Gait Velocity Training Results in Improved Gait Endurance in Persons with Multiple Sclerosis

Background: Diminished gait speed and endurance are common findings in persons with Multiple Sclerosis (pwMS). Little information on effective interventions for these limitations  exists. Neurogenic fatigue prevents large amounts of training being done in this population limiting the volume and intensity of rehabilitation that can occur in this population. Previous research in both non-disabled and non-MS disabled populations has shown that interventions to increase gait speed can improve gait endurance by improving efficiency. To date, these interventions have not been examined in pwMS.

Objectives: The purpose of this pilot study was to examine the effects of a gait velocity training (VT) program on gait and balance performance in pwMS. It is hypothesized that 1) the VT program will be well tolerated by participants, and 2) persons who undergo the training program will demonstrate improvements in gait speed, gait endurance, and balance.

Methods: This is a pretest-posttest pilot study. Subjects are being recruited from local area MS practices and from the NMSS. Following collection of subject characteristics and demographics, subjects will be evaluated using the 6-Minute Walk Test (6MWT), the 25-Foot Walk Test (25FWT), and the MiniBESTest (MBT). . Subjects then undergo a 6-week training period where they perform an increasing number of guarded, 20-second walks (as little as 6 to as many as 30 per session) at their fastest possible speed, 2 times a week, with each individual walk followed by a complete, 1-5-minute recovery period. Following completion of the training program, the 6MWT, 25FWT, and MBT are repeated. Subjective fatigue is measured using the Fatigue Severity Scale as a pretest/postest measure and the Visual Analog Fatigue Scale before and after each 6-minute walk.

Results: To date, 6 pwMS (mean EDSS=3.6)  have completed the program. One subject dropped out due to an unrelated injury. Mean 6MWT performance has improved from 1120'(sd=551.6) to 1408'(sd=624.2),[p=.005], 25FT performance improved from 8.2(sd=4.8) to 6.1(sd=2.5), [p=.012] and MBT performance improved from 17.0(7.2) to 19.5(6.5) [p=.104]. No significant changes were noted in the VAFS suggesting that the training did not result in increased perceptions of fatigue.No adverse events were reported.

Conclusions: Despite there being a relatively small volume of training (8-20 twenty-second bouts of fast walking, 2x/week for 6 weeks), large changes in gait speed, endurance, and balance occurred. These improvements suggest that this intervention could be added to a clinician’s toolbox as a relatively simple, safe, and effective means of improving gait performance in pwMS. Data collection for this study will conclude in the end of 2017. Larger scale studies are being planned to further investigate the effectiveness of this intervention.