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Gait and balance impairment in early multiple sclerosis in the absence of clinical disability

School of Physiotherapy, The University of Melbourne, Melbourne 3010, Australia, Rehabilitation Sciences Research Centre, The University of Melbourne, Melbourne 3010, Australia

B A Phillips

School of Physiotherapy, The University of Melbourne, Melbourne 3010, Australia, Rehabilitation Sciences Research Centre, The University of Melbourne, Melbourne 3010, Australia, b.phillips{at}unimelb.edu.au

T J Kilpatrick

Department of Neuroscience, The Royal Melbourne Hospital, Melbourne 3050, Australia, Howard Florey Institute, The University of Melbourne, Melbourne 3010, Australia

H Butzkueven

Department of Neuroscience, The Royal Melbourne Hospital, Melbourne 3050, Australia, Howard Florey Institute, The University of Melbourne, Melbourne 3010, Australia

N Tubridy

Department of Neuroscience, The Royal Melbourne Hospital, Melbourne 3050, Australia, Department of Neurology, St. Vincent’s Hospital, Dublin 4, Ireland

E McDonald

Multiple Sclerosis Society of Victoria, Melbourne 3130, Australia

M P Galea

School of Physiotherapy, The University of Melbourne, Melbourne 3010, Australia, Rehabilitation Sciences Research Centre, The University of Melbourne, Melbourne 3010, Australia

This study evaluated the gait and balance performance of two clinically distinct groups of recently diagnosed and minimally impaired multiple sclerosis (MS) patients (Expanded Disability Status Scale range 0- 2.5), compared to control subjects. Ten MS patients with mild pyramidal signs (Pyramidal Functional Systems 1.0), 10 MS patients with no pyramidal signs (Pyramidal Functional Systems 0) and 20 age- and gender-matched control subjects were assessed using laboratory-based gait analysis and clinical balance measures. Both MS groups demonstrated reduced speed and stride length (P < 0.001), and prolonged double limb support (P<0.02), compared to the control group, along with alterations in the timing of ankle muscle activity, and the pattern of ankle motion during walking, which occurred independent of gait speed. The pyramidal MS group walked with reduced speed (P=0.03) and stride length (P=0.04), and prolonged double limb support (P=0.01), compared to the non-pyramidal group. Both MS groups demonstrated concomitant balance impairment, performing poorly on the Functional Reach Test compared to the control group (P<0.05). The identification of incipient gait and balance impairment in MS patients with recent disease onset suggests that motor function may begin to deteriorate in the early stages of the disease, even in the absence of clinical signs of pyramidal dysfunction.

Key Words: balance • gait • multiple sclerosis

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