Lower Leg Muscle Function: A Contributory Risk Factor of Gait and Balance Impairment after Six Minutes Walk among People with Multiple Sclerosis
Main Article Content
Abstract
Background/Purpose: Multiple sclerosis (MS) is a progressive neurological disease that results in increased fatigue, decreased muscle function, and impaired gait and balance. The purpose of this study was to evaluate the relationship between lower leg muscle function and changes in gait and balance immediately and 20 minutes after 6mins walk-induced fatigue.
Methods: Six persons with MS (Patient-Determined Disease Steps 3-5) participated in the study. Perceived fatigue and demographic information were taken at baseline. Muscle fatigability and mitochondria capacity was measured in the lower leg muscles before walking. Reported fatigue (VAFS, 0-10), gait variability, gait asymmetry, and static balance were measured before and immediately after a self-paced 6 minutes treadmill walk with slight elevation, and after 20 minutes of rest.
Results: Participant’s baseline MFIS score ranged from 14 - 71. There was a 173% increase in reported fatigue scores after walking. Gait was impaired with a ~26% increase in gait variability and ~40% increase in gait asymmetry immediately after walking (Cohen’s D = 0.4, 0.3 respectively). There was also ~69% increase in balance postural sway with eyes opened and a ~20% increase with eyes closed (Cohen’s D = 0.5, 0.2 respectively). Gait and balance remained impaired after 20 minutes of rest. The decline in gait parameters after walking had a negative correlation with muscle endurance (r=-0.80, p=0.03), and mitochondrial capacity (r=-0.92, p<0.01). The changes in gait and balance were more evident in participants with a higher disability.
Conclusions: Six minutes of self-paced walking with slight elevation worsened gait and balance among people with MS (PwMS), which did not completely recover after 20 minutes of rest. The changes in gait after walking were associated with lower leg muscle function. Lower leg muscle function might be an important intervention target to improve gait and balance fall risk among PwMS.
Keywords:
Fall risk, Muscle fatigue, Muscle Mitochondria capacity, Multiple Sclerosis, Physical activity, gait, balance
Article Details
How to Cite
SANNI, Adeola Adenike et al.
Lower Leg Muscle Function: A Contributory Risk Factor of Gait and Balance Impairment after Six Minutes Walk among People with Multiple Sclerosis.
Medical Research Archives, [S.l.], v. 9, n. 3, mar. 2021.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2331>. Date accessed: 25 apr. 2024.
doi: https://doi.org/10.18103/mra.v9i3.2331.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. Kalron A, Dvir Z, Frid L, Achiron A. Quantifying gait impairment using an instrumented treadmill in people with multiple sclerosis. ISRN Neurol. 2013;2013:867575-867575. doi:10.1155/2013/867575
4. Socie MJ, Motl RW, Pula JH, Sandroff BM, Sosnoff JJ. Gait variability and disability in multiple sclerosis. Gait & posture. 2013/05/01/ 2013;38(1):51-55. doi:https://doi.org/10.1016/j.gaitpost.2012.10.012
5. Comber L, Sosnoff JJ, Galvin R, Coote S. Postural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis. Gait & posture. Mar 2018;61:445-452. doi:10.1016/j.gaitpost.2018.02.018
6. Socie MJ, Sosnoff JJ. Gait variability and multiple sclerosis. Multiple sclerosis international. 2013;2013:645197-645197. doi:10.1155/2013/645197
7. Comber L, Galvin R, Coote S. Gait deficits in people with multiple sclerosis: A systematic review and meta-analysis. Gait & posture. Jan 2017;51:25-35. doi:10.1016/j.gaitpost.2016.09.026
8. Cameron MH, Wagner JMJCN, Reports N. Gait Abnormalities in Multiple Sclerosis: Pathogenesis, Evaluation, and Advances in Treatment. journal article. July 22 2011;11(5):507. doi:10.1007/s11910-011-0214-y
9. Society M. National MS Society Updated 10/8/2019. https://www.nationalmssociety.org/For-Professionals/Researchers/Resources-for-Researchers/Clinical-Study-Measures/Timed-25-Foot-Walk-(T25-FW)
10. Learmonth YC, Motl RW, Sandroff BM, Pula JH, Cadavid D. Validation of patient determined disease steps (PDDS) scale scores in persons with multiple sclerosis. BMC Neurol. 2013;13:37-37. doi:10.1186/1471-2377-13-37
11. Goldman MD, Marrie RA, Cohen JA. Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls. Multiple sclerosis (Houndmills, Basingstoke, England). Apr 2008;14(3):383-90. doi:10.1177/1352458507082607
12. Braley TJ, Chervin RD. Fatigue in multiple sclerosis: mechanisms, evaluation, and treatment. Sleep. 2010;33(8):1061-1067. doi:10.1093/sleep/33.8.1061
13. Willingham TB, Backus D, McCully KK. Muscle Dysfunction and Walking Impairment in Women with Multiple Sclerosis. International Journal of MS Care. 2019;21(6):249-256. doi:10.7224/1537-2073.2018-020 %J International Journal of MS Care
14. Harp MA, McCully KK, Moldavskiy M, Backus D. Skeletal muscle mitochondrial capacity in people with multiple sclerosis. 2016;2:2055217316678020. doi:10.1177/2055217316678020
15. Barcelos IPd, Troxell RM, Graves JS. Mitochondrial Dysfunction and Multiple Sclerosis. Biology (Basel). 2019;8(2):37. doi:10.3390/biology8020037
16. Enoka RM, Duchateau J. Muscle fatigue: what, why and how it influences muscle function. 2008;586(1):11-23. doi:10.1113/jphysiol.2007.139477
17. Enoka R, Baudry S, Rudroff T, Farina D, Klass M, Duchateau J. Unraveling the neurophysiology of muscle fatigue. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology. 11/01 2010;21:208-19. doi:10.1016/j.jelekin.2010.10.006
18. Tripp BL, Yochem EM, Uhl TL. Functional fatigue and upper extremity sensorimotor system acuity in baseball athletes. J Athl Train. Jan-Mar 2007;42(1):90-98.
19. Willingham TB, Backus D, McCully KK. Muscle Dysfunction and Walking Impairment in African American and Caucasian American Women with Multiple Sclerosis. 0(0):null. doi:10.7224/1537-2073.2018-020
20. B Willingham T, McCully K. ASSESSMENT OF SKELETAL MUSCLE ENDURANCE USING TWITCH ELECTRICAL STIMULATION AND ACCELEROMETER-BASED MECHANOMYOGRAPHY. vol 1. 2017.
21. Hebert JR, Corboy JR. The association between multiple sclerosis-related fatigue and balance as a function of central sensory integration. Gait & posture. 2013/05/01/ 2013;38(1):37-42. doi:https://doi.org/10.1016/j.gaitpost.2012.10.015
22. Kalron A. Association between gait variability, falls and mobility in people with multiple sclerosis: A specific observation on the EDSS 4.0-4.5 level. Neurorehabilitation. 02/13 2017;40doi:10.3233/NRE-171445
23. Kalron A, Frid L, Gurevich M. Concern about falling is associated with step length in persons with multiple sclerosis. European journal of physical and rehabilitation medicine. Apr 2015;51(2):197-205.
24. Plotnik M, Wagner JM, Adusumilli G, Gottlieb A, Naismith RT. Gait asymmetry, and bilateral coordination of gait during a six-minute walk test in persons with multiple sclerosis. Scientific Reports. 2020/07/24 2020;10(1):12382. doi:10.1038/s41598-020-68263-0
25. Cameron MH, Nilsagard Y. Balance, gait, and falls in multiple sclerosis. Handbook of clinical neurology. 2018;159:237-250. doi:10.1016/b978-0-444-63916-5.00015-x
26. Karst GM, Venema DM, Roehrs TG, Tyler AE. Center of Pressure Measures during Standing Tasks in Minimally Impaired Persons with Multiple Sclerosis. 2005;29(4):170-180. doi:10.1097/01.Npt.0000282314.40230.40
27. Soyuer F, Mirza M, Erkorkmaz Ü. Balance performance in three forms of multiple sclerosis. Neurological Research. 2006/07/01 2006;28(5):555-562. doi:10.1179/016164105X49373
28. Di Giulio I, Maganaris CN, Baltzopoulos V, Loram ID. The proprioceptive and agonist roles of gastrocnemius, soleus and tibialis anterior muscles in maintaining human upright posture. J Physiol. 2009;587(Pt 10):2399-2416. doi:10.1113/jphysiol.2009.168690
29. Azizah Mbourou G, Lajoie Y, Teasdale N. Step Length Variability at Gait Initiation in Elderly Fallers and Non-Fallers, and Young Adults. Gerontology. 2003;49(1):21-26. doi:10.1159/000066506
30. Crenshaw SJ, Royer TD, Richards JG, Hudson DJ. Gait variability in people with multiple sclerosis. Multiple sclerosis (Houndmills, Basingstoke, England). Oct 2006;12(5):613-9. doi:10.1177/1352458505070609
31. Rietberg MB, Van Wegen EE, Kwakkel G. Measuring fatigue in patients with multiple sclerosis: reproducibility, responsiveness and concurrent validity of three Dutch self-report questionnaires. Disability and rehabilitation. 2010;32(22):1870-6. doi:10.3109/09638281003734458
32. Hill KD, Schwarz JA, Kalogeropoulos AJ, Gibson SJ. Fear of falling revisited. Arch Phys Med Rehabil. Oct 1996;77(10):1025-9. doi:10.1016/s0003-9993(96)90063-5
33. Hagströmer M, Oja P, Sjöström M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutrition. 2006;9(6):755-762. doi:10.1079/PHN2005898
34. Society NMS. Timed 25Foot Walk (T25-FW). 2020;
35. Liss CM, Sanni AA, McCully KK. Endurance of the Dorsal and Ventral Muscles in the Neck. 2020;5(3):47.
36. Sumner MD, Beard S, Pryor EK, Das I, McCully KK. Near Infrared Spectroscopy Measurements of Mitochondrial Capacity Using Partial Recovery Curves. Frontiers in physiology. 2020;11:111. doi:10.3389/fphys.2020.00111
37. Borg G, Dahlstrom H. A pilot study of perceived exertion and physical working capacity. Acta Soc Med Ups. 1962;67:21-7.
38. Hausdorff J, A. Rios D, K. Edelberg H. Gait Variability and Fall Risk in Community-Living Older Adults: A 1-Year Prospective Study. vol 82. 2001:1050-6.
39. Callisaya ML, Blizzard L, Schmidt MD, et al. Gait, gait variability and the risk of multiple incident falls in older people: a population-based study. Age and ageing. Jul 2011;40(4):481-7. doi:10.1093/ageing/afr055
40. Wong DW-C, Lam W-K, Lee WC-C. Gait asymmetry and variability in older adults during long-distance walking: Implications for gait instability. Clinical Biomechanics. 2020/02/01/ 2020;72:37-43. doi:https://doi.org/10.1016/j.clinbiomech.2019.11.023
41. Egerton T, Thingstad P, Helbostad JL. Comparison of programs for determining temporal-spatial gait variables from instrumented walkway data: PKmas versus GAITRite. BMC Res Notes. 2014;7:542-542. doi:10.1186/1756-0500-7-542
42. Barclay-Goddard R, Stevenson T, Poluha W, Moffatt ME, Taback SP. Force platform feedback for standing balance training after stroke. The Cochrane database of systematic reviews. Oct 18 2004;2004(4):Cd004129. doi:10.1002/14651858.CD004129.pub2
43. Prieto TE, Myklebust JB, Hoffmann RG, Lovett EG, Myklebust BM. Measures of postural steadiness: differences between healthy young and elderly adults. IEEE Transactions on Biomedical Engineering. 1996;43(9):956-966. doi:10.1109/10.532130
44. Golriz S, Hebert JJ, Foreman KB, Walker BF. The reliability of a portable clinical force plate used for the assessment of static postural control: repeated measures reliability study. Chiropr Man Therap. 2012;20(1):14-14. doi:10.1186/2045-709X-20-14
45. McCully KK, Prins P, Mistry K, Willingham TB. Muscle-specific endurance of the trapezius muscles using electrical twitch mechanomyography. Shoulder Elbow. Apr 2018;10(2):136-143. doi:10.1177/1758573217726269
46. Escudero-Uribe S, Hochsprung A, Izquierdo-Ayuso G. Gait pattern changes after six-minute walk test in persons with multiple sclerosis. 2019;24(1):e1741. doi:10.1002/pri.1741
47. Prosperini L, Fortuna D, Giannì C, Leonardi L, Pozzilli C. The Diagnostic Accuracy of Static Posturography in Predicting Accidental Falls in People With Multiple Sclerosis. Neurorehabilitation and neural repair. 2013/01/01 2012;27(1):45-52. doi:10.1177/1545968312445638
48. Prosperini L, Fortuna D, Giannì C, Leonardi L, Marchetti MR, Pozzilli C. Home-based balance training using the Wii balance board: a randomized, crossover pilot study in multiple sclerosis. Neurorehabilitation and neural repair. Jul-Aug 2013;27(6):516-25. doi:10.1177/1545968313478484
49. Karpatkin H, Rzetelny A. Effect of a Single Bout of Intermittent versus Continuous Walking on Perceptions of Fatigue in People with Multiple Sclerosis. International journal of MS care. Fall 2012;14(3):124-131. doi:10.7224/1537-2073-14.3.124
50. Coote S, Sosnoff JJ, Gunn H. Fall Incidence as the Primary Outcome in Multiple Sclerosis Falls-Prevention Trials: Recommendation from the International MS Falls Prevention Research Network. International journal of MS care. Winter 2014;16(4):178-184. doi:10.7224/1537-2073.2014-059
51. Mazumder R, Murchison C, Bourdette D, Cameron M. Falls in people with multiple sclerosis compared with falls in healthy controls. PLoS One. 2014;9(9):e107620-e107620. doi:10.1371/journal.pone.0107620
52. Gunn H, Creanor S, Haas B, Marsden J, Freeman J. Frequency, Characteristics, and Consequences of Falls in Multiple Sclerosis: Findings From a Cohort Study. Archives of Physical Medicine and Rehabilitation. 2014;95(3):538-545. doi:10.1016/j.apmr.2013.08.244
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54. Health NIo. Muscle Mitochondria May form Energy Power Grid. July 14, 2020. Accessed July 14, 2020. https://www.nih.gov/news-events/nih-research-matters/muscle-mitochondria-may-form-energy-power-grid#:~:text=At%20a%20Glance.%20Skeletal%20muscles%20are%20made%20of,meet%20this%20energy%20demand%2C%20muscle%20cells%20contain%20mitochondria.
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