A Multi-Faceted, Task Specific Approach for Successful Gait Intervention in MS

Background: Gait dysfunction has been referred to as the most visible feature of multiple sclerosis (MS).  It appears that individuals with MS who also have gait impairments initially present with weakness primarily affecting distal muscles.  This primary weakness may lead to   faulty biomechanics over time thus causing secondary impairments and further gait dysfunction.  Mobility is vital to patients’ quality of life, overall health, and life roles.  There is no consensus on the best gait intervention for this population.  The interventions chosen in these cases were based on evidence based principles of task specific training stressing:   maximal repetitions, appropriate gait mechanics, and functional skills both in the clinic and at home.  We selected three patients from the UT Southwestern Gait Disorders Clinic to represent the various innovative strategies that are typically utilized to achieve meaningful functional outcomes for this patient population.

Objectives: To highlight three innovative strategies for optimizing gait outcomes in persons with MS.

Methods: A comprehensive physical therapy evaluation was performed on each individual.  Intervention was chosen based on the patient’s impairments in addition to gait deficits.  The gait interventions included lower extremity orthoses, assistive devices, and neuromuscular electrical stimulation.  All patients also received an individualized home based exercise and walking program.

Results: Spatiotemporal gait measurement (GAITRite), 6 Minute Walk Test, and video observational gait analysis were used to assess the impact of the interventions.  Each of the case examples described exhibit improvements in the above measures.

Conclusions: Through the application of the described combination of interventions, the patients discussed had excellent outcomes related to their gait. Thus, these patients were able to continue with safe community mobility, engage in their life roles, and have improved quality of life.