Clinical assessment, management, and rehabilitation of walking impairment in MS: an expert review

ABSTRACT

Introduction

One of the most common and life-altering consequences of Multiple Sclerosis (MS) is walking impairment. The distance, speed, and Gait pattern functions are components of the International Classification of Functioning, Disability, and Health (ICF) and are also predictors of dependency in terms of daily living activities in patients with MS (pwMS).

Areas covered

This article provides an overview of walking impairment in pwMS, with focus on the assessment of gait and the rehabilitation approaches.

Expert opinion

The authors recommend that pwMS undergo gait assessment integrating the ICF perspective using validated clinical outcome measures that cover spatiotemporal gait parameters. Moreover, assessment of walking speed with short walking capacity tests such as the timed 25-foot walk (T25FW) or the 10-m walk test (10 MWT) and tests for walking distance with middle distance tests such as the 2-min walk test (2MWT) and the 6-min walk test (6MWT). This review further highlights strategies that may restore walking function including pharmacological symptomatic treatment and non-pharmacological rehabilitation approaches such as exercise and task-specific training providing an appraisal of mobility targeted therapies to be considered when planning multidisciplinary comprehensive-care of pwMS. Finally, new and novel strategies such as motor imagery and rhythmic auditory stimulation have been developed to improve walking speed and distance in pwMS.

KEYWORDS:

• Ambulation
• ICF
• multiple sclerosis
• rehabilitation
• walking assessment

Article highlights

• Walking dysfunction is present in the majority of pwMS and contributes to disability and daily living restrictions.

• Walking can be categorized according to ICF, where the gait pattern is categorized at the ‘ICF body function level,’ whereas walking capacity and perceived walking ability are categorized at ‘ICF activity level.’

• The abnormal MS gait pattern can most often be characterized as either paretic or spastic, cerebellar, sensory ataxia, or mixed, which have consequences for the subsequent symptomatic treatment and rehabilitation strategies.

• Research and clinical practice are encouraged to apply validated walking outcomes with well-established MS-specific values of clinically meaningful changes.

• Symptomatic treatment focuses on impairments and can effectively improve walking speed and gait pattern in pwMS, and should, therefore, be included in multi-disciplinary treatment programs.

• Exercise and task-specific training have well-established beneficial effects on walking speed and distance in pwMS.

Declaration of interest

B Soler has received travel grants from Biogen Idec, Merck Serono, Technofarma, and/or teaching honorary from Merck. P Feys has provided consultancy to Neurocompass and Biogen Idec. P Feys is an editorial board member of MSJ and NNR journal. U Dalgas has received research support, travel grants, and/or teaching honorary from Biogen Idec, Merck Serono, Novartis, Bayer Schering, and Sanofi Aventis as well as honoraria from serving on scientific advisory boards of Biogen Idec and Genzyme. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.