Erken Dönem Multipl Skleroz Hastalarında Yürüyüşü Başlatmanın İncelenmesi

Abstract

This study was conducted to examine the time-distance variability and anticipatory postural adjustments (APAs) of gait initiation in early stage multiple sclerosis (MS) patients with no functional loss (Extended Disability Status Scale (EDSS): 0-1.5) and minimal functional loss (EDSS: 2-3). Aged between 20-40 years, 31 MS patients who were definitively diagnosed by a neurologist (EDSS 0-3) and 13 healthy individual were included this study. MS patients were divided into 2 study groups as 14 individuals group-I (EDSS 0-1.5) and 17 individuals group-II (EDSS 2-3). 13 healthy individuals were included in group-III The GAITRite electronic walkway system was used to evaluate the time-distance parameters of gait initiation. Superficial electromyography (EMG) was used to record the electromyographic amplitudes created by the APAs in the muscles. In addition, the BERTEC force plate was used to record the amount of posterior shift center of pressure (CoPap). To examine the time-distance variability of gait initiation; first and second stride length, stride time, stride width and first double support time were used of 40 walking to calculate coefficient of variation. Activation and inhibition amplitude changes of rectus femoris, biceps femoris, tibialis anterior and gastrocnemius medialis were analyzed for APAs. Significant differences was found between the 3 groups, in terms of the coefficients of variation of the first stride length (p=0.001), second stride time, (p<0.0001), stride width (p<0.0001) and first double support time (p=0.003). In the pairwise comparison between the groups; there was a significant difference in first step length and step width between group-I and group-II, step width between group-I and group-III, and in all variability between group-II and Group-III (p<0.016). In EMG, a significant difference was found in all muscles except the rectus femoris of stance phase leg (p<0.05). In the pairwise comparison of the groups; a significant difference was found between group-I and group-II, amplitudes of biceps femoris and gastrocnemius medialis in stance phase and biceps femoris amplitudes in swing phase, between group-I and group-III amplitudes of biceps femoris, tibialis anterior and gastrocnemius medialis in swing phase and tibialis anterior amplitudes in stance phase, and between group-II and group-III in all muscle amplitudes (p<0.016). In group comparison of CoPap, a significant difference was found between the three groups (p<0.001) and there was a difference between all groups, while group-II had the worst value. As a result, there are deteriorations in the ability of gait initiation, which becomes more evident with functional loss in early stage MS patients, although there is no functional loss. In Group-I, just an increase in stride width variability, associated with postural control, was observed compared to group-III. Therefore, the first parameter of variability to break down in MS is the step width, The addition of stride length and double-support time variability shows that gait initiation deterioration are also located with EDSS increase. In terms of APAs, the decrease in amplitude of 4 different muscles and the decrease in the amount of CoPap posterior shift between Group-III and Group-I are indicators of deterioration of APAs even in the absence of functional loss. The fact that, Group-II had lower amplitude in all muscles except for rectus femoris in stance phase compared to healthy group shows that the effect of functional loss on APAs are more established.