Walking while talking--difficulties incurred during the initial stages of multiple sclerosis disease process

Abstract

Patients with multiple sclerosis (MS) frequently experience poor gait and/or cognitive impairment, even in the early stages of the disease. As gait is often executed simultaneously with different cognitive tasks, it is essential to test gait during a cognitive load. Therefore, the main objective of this study was to assess gait and gait variations while simultaneously performing a cognitive task in patients with a clinically isolated syndrome (CIS) suggestive of MS. Fifty-two CIS patients, aged 33.8±0.2 years with an Expanded Disability Status Scale (EDSS) score of 1.7±0.2 were included in the study. The control group consisted of 28 age- and gender-matched healthy subjects. Major spatio-temporal parameters were collected via an electronic walkway (GAITRite electronic walkway system). Participants were instructed to walk under three different conditions: normal, fast, and at a normal pace while performing the modified word list generation (WLG) test. Compared to healthy subjects, the CIS patients' gait was slower and asymmetrical with a wider base of support. The combined walking and cognitive task was expressed in prolonged double support (% gait cycle) and reduced velocity in patients only. As these findings are associated with the very early phase of MS, it appears that the ongoing pathological disease process is already taking place with regard to gait abilities. Since in early MS patients, gait-cognitive dual tasking may lead to an increased risk of falling, this important function should be addressed by physical rehabilitation clinicians.