Foot placement patterns of female rollator users with multiple sclerosis in the community

Abstract

Purpose: The objective of this study was to investigate the relationship between medio-lateral foot placement characteristics and environmental context when individuals with Multiple Sclerosis (MS) walk with a rollator (four-wheeled walker). Method: Ten women diagnosed with MS, who used rollators regularly, participated in this study. First, a rollator-based technique of calculating step width (SW) was validated in this patient population by comparing the output of an instrumented rollator (iWalker) to a laboratory-based Vicon Motion Capture System. Secondly, the iWalker-based technique was used to calculate the participants’ SW and SW variability as they used the iWalker in four common outdoor community environments. Results: There was a strong level of agreement between the iWalker and Vicon SW calculations, with an intra-class correlation coefficient of 0.993 and a root-mean-square difference of 0.71 cm. Furthermore, SW variability (P = 0.002), but not SW (P = 0.288), was influenced by the walking environment (i.e. between the in-lab vs. up-ramp and up-ramp vs. down-ramp conditions). Conclusions: Foot placement variability appears to be influenced by the walking environment of MS patients. Therefore, an enhanced understanding of walker-user interactions in relation to the environment must be established in order to improve mobility.

Implications for Rehabilitation

• The walking environment may have an effect on the foot placement patterns of females with Multiple Sclerosis who use rollators to compensate for their gait difficulties.

• Developing an enhanced understanding of the environmental factors that affect rollator-user interactions may inform how to more effectively improve the mobility of individuals who rely on these devices in the community.

Keywords::

• Physical mobility
• multiple sclerosis
• mobility aids
• walking
• motor performance

Acknowledgements

The authors would like to thank Triina Forbell at the Elkie Adler Multiple Sclerosis Clinic, Carol Kim at the Multiple Sclerosis Society of Canada, as well as Rina Reyes and Caryn Brady at the Toronto Rehabilitation Institute for assistance with patient recruitment.

Declaration of Interest: The authors acknowledge the support of the Toronto Rehabilitation Institute who receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-Term Care in Ontario. The views expressed do not necessarily reflect those of the Ministry. Equipment and space have been funded with grants from the Canada Foundation for Innovation, Ontario Innovation Trust and the Ministry of Research and Innovation. The authors would also like to thank the Institute of Aging of the Canadian Institutes of Health Research (CIHR) (IAP #82640) for providing funding in support of this work.