Analysis of foot and ankle disorders and prediction of gait in multiple sclerosis rehabilitation (original) (raw)

Abstract

Background: Multiple sclerosis (MS) is a disease of the central nervous system probably based on the autoimmune mechanism against myelin and the action of lymphocyte T. In the last 50 years, more than 150 descriptive studies regarding MS have focused on the etiopathogeny, treatment, diagnosis and prevention of the progressive evolution of MS. Most recently, studies in the field of rehabilitation and diagnosis have tried to present the postural aspects of control/foot and ankle control and gait pattern in MS. The aim of this study is focused on biomechanical foot analyses of MS patients. Methods: Our clinical research and functional assessment was based on a scale like the EDSS/Kurtzke score: biomechanical foot assessment used the RSscan force plate to assess the foot loading, impulse and foot-ankle angle (subtalar angle), and pressure distribution methods for statistical analyses. The study included MS patients at the Neurologic Rehabilitation Unit, Craiova, we studied 48 patients (46.04 ± 10.99 years) diagnosed with MS. Results: This study shows that the major lesion is to the pyramidal system and the average value for functionality index (EDSS score) is 3.03 ± 0.13, where 3 means easy paraparesis or hemiparesis. In considering postural strategies, we observed an instability left to right to be more evident in the swing phase and it influences the under the foot impulse for the next step and postural control. From the analysis of the data and pressure centre position, we can see that the high pressure is on metatarsian II to III and more or less at the heel. This means the development of an ankle strategy necessary to restore balance, stability and motor control cannot be assessed other than by clinical evaluation. Even if many physicians and physical therapists do use the functional scale in their daily assessment, it does not help us achieve a complex assessment of gait and lower limb behaviour during gait, nor does it provide information about the impact of gait on daily activities and on quality of life. Conclusions: Biomechanical assessment can help the clinician predict the functional evolution of MS patients without visible clinical gait disorders and allows the development of a strategy for rehabilitation to prevent an incorrect ankle/ankle and foot position, resulting in a lack of motor control. Keywords: Assessment, Biomechanical, Foot, Gait, Motor control

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

References (24)

  1. Pozzilli C, Antonini G, Bagnato F: Monthly corticosteroids decrease neutralizing antibodies to IFNbeta1 b: a randomized trial in multiple sclerosis. J Neurol 2002, 249:50-56.
  2. Kelleher KJ, Spence W, Solomonidis S, Apatsidis D: The characterisation of gait patterns of people with multiple sclerosis. Disabil Rehabil 2010, 32:1242-1250.
  3. Djaldetti R, Ziv I, Achiron A, Melamed E: Fatigue in multiple sclerosis compared with chronic fatigue syndrome: a quantitative assessment. Neurology 1996, 46:632-635.
  4. Ng AV, Kent-Braun JA: Quantitation of lower physical activity in persons with multiple sclerosis. Med Sci Sports Exerc 1997, 29:517-523.
  5. Nilsagård Y, Lundholm C, Denison E, Gunnarsson LG: Predicting accidental falls in people with multiple sclerosis-a longitudinal study. Clin Rehabil 2009, 23:259-269.
  6. Rice PM, Elliston K, Gribskov M: Identification of simple sites and transcriptional signals. In Sequence Analysis Primer. New York: W. H. Freeman and Co; 1992:23-43.
  7. Fjeldstad C, Pardo G, Frederiksen C, Bemben D, Bemben M: Assessment of postural balance in multiple sclerosis. Int J MS Care 2009, 11:1-5.
  8. Kalron A, Dvir Z, Achiron A: Walking while talking -difficulties incurred during the initial stages of multiple sclerosis disease process. Gait Posture 2010, 32:332-335.
  9. Sosnoff JJ, Shin S, Motl RW: Multiple sclerosis and postural control: the role of spasticity. Arch Phys Med Rehabil 2010, 91:93-99.
  10. Remelius JG, Hamill J, Kent-Braun J, Van Emmerik RE: Gait initiation in multiple sclerosis. Motor Control 2008, 12:93-108.
  11. Van den Noort S, Eidelman B, Rammohan K: National Multiple Sclerosis Society (NMSS): Disease Management Consensus Statement. New York, NY: National MS Society; 1998.
  12. Waxman SG: Demyelinating diseases -new pathological insights, new therapeutic targets. N Engl J Med 1998, 338:323-325.
  13. Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG: Revised diagnostic criteria for neuromyelitis optica. Neurology 2006, 66:1485-1489.
  14. Granger CV, Cotter AC, Hamilton BB: Functional assessment scales: a study of persons with multiple sclerosis. Arch Phys Med Rehabil 1990, 71:870-875.
  15. Harwood RH, Rogers A, Dickinson E: Measuring handicap. London handicap scale, a new outcome measure for chronic disease. Qual Health Care 1994, 3:11-16.
  16. Hobart JC, Freeman JA, Thompson AJ: Kurtzke scales revisited: the application of psychometric methods to clinical intuition. Brain 2000, 123:1027-1040.
  17. Givon U, Zeilig G, Achiron A: Gait analysis in multiple sclerosis: characterization of temporal-spatial parameters using GAITRite functional ambulation system. Gait Posture 2009, 29:138-142.
  18. Crenshaw SJ, Royer TD, Richards JG, Hudson DJ: Gait variability in people with multiple sclerosis. Mult Scler 2006, 2:613-619.
  19. Baram Y, Miller A: Virtual reality cues for improvement of gait in patients with multiple sclerosis. Neurology 2006, 66:178-181.
  20. Sadeghi H: Local or global asymmetry in gait of people without impairments. Gait Posture 2003, 17:197-204.
  21. Goble DJ, Marino GW, Potvin JR: The influence of horizontal velocity on interlimb symmetry in normal walking. Hum Mov Sci 2003, 22:271-283.
  22. Fjeldstad C, Pardo G, Bemben D, Bemben M: Decreased postural balance in multiple sclerosis patients with low disability. Int J Rehabil Res 2011, 34:53-58.
  23. Houglum P: Therapeutic Exercise for Musculoskeletal Injuries. 2nd edition. Champaign, IL: Human Kinetics; 2005:262-266.
  24. Benedetti MG, Simoncini L, Bonato P, Tonini A, Giannini S: Gait abnormalities in minimally impaired multiple sclerosis patients. Mult Scler 1999, 5:363-368.