Gait characteristics of MSers in the absence of disability.

No disability on EDSS but subtle deficits when assessed with more sensitive test. #MSBlog #MSResearch 

"This study demonstrates a point I have made on numerous occasions that despite having little, or no, disability on the EDSS, a physician-rated scale, when you do more challenging and detailed assessments MSers have subtle deficits. The so called hidden, early burden, of this disease is not detected using the EDSS. These deficits are not noticed or ignored as most MSers have compensatory mechanisms to cope with them. The problem starts when these compensatory mechanisms, or the so called brain reserve, is exhausted; this is when fixed disability or progressive disease starts. The so called MS iceberg just got a whole lot bigger." 


"These hidden deficits although subtle do manifest in other ways, for example fatigue and reduced attention and concentration spans. The so called hidden deficits probably account for a lot of problems MSers have in the competitive environments, in particular in work and on the sports field." 

"Is there a solution to iceberg problem? Yes, you should not ignore it and do not simply that because you are well and fully functional that your MS is in remission and/or not causing damage. You need to ask your neurologist to assess your MS disease activity using more sensitive tools, in particular using MRI."



Nogueira et al. Gait characteristics of multiple sclerosis patients in the absence of clinical disability. Disabil Rehabil. 2013 Aug;35(17):1472-8

Purpose: Motor deficits in lower extremities and gait abnormalities are a major feature of MS. MSers with minimal clinical disability have subtle gait changes. The aim of this study was to analyze the gait characteristics of MSers in the absence of clinical disability.

Method: A case-control study was carried out with 12 MSers and 12 matched healthy controls. The subjects underwent a clinical neurological evaluation to determine their disability level (EDSS ≤ 1.5). Then, the subjects were referred for completion self-report questionnaires (gait, perceived balance confidence, physical activity and fatigue), gait clinical trials, and 3D kinematic analysis.

Results: MSers showed more impairment of perceived fatigue, perceived of walking impact and perceived balance confidence, despite having no disability. Gait characteristics showed no differences when they were determined by clinical observation. The 3D kinematic analysis of gait showed slight but significant changes in ankle movement.


Conclusion: MSers with no clinical disability have discrete changes in gait that can be evidenced by perceived impact on walking and kinematic evaluation, mainly of ankle movement. Moreover, there is a decrease in perceived balance confidence and an increase in perceived fatigue, which are correlated despite having different origins.

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