Measuring Walking Ability in Multiple Sclerosis
Current ways of measuring walking ability in multiple sclerosis are not winning any friends among researchers, doctors, and patients alike. That’s one reason why one of the presentations recently given at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) is of special interest.
Improved ways of measuring disability and function in people who have MS could lead to more effective treatments and thus better quality of life. One tool that is used extensively is the Expanded Disability Status Scale (EDSS).
The test has two portions: it takes about 30 minutes to establish a score (using the Functional System Score [FSS]), which considers factors such as weakness in the limbs, lack of coordination, loss of sensation, and problems with swallowing, speech, vision, and mental functions. Along with the FSS, a practitioner rates disability using a scale of 0 to 10, with the higher numbers indicating greater disability. A major problem with the EDSS, however, is that it is not even in how it weighs various functions and it is not sensitive to differences among patients.
Among the most common functions that is measured is walking. It is deceptively challenging to accurately identify how well a person walks, as numerous factors are involved such as muscle weakness, loss of balance, sensory deficits, fatigue, spasticity, and vision problems.
If observers rely on a visual evaluation of ambulation, the results can be highly subjective and unreliable while use of a motion measuring device is expensive. What to do?
According to Jacob Sosnoff, PhD, of the University of Illinois in Urbana-Champaign, another option can offer clinicians and patients alike more accurate and reliable measures of walking: a pressure-sensitive portable walkway called GAITRite. Sosnoff and his team tested the portable device in 86 individuals who have multiple sclerosis. Two testing sessions were conducted six months apart.
The authors found five walking measures that were measured reliably using GAITRite: gait velocity, functional ambulation, cadence, step time, and double support. Since challenged walking is one of the most common complaints among people with multiple sclerosis (it was reported by 85% in this study), it’s important to find accurate, reliable, and effective ways to evaluate it.
How do you feel about the way your healthcare providers evaluate your ability to walk? What types of improvements would you like to see?
Sosnoff J et al. Reliability of clinically feasible gait analysis in multiple sclerosis. ACTRIMS-ECTRIMS 2014; abstract PS12.5