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Hilfiker R.,University of Applied Sciences and Arts Western Switzerland | Hilfiker R.,Institute Of Recherche En Readaptation Reinsertion | Vaney C.,Berner Klinik Montana | Gattlen B.,Berner Klinik Montana | And 8 more authors.
BMC Research Notes | Year: 2013

Background: Gait and balance problems are common in patients with multiple sclerosis, leading to high risk for falls. Local Dynamic Stability (LDS), a non-linear gait stability index, has been advocated as an early indicator of risk for falls. With this longitudinal study over three weeks, we aimed to assess the responsiveness of Local Dynamic Stability to a rehabilitation program and to compare it to other measures. Methods. Eighteen patients (mean 54 years, median EDSS score: 5) participated. They were admitted to inpatient rehabilitation and received a three weeks individually tailored program. They performed a 3-minute walking test at the beginning and at the end of the stay, as well as pain, wellbeing, fatigue, and balance assessment. The Local Dynamic Stability was computed from the acceleration signals measured with a 3D-accelerometer. Results: At the end of the rehabilitation process, patients reported reduced pain (Effect Size: -0.7), fatigue (ES:-0.6), and increased wellbeing (ES: 1.1). A small positive effect on static balance was observed (ES: 0.3). LDS was improved (ES: 0.6), and the effect was higher than walking speed improvement (ES: 0.4). Conclusions: The Local Dynamic Stability seemed responsive to assess rehabilitation effects in patients with multiple sclerosis. It could constitute a valuable gait quality index, which could evaluate potential effects of rehabilitation on fall risk. Trial registration. Current Controlled Trials ISRCTN69803702. © 2013 Hilfiker et al.; licensee BioMed Central Ltd.


Feys P.,Hasselt University | Bibby B.,University of Aarhus | Romberg A.,Masku Neurological Rehabilitation Center | Santoyo C.,Neurorehabilitation Unit | And 10 more authors.
Journal of the Neurological Sciences | Year: 2014

Objective To compare within-day variability of short (10 m walking test at usual and fastest speed; 10MWT) and long (2 and 6-minute walking test; 2MWT/6MWT) tests in persons with multiple sclerosis. Design Observational study. Setting MS rehabilitation and research centers in Europe and US within RIMS (European network for best practice and research in MS rehabilitation). Subjects Ambulatory persons with MS (Expanded Disability Status Scale 0-6.5). Intervention Subjects of different centers performed walking tests at 3 time points during a single day. Main measures 10MWT, 2MWT and 6MWT at fastest speed and 10MWT at usual speed. Ninety-five percent limits of agreement were computed using a random effects model with individual pwMS as random effect. Following this model, retest scores are with 95% certainty within these limits of baseline scores. Results In 102 subjects, within-day variability was constant in absolute units for the 10MWT, 2MWT and 6MWT at fastest speed (+/- 0.26, 0.16 and 0.15 m/s respectively, corresponding to +/- 19.2 m and +/- 54 m for the 2MWT and 6MWT) independent on the severity of ambulatory dysfunction. This implies a greater relative variability with increasing disability level, often above 20% depending on the applied test. The relative within-day variability of the 10MWT at usual speed was +/- 31% independent of ambulatory function. Conclusions Absolute values of within-day variability on walking tests at fastest speed were independent of disability level and greater with short compared to long walking tests. Relative within-day variability remained overall constant when measured at usual speed. © 2013 Elsevier B.V.


Vaney C.,Berner Klinik Montana | Gattlen B.,Berner Klinik Montana | Lugon-Moulin V.,Berner Klinik Montana | Lugon-Moulin V.,University of Applied Sciences and Arts Western Switzerland | And 7 more authors.
Neurorehabilitation and Neural Repair | Year: 2012

Background. Robot-assisted gait training (RAGT) has been suggested as an intervention to improve walking capacity in patients with multiple sclerosis (MS). Objective. This study aimed to evaluate whether RAGT (Lokomat) is superior to over-ground walking training in terms of quality of life, activity level, and gait. Methods. A total of 67 patients with MS with the Expanded Disability Status Scale (EDSS) 3.0 to 6.5 were randomized to walking or RAGT, in addition to multimodal rehabilitation. Primary outcomes were walking speed, activity level (estimated metabolic equivalent, metabolic equivalents [METs], using an accelerometer), and quality of life (Well-Being Visual Analogue Scale (VAS) and EQ-5D European VAS. Results. In all, 49 patients finished the interventions. Mean age was 56 years (range 36-74 years), mean EDSS was 5.8 (3.0-6.5), and the preferred walking speed at baseline was 0.56 m/s (0.06-1.43 m/s). Before rehabilitation, participants spent on average 68 min/d at an MET ≥3. The walking group improved gait speed nonsignificantly more than the RAGT; the upper bound of the confidence interval (CI) did not exclude a clinically relevant benefit (defined as a difference of 0.05 m/s) in favor of the walking group; the lower bound of the CI did exclude a clinically important benefit in favor of the Lokomat. Quality of life improved in both groups, with a nonsignificant between-group difference in favor of the walking group. Both groups had reduced their activity by 8 weeks after the rehabilitation. Conclusion. It is unlikely that RAGT is better than over-ground walking training in patients with an EDSS between 3.0 and 6.5. © 2012 American Society of Neurorehabilitation.

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