Multiple Sclerosis Disease Progression in Multiple Sclerosis
II. Methods for the Determination of Walking Impairment and Its Impact on Activities and Social Participation
Jürg Kesselring
Head, Department of Neurology and Neurorehabilitation, Rehabilitation Centre, Valens, and Professor of Clinical Neurology and Neurorehabilitation, University of Bern and Neuroscience Centre, Zürich
Abstract
Walking ability is a vital component of validated test procedures to assess mobility impairment in multiple sclerosis (MS). The methods used to assess walking ability vary widely between treatment centres, and the accuracy of the methods used and numbers of parameters determined to analyse specific aspects of walking and gait are often limited. The questionnaire- and task-based methods used to assess walking in MS can be divided into different categories. First, there are the general-purpose tests such as the Expanded Disability Status Scale (EDSS), the Multiple Sclerosis Functional Composite (MSFC), the Family Assessment of Multiple Sclerosis Trial Outcome Index (FAMS-TOI) and the Short Form-36 (SF-36). These, particularly EDSS, are widely used in MS to assess limitations of all activities and social participation, of which walking is only a part. Others, such as SF-36, assess health-related quality of life (HRQoL). Second, there are methods designed to specifically assess walking or gait, including the timed 25-foot walk (T25FW), the Dynamic Gait Index (DGI), the 12-Item MS Walking Scale (MSWS-12) and the Timed Up and Go Test (TUGT). These test methods require minimal equipment to perform such as a stopwatch, a hallway or a chair, and can be completed at a medical centre in a few minutes. Most of these tests provide reliable and valid data but some lack accurate assessment of gait and some require clinician training. Third, there are tests that specifically measure balance, such as the Berg Balance Test, in which the patient completes a series of balance exercises while being observed. A recent development is the use of accelerometers to monitor MS patients over extended periods; these can provide more accurate data than patient self-report tools. In future, it is likely that more specific tests of walking ability will be more widely used as an important part of MS diagnosis and to more precisely monitor disease progression and assess patient needs.
Keywords Multiple sclerosis, walking impairment, ambulation tests, gait, balance, mobility determination methods
Disclosure: Jürg Kesselring serves or has served on data safety monitoring and advisory boards of clinical trials in multiple sclerosis sponsored by Biogen, Novartis, Serono, Schering and Wyeth. Acknowledgement: Editorial assistance was provided by James Gilbart at Touch Briefings. Received: 14 June 2010 Accepted: 1 July 2010 Citation: European Neurological Review, 2010;5(1):61–8 Correspondence: Jürg Kesselring, Head, Department of Neurology and Neurorehabilitation, Rehabilitation Centre, Neuroscience Centre Zurich, CH 7317 Valens, Switzerland. E:
kesselring.klival@spin.ch
Support: The publication of this article was funded by Biogen Idec, Inc. The views and opinions expressed are those of the author and not necessarily those of Biogen Idec, Inc.
Overview of Disability and Walking Impairment in Multiple Sclerosis
In multiple sclerosis (MS), walking ability is an important component of a variety of validated measures of mobility impairment.1–3
The
methods used to assess the degree of impairment vary widely between studies, investigation groups and treatment centres, and few of the more commonly used approaches determine walking impairment with sufficient precision. In fact, subtle changes in walking ability can indicate early stages of neurodegeneration, but these signs are not used as a central part of the diagnostic process in MS. Moreover, detailed changes over time are rarely monitored in sufficient detail at any disease stage. The continued accurate monitoring of mobility is important in determining both the treatments and support needs of patients. A variety of methods have been used to assess outcome measures in patients with MS in many studies.4
The most frequently used scales determine disability and mobility only as a component of overall disease assessment, but
© TOUCH BRIEFINGS 2010
The purpose of this article is to outline the more commonly used methods of general disability assessment in MS and also the methods for specifically analysing walking ability, gait, balance and the likelihood of falling. It will also discuss the advantages of some of these test methods and consider the clinical studies in which they have been used.
many neurologists and rehabilitation specialists argue that these do not provide an adequate assessment of mobility and certainly fail to capture small changes that can indicate the gradual accumulation of neuronal loss.5–7
Methods for General Assessment of Activities and Social Participation in Multiple Sclerosis In clinical studies of MS, and in regular practice, a variety of methods are used for the general assessment of activities and social participation. Many of these methods were designed for application in different diseases or across a general health spectrum; some were designed to assess overall health-related quality of life (HRQoL) and,
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