Service de Médecine Physique et de Réadaptation, Hôpital Saint Philibert, Lomme, France
Ankle dysfunction in multiple sclerosis and the effects on walking
Purpose: Even in the early stage of the disease, for patients suffering from multiple sclerosis (MS), the most common and reported biomechanical alterations in the lower limb are located at the ankle joint. However, the effects of these impairments on gait deterioration should be discussed.Materials and methods: This review was written according to the PRISMA guidelines. The search focussed on biomechanical changes (kinetic, kinematic, and electromyographic data) at the ankle during gait in MS patients. The search was performed in the databases: Pubmed, Web of Science, and Cochrane Library. Results: Eleven studies were included. The reduction in the ankle range of motion (RoM) induced by increased cocontractions of the tibialis anterior and triceps surae muscles could be a compensatory strategy to improve body-weight support and balance during the stance phase. Conclusions: Future rehabilitation programmes should consider the control of weight support at the ankle during gait training. Implications for rehabilitation: The ankle supports and stabilises the body during the stance phase of gait. The reduced ankle range of motion in multiple sclerosis (MS), even at an early stage of the disease, is due to cocontractions of tibialis anterior and triceps surae and could be a compensatory strategy to be more stable. Rehabilitation programmes for MS patients should focus on the control of body segments motion during the weight transfer above the ankle.
Department of Biomedical Sciences, University of Sassari, Sassari, Italy
Gait Changes Following Direct Versus Contralateral Strength Training: A Randomized Controlled Pilot Study in Individuals With Multiple Sclerosis
Background: Contralateral strength training (CST) is increasingly investigated and employed as a non-conventional way to induce an indirect gain in strength in the weakened untrained limb. However, its effects on gait performance are more controversial.
Research question: To assess and compare the effects of contralateral (CST) and direct (DST) strength training on spatio-temporal parameters, kinematic and kinetic descriptors of gait in persons with relapsing-remitting multiple sclerosis (PwMS).
Methods: Twenty-eight PwMS (EDSS 2.0-5.5) with inter-side difference in ankle dorsiflexors' strength ≥ 20 % and moderate gait impairment (walking speed 0.70-0.94 m/s), were randomly assigned to a CST (undergoing training of the less-affected dorsiflexors) or DST group (where the most-affected dorsiflexors were trained). Before and after a 6-week high-intensity resistance training (three 25-minute sessions/week), PwMS underwent bilateral measurements of dorsiflexors' maximal strength and assessment of gait spatio-temporal parameters, lower limb joint kinematics and kinetics.
Results and significance: Following the training period, muscle strength increased significantly in both groups (on average, CST + 29.5 %, p < 0.0005; DST + 15.7 %, p = 0.001) with no difference between the two interventions. Significant changes in gait speed (+16.5 %; p < 0.0001) and stride length (+6.0 %; p = 0.04) were detected only after DST, while no difference was detected in the CST group. Ankle moment and ROM were unaffected by the training. In PwMS with mild to moderate disability and lower limb dorsiflexors' strength asymmetry, CST was not inferior to DST in inducing significant strength gains in the untrained most-affected limb. However, only DST significantly improved gait performance and, specifically, walking speed. Even though CST did not worsen asymmetry, data suggest that contralateral approaches should not be recommended straightaway if the training goal is to improve outcomes other than strength and, specifically, walking speed.