between slow and fast pace did not change significantly.

Conclusions: ST parameters of gait improved significantly between slow and fast pace in ambulatory patients with MS. Despite significant differences in ST gait parameters according to the habitual level of support needed, the changes observed between slow and fast pace were similar. The lack of statistically significant difference in gait parameters when patients were tested with or without walking aide may be due to small sample sizes, and to the need for training to the use of the device. Further research is needed to determine how to optimize the impact of walking aides on gait pattern.