Gait Termination in Individuals with Multiple Sclerosis

Background: Multiple sclerosis (MS) is a neurodegenerative disease that commonly impacts walking. Walking is typically examined during continuous tasks. Consequently, there is little knowledge regarding the impact of MS on essential components of walking, such as gait termination (GT).

Objectives: The purpose of this investigation was to compare planned GT in individuals with MS and healthy controls during simple walking tasks and cognitively distracting tasks. We hypothesized that individuals with MS would have impairments in GT compared to age matched controls, especially during the cognitive challenging condition.

Methods: Twenty-five individuals with MS (mean age 61.1±8.4yrs) and 30 age-matched controls (mean age 64.3±5.3yrs) participated. Participants completed 4 comfortable paced walking trials in which they terminated their walking at a prescribed location on a pressure sensitive walkway. The first 2 trials consisted of simply walking while the last 2 consisted of walking while engaged in a cognitive task. Maximum gait velocity for each trial was determined. GT performance was quantified with two approaches. First, a global measure of success or failure to stop reported as failure rate was computed. Second, the time to stop normalized to maximum walking velocity was calculated for successful trials. A repeated measures ANOVA was used to investigate group and task differences in gait velocity and termination time. Two-proportion Z-tests were utilized to compare failure rates as a function of group and task.

Results: The MS group had a lower velocity (89.9±33.3 cm/s) than the control group (142.8±22.4 cm/s) and there was a significant reduction with the added cognitive task in both groups (MS: 73.9±30.7 cm/s; control: 120.0±25.9 cm/s). There was no difference in failure rates between groups (MS (21%) vs. control (16%)). There was nearly a 10-fold increase in failure rates in both groups when performing the cognitive condition compared with baseline (3.6% vs. 33%). There was a group difference in GT time (MS: 1.11±1.03 vs. control: 0.47±0.17).

Conclusions: Compared to controls, the MS group had a similar amount of GT failures despite walking at slower speeds. Although individuals with MS walked slower than age-matched controls, they required a greater amount of time to terminate their gait. Future research examining the clinical significance of GT is warranted.