Multiple Sclerosis
Table 3: Tests Used for the Specific Assessment of Walking and Gait in Multiple Sclerosis Test Method
Purpose
Dynamic Gait Index
Details of Assessments Included
Assess aspects of gait and Series of 8 tasks including walking at balance during walking.
12-Item Multiple Provide a patient-based Sclerosis Walking measure of walking ability Scale (MSWS-12) in MS.
different speeds for fixed times, walking and keeping balance while head is turned or tilted, stepping over or around obstacles and climbing stairs. 2 questions with responses rated on scale of 1 (not at all) to 5 (extremely). Questions ask if MS has decreased ability to walk, run, stand, walking difficulty and support needed. Interview with neurologist.
Timed 25 Foot Part of the MS functional Walking Test (T25FW)
composite (MSFC – see Table 1).
Patient is timed walking 25ft as fast as he/she is able without injury.
Open area needed to conduct test. 20–30 minutes. Minimal cost.
Tests forms, pen. 15–20 minutes. Minimal cost.
Equipment Needed, Validity of Data, Time to Perform and Cost
Advantages/Disadvantages
Reliable functional assessment tool – inversely correlated with timed walk.28
Open area,
stopwatch, pen. Easy to conduct. Low cost.
6 Minute Walking Provide a measure of Test (6MWT)
overall mobility and physical functioning.
Timed Up and Go Assess propensity for Test (TUGT)
falling and general mobility in the elderly.
Six Spot Step Test (SSST)
Distance walked is measured over 6-minute time period; walking is self-paced.
Subjects are instructed to stand up, using chair armrests, walk to a line 3 metres away, turn and return to the chair.
Quantitative measurement Subject is required to walk down a of ambulation in MS; a lower limb counterpart to 9-hole peg test.
marked test field/floor and push wooden blocks out of circles in a specific order with the same foot each time (see Figure 1).
Hauser
Ambulation Index (HAI)
Subjective assessment of walking ability and dependence on a wheelchair.
Kinetic and Kinematic
Analysis (KKA) Functional Independence Assess physical and Provide precise, objective
Questions rate subjects on a scale of 1 (fully active) to 9 (wheelchair-bound and unable to transfer self indepen- dently). Walking time is used together with other factors to rate the patient on an ordinal scale with 11 gradations. Test determines force and angle
data on gait during walking. of joints during gait cycle and
More responsive than Family Assessment of MS Trial Outcome Index (FAMS-TOI) mobility scale, the SF-36 Health Survey physical functioning scale and Expanded Disability Status Scale (EDSS).1 High inter-rater and test–retest reliability and good concurrent validity.37,38
Low responsiveness and
floor and ceiling effects. Does not distinguish gait changes resulting from fatigue.
Open area, stopwatch, Easy to administer. Provides valuable pen. 6 minutes to complete plus time for recovery. Minimal cost.
information on effects of fatigue on ambulation. Does not address
qualitative changes or changes over the 6-minute period.54
Armchair, stopwatch, As yet, there are no validity and tape measure. 1–5 minutes to
complete. Minimal cost. Marked test field, wooden blocks, stopwatch.
5–10 minutes to
reliability data for the MS population using the TUGT.29–31
Only moderately correlated with EDSS and MS Impact Scale (MSIS). SSST superior to T25FW for dynamic range, floor effect and
complete. Low cost. discriminatory power.39 Stopwatch, test form, pen.
1–5 minutes to complete. Minimal cost.
Good test–retest and inter-rater reliability and convergent validity. Due to more desirable psychometric properties, the T25FW has largely replaced the HAI in clinical studies.55
Tests require special In KKA, biomechanics may not reflect training and test
provides data on spatial and temporal equipment. gait parameters.
Includes 18 items; 13 are physical cognitive disability focusing domains based on the Barthel Index
Measure (FIM) on the burden of care. The and 5 are cognition items. Each item test can be performed by any trained person.
is scored from 1 to 7 (1 = total dependence and 7 = complete
independence). Scores range from 18 to 126 (higher = greater ability).
Rivermead Mobility
Index (RMI) Assess aspects of mobility. Patient is asked 15 questions
regarding turning over in bed, lying to sitting, sitting balance, standing, stairs, getting up off the floor, bathing
Observation
Clinical observation of patient’s gait and walking ability in a controlled setting.
and running. All questions require a yes/no response; maximum score = 15. Patient is asked to walk while being observed by a neurologist.
Tests forms, pen. 5–10 minutes to complete. Minimal cost.
Studies indicate that the reliability and validity of RMI data are good.59, 60
High cost of
activity limitations/participation restrictions. Moderate reliability in paediatric population but no data on
equipment needed. application to MS population.56 15 minutes to complete test.
Adequate to high inter-rater
Requires training. Low cost.
reliability and high internal validity. High concurrent validity with the Barthel Index, TUGT and the Tinetti Balance Test.57, 58
Requires training to This method has poor recognise normal and inter-rater reliability.4 abnormal gait
characteristics. 5–10 minutes to complete. Easy. Minimal cost.
64 EUROPEAN NEUROLOGICAL REVIEW
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