RESUMO
BACKGROUND: Multiple sclerosis can cause locomotor and cognitive impairments even at lower levels of disability, which can impact daily life. The cognitive-motor dual task is commonly used to assess everyday locomotion. Thus, this study aimed to examine the effect of cognitive-motor dual tasks on gait parameters among patients with multiple sclerosis in the early disease stages and to determine whether dual tasks could be used as a clinical test to detect locomotion impairments. METHODS: A systematic search of five databases was conducted in May 2024. The population of interest was patients with multiple sclerosis with an Expanded Disability Status Scale score of 4 or less. The following outcome measures were examined: spatiotemporal and kinematic parameters. The Newcastle-Ottawa Scale was used to assess the quality of the studies. FINDINGS: Eleven studies including 270 patients with multiple sclerosis and 221 healthy controls. Three spatiotemporal parameters were modified both in patients with multiple sclerosis and healthy controls during dual-task performance: gait speed, stride length and the double support phase. No spatiotemporal parameter was affected during dual-task performance in patients with multiple sclerosis alone. INTERPRETATION: Dual-task performance could be useful for assessing gait impairments in patients with multiple sclerosis provided that assessments and protocols are standardized. Nevertheless, the spatiotemporal parameters did not allow discrimination between patients with multiple sclerosis at an early stage and healthy controls. Three-dimensional gait analysis during dual-task performance could be a useful approach for detecting early gait impairments in patients with multiple sclerosis, assessing their progression and adjusting rehabilitation programs.
RESUMO
BACKGROUND: Although patients with an early stage of Multiple Sclerosis (MS) commonly complain about balance and gait impairments, their troubles remain misunderstood. The objective was to compare body kinematics and lower limb kinetics during gait initiation between patients with MS with an EDSS score ≤ 4 and healthy participants. METHODS: Sixteen patients with MS with a median EDSS score of 2.5 [0-4] and disease duration of 7.4 ± 4.2 years, as well as 16 healthy participants were included, and 3-D motion analysis was performed during gait initiation to calculate spatiotemporal, kinematic and kinetic parameters. FINDINGS: The center of pressure position at the beginning of the gait initiation was more anterior (p = 0.02) in patients with MS than healthy participants. The kinetic parameters of the stance limb were highly affected in patients with MS compared to healthy participants during gait initiation. The net muscular moments for each joint were significantly different during the anticipatory postural adjustment phase with smoother variations for patients with MS compared to healthy participants. INTERPRETATION: Early stage MS strongly affects the motor modulation of stance limb kinetics during the anticipatory postural adjustment of gait initiation, without alteration of the execution phase. The net muscular moments are sensitive in detecting unobservable balance impairments and can be used to assess disease progression at the early stage. These results suggest that early rehabilitation programs aimed at improving motor modulation and flexibility in gait initiation should be implemented.
