Exercise-induced changes in gait kinematics in multiple sclerosis with minimal neurological disability.

BACKGROUND: Exercise-induced gait deterioration is a frequently encountered symptom that limits ambulation throughout the clinical course, becoming more prominent with increasing neurological disability in people with MS (pwMS). OBJECTIVE: We attempted to objectively document exercise-induced gait changes in pwMS with minimal neurological disability and stable disease. METHODS: Gait kinematics and spatio-temporal parameters were recorded using 3D motion analysis before and after a 20-minute treadmill walk (Group A, n=15)/run (Group B, n=15) at a self-selected speed in pwMS and compared with healthy controls (n=15). RESULTS: Gait analysis revealed a significant decrease in peak ankle dorsiflexion in swing of the most affected leg, post-exercise task, in both Group A (EDSS 2.5-3.5) and Group B (EDSS 1-2.5) and not in healthy controls. Fourteen out of 30 MS participants showed an exercise-induced gait deterioration, based on minimal detectable change. Pre-exercise gait parameters in Group A showed a significantly higher peak dorsiflexion in swing with shorter step length and higher cadence, whereas Group B was comparable to healthy controls. CONCLUSION: The detection of exercise-induced gait deterioration (foot drop) in pwMS with minimal neurological disability and stable disease indicates the potential of gait kinematics, before and after an exercise task, to monitor subtle neurological deficits from an early stage of MS.

Simplified technique for injection of Botulinum Toxin to Obturator Internus muscle using ultrasound-guided nerve stimulation for persistent pelvic pain.

Botulinum toxin (BoNT) injections have been used to reduce muscle spasm in the presence of severe pelvic pain. However, while pubococcygeus is easily accessed vaginally, injection to obturator internus is more complex - with variation in operative technique and needle placement confounding the ability to assess outcomes. We describe a simplified technique for BoNT injection to obturator internus using neurostimulation under ultrasound guidance.