Reliability and Repeatability Analysis of Indices to Measure Gait Deterioration in MS Patients during Prolonged Walking

Gait deterioration caused by prolonged walking represents one of the main consequences of multiple sclerosis (MS). This study aims at proposing quantitative indices to measure the gait deterioration effects. The experimental protocol consisted in a 6-min walking test and it involved nine patients with MS and twenty-six healthy subjects. Pathology severity was assessed through the Expanded Disability Status Scale. Seven inertial units were used to gather lower limb kinematics. Gait variability and asymmetry were assessed by coefficient of variation (CoV) and symmetry index (SI), respectively. The evolution of ROM (range of motion), CoV, and SI was computed analyzing data divided into six 60-s subgroups. Maximum difference among subgroups and the difference between the first minute and the remaining five were computed. The indices were analyzed for intra- and inter-day reliability and repeatability. Correlation with clinical scores was also evaluated. Good to excellent reliability was found for all indices. The computed standard deviations allowed us to affirm the good repeatability of the indices. The outcomes suggested walking-related fatigue leads to an always more variable kinematics in MS, in terms of changes in ROM, increase of variability and asymmetry. The hip asymmetry strongly correlated with the clinical disability.

[1]  M. Morris,et al.  Changes in gait and fatigue from morning to afternoon in people with multiple sclerosis , 2002, Journal of neurology, neurosurgery, and psychiatry.

[2]  J. Kurtzke.  Rating neurologic impairment in multiple sclerosis , 1983, Neurology.

[3]  L Simoncini,et al.  Gait abnormalities in minimally impaired multiple sclerosis patients , 1999, Multiple sclerosis.

[4]  Eduardo Palermo,et al.  Factorization of EMG via muscle synergies in walking task: Evaluation of intra-subject and inter-subject variability , 2017, 2017 IEEE International Instrumentation and Measurement Technology Conference (I2MTC).

[5]  Alon Kalron,et al.  Association between perceived fatigue and gait parameters measured by an instrumented treadmill in people with multiple sclerosis: a cross-sectional study , 2015, Journal of NeuroEngineering and Rehabilitation.

[6]  Eduardo Palermo,et al.  Automatic Detection of Faults in Race Walking: A Comparative Analysis of Machine-Learning Algorithms Fed with Inertial Sensor Data , 2019, Sensors.

[7]  Catherine Dehollain,et al.  Gait assessment in Parkinson's disease: toward an ambulatory system for long-term monitoring , 2004, IEEE Transactions on Biomedical Engineering.

[8]  D. Kerrigan,et al.  Predicting peak kinematic and kinetic parameters from gait speed. , 2003, Gait & posture.

[9]  N. Larocca,et al.  Multiple sclerosis; earning a living. , 1980, New York state journal of medicine.

[10]  Eduardo Palermo,et al.  Disability and Fatigue Can Be Objectively Measured in Multiple Sclerosis , 2016, PloS one.

[11]  Krzysztof Mackala,et al.  Strength asymmetry increases gait asymmetry and variability in older women. , 2012, Medicine and science in sports and exercise.

[12]  Susan L. Kasser,et al.  A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis. , 2011, Archives of physical medicine and rehabilitation.

[13]  Pamela Newland,et al.  Central fatigue in multiple sclerosis: a review of the literature , 2016, The journal of spinal cord medicine.

[14]  S. Taş,et al.  An investigation of the sex-related differences in the stiffness of the Achilles tendon and gastrocnemius muscle: Inter-observer reliability and inter-day repeatability and the effect of ankle joint motion. , 2019, Foot.

[15]  Agnieszka Michalczuk,et al.  Assessment of Gait Parameters in Virtual Environment , 2018, 2018 IEEE 20th International Conference on e-Health Networking, Applications and Services (Healthcom).

[16]  Jacob J. Sosnoff,et al.  Gait Variability and Multiple Sclerosis , 2013, Multiple sclerosis international.

[17]  G. Bleijenberg,et al.  The measurement of fatigue in patients with multiple sclerosis. A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects. , 1996, Archives of neurology.

[18]  François Curtin,et al.  Multiple correlations and bonferroni’s correction , 1998, Biological Psychiatry.

[19]  T. Royer,et al.  Gait variability in people with multiple sclerosis , 2006, Multiple sclerosis.

[20]  Annegret Mündermann,et al.  Objective assessment of motor fatigue in multiple sclerosis using kinematic gait analysis: a pilot study , 2011, Journal of NeuroEngineering and Rehabilitation.

[21]  Fary Khan,et al.  The use of laboratory gait analysis for understanding gait deterioration in people with multiple sclerosis , 2016, Multiple sclerosis.

[22]  William Spence,et al.  The characterisation of gait patterns of people with multiple sclerosis , 2010, Disability and rehabilitation.

[23]  B. Phillips,et al.  Gait and balance impairment in early multiple sclerosis in the absence of clinical disability , 2006, Multiple sclerosis.

[24]  Eduardo Palermo,et al.  On the Reliability and Repeatability of Surface Electromyography Factorization by Muscle Synergies in Daily Life Activities , 2018, Applied bionics and biomechanics.

[25]  Zaccaria Del Prete,et al.  Reactive Postural Responses to Continuous Yaw Perturbations in Healthy Humans: The Effect of Aging , 2019, Sensors.

[26]  Stefano Rossi,et al.  A Redundant Accelerometric Cluster for the Measurement of Translational and Angular Acceleration and Angular Velocity of the Head , 2007 .

[27]  J. Jakobsen,et al.  Fatigued patients with multiple sclerosis have impaired central muscle activation , 2009, Multiple sclerosis.

[28]  Kaat Desloovere,et al.  Inter-laboratory and inter-operator reproducibility in gait analysis measurements in pediatric subjects , 2019, International biomechanics.

[29]  Juri Taborri,et al.  Measuring changes in gait kinematics due to walking-related fatigue in patients with Multiple Sclerosis , 2019, 2019 IEEE International Symposium on Medical Measurements and Applications (MeMeA).

[30]  Thompson Sarkodie-Gyan,et al.  Application of wearable sensors for human gait analysis using fuzzy computational algorithm , 2011, Eng. Appl. Artif. Intell..

[31]  Roger M Enoka,et al.  Fatigue and fatigability in neurologic illnesses , 2013, Neurology.

[32]  P. Cavanagh,et al.  Increased variability of continuous overground walking in neuropathic patients is only indirectly related to sensory loss. , 2001, Gait & posture.

[33]  Eduardo Palermo,et al.  Experimental evaluation of accuracy and repeatability of a novel body-to-sensor calibration procedure for inertial sensor-based gait analysis , 2014 .

[34]  Kourosh Khoshelham,et al.  Accurate Step Length Estimation for Pedestrian Dead Reckoning Localization Using Stacked Autoencoders , 2019, IEEE Transactions on Instrumentation and Measurement.

[35]  Stijn Verwulgen,et al.  Capturing Joint Angles of the Off-Site Human Body , 2018, 2018 IEEE SENSORS.

[36]  Qingguo Li,et al.  Concurrent validation of Xsens MVN measurement of lower limb joint angular kinematics , 2013, Physiological measurement.

[37]  Deepak Joshi,et al.  A Force Myography-Based System for Gait Event Detection in Overground and Ramp Walking , 2018, IEEE Transactions on Instrumentation and Measurement.

[38]  P Cappa,et al.  Experimental evaluation of indoor magnetic distortion effects on gait analysis performed with wearable inertial sensors , 2014, Physiological measurement.

[39]  Andrea Cereatti,et al.  Effects of a virtual reality and treadmill training on gait of subjects with multiple sclerosis: a pilot study. , 2016, Multiple sclerosis and related disorders.

[40]  Benno M. Nigg,et al.  Daily changes of individual gait patterns identified by means of support vector machines. , 2016, Gait & posture.

[41]  Kenneth J Harwood,et al.  Validation of the 2-Minute Walk Test with the 6-Minute Walk Test and Other Functional Measures in Persons with Multiple Sclerosis. , 2017, International journal of MS care.

[42]  Ying-Chih Wang,et al.  Six-Minute Walk Test Vs. Three-Minute Step Test for Measuring Functional Endurance , 2015, Journal of strength and conditioning research.

[43]  Kamiar Aminian,et al.  Comparison of gait characteristics between clinical and daily life settings in children with cerebral palsy , 2020, Scientific Reports.

[44]  Daina L. Sturnieks,et al.  Fatigue induced changes to kinematic and kinetic gait parameters following six minutes of walking in people with multiple sclerosis , 2016, Disability and rehabilitation.

[45]  Bryan R. Schlink,et al.  Gait asymmetries in unilateral symptomatic hip osteoarthritis and their association with radiographic severity and pain , 2019, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[46]  Shyamal Patel,et al.  A machine learning approach for gait speed estimation using skin-mounted wearable sensors: From healthy controls to individuals with multiple sclerosis , 2017, PloS one.

[47]  Adamantios Arampatzis,et al.  Fuzziness of muscle synergies in patients with multiple sclerosis indicates increased robustness of motor control during walking , 2020, Scientific Reports.

[48]  Dominique Hansen,et al.  Is Walking Capacity in Subjects with Multiple Sclerosis Primarily Related to Muscle Oxidative Capacity or Maximal Muscle Strength? A Pilot Study , 2014, Multiple sclerosis international.

[49]  Friedemann Paul,et al.  Maximum walking speed in multiple sclerosis assessed with visual perceptive computing , 2017, PloS one.

[50]  Thomas Kohlmann,et al.  Systematic literature review and validity evaluation of the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) in patients with multiple sclerosis , 2013, BMC Neurology.

[51]  Peter Feys,et al.  Prevalence of Walking-Related Motor Fatigue in Persons With Multiple Sclerosis , 2016, Neurorehabilitation and neural repair.

[52]  S C Gupta,et al.  Gait characteristics of individuals with multiple sclerosis before and after a 6-month aerobic training program. , 1999, Journal of rehabilitation research and development.