- Changes in walking can occur even in the absence of clinical signs in people living with MS, and these cannot be detected using standard methods.
- An MS Australia-supported researcher and her team have investigated the use of a sensitive measure of walking stability to detect subtle changes in people with MS at the early stages of disease.
- This may help identify if a treatment is not optimal early in the disease course, allowing clinicians to act upon this quickly to prevent further progression.
Better ways are needed to detect disease progression
MS can cause a variety of symptoms attributed to the immune system mistakenly attacking and damaging the myelin sheath in the brain and spinal cord.
One such symptom is changed walking, or gait, which can occur even in the absence of clinical signs.
These subtle changes in gait cannot be detected using standard clinical measures (e.g. walking speed), particularly earlier in the disease course. This makes it difficult to monitor progression and make changes to current treatments to prevent further disease activity.
It has been proposed that the local divergence exponent (LDE), a sensitive measure of gait stability, better reflects the MS-related changes in walking, and may parallel changes in the brain and spinal cord detected on magnetic resonance imaging (MRI).
Research has shown that this measure is lower in people living with MS than those without MS, and is associated with falls and self-reported walking ability.
Previous studies have explored the use of LDE in clinical settings, but the data has been obtained from different body locations using various methods (e.g. treadmill walking vs overground walking).
It is not clear which approach would be best to assess walking stability earlier in the disease course when treatments may be more effective in preventing progression.
What did the researchers do?
Published in Gait Posture, MS Australia-supported researcher Professor Mary Galea and her team recruited 49 people living with MS with an expanded disability status scale (EDSS) of ≤2.5 (no walking impairment), and 24 people living without MS to walk overground for 5 min while movement data was obtained from sensors placed on the sternum (mid chest) and lumbar (lower back) areas.
The data was used to develop models to identify gait impairment in people with MS at early disease stages.
What did the researchers find?
The researchers found that the LDE measures from the sternum were more sensitive to MS-related changes, which is in line with previous studies.
This suggests that this sensor location is better suited to monitor walking impairment in people living with MS earlier in the disease course.
What does it mean?
By focusing on people with MS with no impairment in walking, this study highlights the sensitivity of the LDE measurements in detecting progression at the early stages of disease.
While further research is required, the LDE may offer an alternative to currently insensitive tests of walking impairment in people living with MS at the early stages of disease.