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(REH16) The Effects of Cooling Vests on Gait Fatigability in Persons with Multiple Sclerosis.
Source: International Journal of MS Care 2020, Vol. 22 Issue S2, p73-73. 1/3p.
Author(s): Karpatkin, Herbert; Riva, Sean; Russo, Kaitlin; Stevens, Sandon; Winnie Yu
Abstract: Background: Gait dysfunction is a ubiquitous and multifactorial finding in persons with multiple sclerosis (PwMS). A major reason for gait dysfunction in PwMS is objective fatigability (OF), characterized by progressive worsening of gait parameters over the course of a walk. Although OF is also multifactorial, it is presumed to be due in large part to multiple sclerosis (MS) thermosensitivity, where increased heat leads to decreased conduction through demyelinated nerves. Prolonged exercise such as long walks can lead to increased core temperature in PwMS, and therefore lead to progressive worsening of gait over the course of the walk. An intervention to prevent core temperature rise could limit OF during gait in PwMS.
Objectives: The purpose of this study was to investigate whether the use of a commercially available cooling vest would result in decreased OF of gait in PwMS. We hypothesized that wearing the vest for 30 minutes prior to a 6-minute walk (6MW) would result in less evidence of gait fatigability in PwMS when compared to performing the 6MW without prior cooling. If our hypothesis is correct, it will suggest that PwMS who experience gait fatigability can mitigate this by the use of cooling garments.
Methods: A randomized crossover design is being used. Ambulatory patients with a diagnosis of MS are randomized into a cooled and uncooled condition. Cooling is accomplished by the wearing of a commercially available cooling vest for 30 minutes while seated. The uncooled condition is sitting for 30 minutes without wearing the vest. Immediately after the 30 minutes, subjects perform a 6MW test. Objective fatigability is measured by comparing the speed of the walk in the first minute to the speed of the walk in the sixth minute. Subjective fatigue is measured using the Visual Analog Scale of Fatigue (VASF). Data collection began fall of 2019 and will conclude winter of 2020.
Results: To date, 5 subjects (Expanded Disability Status Scale score 4.4) have completed the study. Due to the small sample size, only descriptive statistics are reported. Mean 6MW test distance was higher in the cooled condition (1137.3') than in the uncooled condition (1087.9'). Mean differences between the distance walked in first minute and sixth minute was less in the cooled condition (-1.6') than in the uncooled (-12.4'). Subjects experienced less subjective fatigue as measured by the VASF in the cooled condition (7.4 mm) than in the uncooled (13.8 mm).
Conclusions: These findings, although preliminary, support our hypothesis that cooling may diminish OF of gait in PwMS and thereby improve gait endurance. Once we have achieved an adequate sample size, a more in-depth analysis will be performed. If our hypothesis is then reaffirmed, it will suggest that the use of a commercially available cooling vest may decrease the impact of fatigue on gait in PwMS.
Source: International Journal of MS Care 2020, Vol. 22 Issue S2, p73-73. 1/3p.
Author(s): Karpatkin, Herbert; Riva, Sean; Russo, Kaitlin; Stevens, Sandon; Winnie Yu
Abstract: Background: Gait dysfunction is a ubiquitous and multifactorial finding in persons with multiple sclerosis (PwMS). A major reason for gait dysfunction in PwMS is objective fatigability (OF), characterized by progressive worsening of gait parameters over the course of a walk. Although OF is also multifactorial, it is presumed to be due in large part to multiple sclerosis (MS) thermosensitivity, where increased heat leads to decreased conduction through demyelinated nerves. Prolonged exercise such as long walks can lead to increased core temperature in PwMS, and therefore lead to progressive worsening of gait over the course of the walk. An intervention to prevent core temperature rise could limit OF during gait in PwMS.
Objectives: The purpose of this study was to investigate whether the use of a commercially available cooling vest would result in decreased OF of gait in PwMS. We hypothesized that wearing the vest for 30 minutes prior to a 6-minute walk (6MW) would result in less evidence of gait fatigability in PwMS when compared to performing the 6MW without prior cooling. If our hypothesis is correct, it will suggest that PwMS who experience gait fatigability can mitigate this by the use of cooling garments.
Methods: A randomized crossover design is being used. Ambulatory patients with a diagnosis of MS are randomized into a cooled and uncooled condition. Cooling is accomplished by the wearing of a commercially available cooling vest for 30 minutes while seated. The uncooled condition is sitting for 30 minutes without wearing the vest. Immediately after the 30 minutes, subjects perform a 6MW test. Objective fatigability is measured by comparing the speed of the walk in the first minute to the speed of the walk in the sixth minute. Subjective fatigue is measured using the Visual Analog Scale of Fatigue (VASF). Data collection began fall of 2019 and will conclude winter of 2020.
Results: To date, 5 subjects (Expanded Disability Status Scale score 4.4) have completed the study. Due to the small sample size, only descriptive statistics are reported. Mean 6MW test distance was higher in the cooled condition (1137.3') than in the uncooled condition (1087.9'). Mean differences between the distance walked in first minute and sixth minute was less in the cooled condition (-1.6') than in the uncooled (-12.4'). Subjects experienced less subjective fatigue as measured by the VASF in the cooled condition (7.4 mm) than in the uncooled (13.8 mm).
Conclusions: These findings, although preliminary, support our hypothesis that cooling may diminish OF of gait in PwMS and thereby improve gait endurance. Once we have achieved an adequate sample size, a more in-depth analysis will be performed. If our hypothesis is then reaffirmed, it will suggest that the use of a commercially available cooling vest may decrease the impact of fatigue on gait in PwMS.