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The effect of different assistive devices on gait and walking in persons with multiple sclerosis-related walking difficulty
E.T. Cohen1, D.A. Barone2, S. Soliman2, C. Beswick2, E. Goldwasser2, A. Caruana2, A. Manzoor2, N. Parikh2
1Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, 2Rowan University, School of Osteopathic Medicine, Stratford, NJ, United States
Purpose: To compare temporal-spatial parameters of gait in persons with multiple sclerosis (MS) using three assistive devices (AD): single-point cane (SPC), four-point cane (FPC), and trekking pole (TP).
Methods: 19 persons with MS (16 women, 3 men; mean age=52 years), and Extended Disability Severity Scale scores of 2.5-6.0 (median=4.0, IQR=1.75). A randomized, crossover, design was used. Participants were randomly assigned the AD order. Each participant was provided with an AD and instructed in its use. They were then instructed to regularly utilize the AD until the next visit 1-2 weeks later. This was repeated for all AD. Participants walked across a 4.9-meter GAITRite walkway (CIR Systems, Sparta, NJ) three times with each AD. Data was collected using PKMAS software (Protokinetics, Havertown, PA). Data for each pass in each condition was combined using PKMAS resulting in averaged values. Measures were step length (SL), stride length (STL), step time (ST), stride width (SW), stride velocity (SV), cycle time (CT), stance-time percent (STT%), swing-time percent (SWT%), single-limb-support percent (SLS%), double-limb support percent (DLS%), walking velocity (WV) and cadence (CAD). Data was analyzed with ANOVAs and planned pairwise comparisons. Greenhouse-Geisser correction was used when spehericity was violated.
Results: Differences were found between AD conditions for all parameters except SW. SL was larger with the SPC (p=.03) and TP (p=.000) then the FPC. STL was larger with the TP (p=.001) than the FPC. STT was faster with the SPC (p=.008) and TP (p=.000) than the FPC. SV was faster with the SPC (p=.001) and TP (p=.000) than the FPC. CT was faster with the SPC (p=.01) and TP (p=.000) than the FPC. SLS% was greater with the SPC (p=.047) and TP (p=.002) than the FPC. DLS% was lesser with the TP (p=.015) than the FPC. WV was faster with the SPC (p=.001) and TP (p=.000) than the FPC. CAD was greater with the SPC (p=.002) and TP (p=.000) than the FPC. The difference in ST% and SW% did not persist in the pairwise comparisons.
Conclusions: Participants generally performed better with the SPC and TP than with the FPC. These may be useful AD options for persons with MS. A previous study showed that the SPC and TP have a more positive psychosocial impact than the FPC. The combination of better gait performance and lower negative psychosocial impact should make the SPC or TP first-line options for persons with MS who may benefit from the use of a walking AD.
E.T. Cohen1, D.A. Barone2, S. Soliman2, C. Beswick2, E. Goldwasser2, A. Caruana2, A. Manzoor2, N. Parikh2
1Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, 2Rowan University, School of Osteopathic Medicine, Stratford, NJ, United States
Purpose: To compare temporal-spatial parameters of gait in persons with multiple sclerosis (MS) using three assistive devices (AD): single-point cane (SPC), four-point cane (FPC), and trekking pole (TP).
Methods: 19 persons with MS (16 women, 3 men; mean age=52 years), and Extended Disability Severity Scale scores of 2.5-6.0 (median=4.0, IQR=1.75). A randomized, crossover, design was used. Participants were randomly assigned the AD order. Each participant was provided with an AD and instructed in its use. They were then instructed to regularly utilize the AD until the next visit 1-2 weeks later. This was repeated for all AD. Participants walked across a 4.9-meter GAITRite walkway (CIR Systems, Sparta, NJ) three times with each AD. Data was collected using PKMAS software (Protokinetics, Havertown, PA). Data for each pass in each condition was combined using PKMAS resulting in averaged values. Measures were step length (SL), stride length (STL), step time (ST), stride width (SW), stride velocity (SV), cycle time (CT), stance-time percent (STT%), swing-time percent (SWT%), single-limb-support percent (SLS%), double-limb support percent (DLS%), walking velocity (WV) and cadence (CAD). Data was analyzed with ANOVAs and planned pairwise comparisons. Greenhouse-Geisser correction was used when spehericity was violated.
Results: Differences were found between AD conditions for all parameters except SW. SL was larger with the SPC (p=.03) and TP (p=.000) then the FPC. STL was larger with the TP (p=.001) than the FPC. STT was faster with the SPC (p=.008) and TP (p=.000) than the FPC. SV was faster with the SPC (p=.001) and TP (p=.000) than the FPC. CT was faster with the SPC (p=.01) and TP (p=.000) than the FPC. SLS% was greater with the SPC (p=.047) and TP (p=.002) than the FPC. DLS% was lesser with the TP (p=.015) than the FPC. WV was faster with the SPC (p=.001) and TP (p=.000) than the FPC. CAD was greater with the SPC (p=.002) and TP (p=.000) than the FPC. The difference in ST% and SW% did not persist in the pairwise comparisons.
Conclusions: Participants generally performed better with the SPC and TP than with the FPC. These may be useful AD options for persons with MS. A previous study showed that the SPC and TP have a more positive psychosocial impact than the FPC. The combination of better gait performance and lower negative psychosocial impact should make the SPC or TP first-line options for persons with MS who may benefit from the use of a walking AD.