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Effect of walking on sand on gait kinematics in individuals with multiple sclerosis

  • Maayken E.L. van den Berg
    Correspondence
    Correspondence to: Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia.
    Affiliations
    Rehabilitation, Aged & Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
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  • Christopher J. Barr
    Affiliations
    Rehabilitation, Aged & Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
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  • James V. McLoughlin
    Affiliations
    Rehabilitation, Aged & Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
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  • Maria Crotty
    Affiliations
    Rehabilitation, Aged & Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia

    Rehabilitation, Aged & Extended Care, Repatriation General Hospital, Adelaide, Australia
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      Highlights

      • Reduced lower limb flexion on level ground in people with MS.
      • Sand walking increases hip and knee flexion and ankle dorsiflexion during swing.
      • The cumulative effect results in lower limb flexion within the normal range.
      • Gait parameters back to baseline values after return to level ground walking.

      Abstract

      Background

      Walking in the real-world involves negotiating challenging or uneven surfaces, including sand. This can be challenging for people with Multiple Sclerosis (PWMS) due to motor deficits affecting the lower extremities. The study objective was to characterise kinematic gait adaptations made by PWMS when walking on sand and describe any immediate post-adaptation effects.

      Methods

      17 PWMS (mean age 51.4 ± 5.5, Disease Steps 2.4 ± 1.0), and 14 age-and gender matched healthy adults (HA) took part in a case-control study. 3D gait analysis was conducted using an eight-camera Vicon motion capture system. Each participant completed walking trials over level ground (baseline), sand (gait adaptation response), and again level ground (post-adaptation). Spatiotemporal data and kinematic data for the hip knee and ankle were recorded.

      Results

      At baseline PWMS showed significantly less total lower limb flexion (p<0.05) compared to HA. PWMS adapted to walking on sand by significantly increasing hip and knee flexion and ankle dorsiflexion (p<0.05) during swing, resulting in an overall 23° greater total lower limb flexion (p<0.05), reaching values within normal range. During the return to level ground walking values of temporal-spatial and kinematic parameters returned towards baseline values.

      Conclusions

      PWMS adapted to walking on sand by increasing lower limb flexion during swing, and returned to their gait pattern to near baseline levels, in a manner similar to but with values not equalling HA. Further work is required to determine whether this mode of walking has potential to act as a gait retraining strategy to increase flexion of the lower limb.

      Keywords

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