Gait analysis e Scale di valutazione della mobilità

SCLEROSI MULTIPLA
Gait Analysis e scale di valutazione della mobilità
Marco Paoloni
XX CONGRESSO NAZIONALE SICD - ROME REHABILITATION 2011
Sindromi algiche del distretto lombo-sacrale e dell’arto inferiore
Valutazione della funzione deambulatoria
nella SM
• Scale di valutazione clinica
• Test temporali
• Questionari auto-somministrati
• Osservazione clinica del cammino
• Camminatoi attrezzati
• 3-D gait analysis
Scale di valutazione
Cameron & Wagner, Curr Neurol Neurosci Rep (2011) 11:507–515
Scale di valutazione
Expanded Disability Status Scale (EDSS)
•Funzioni piramidali,
•Funzioni cerebellari,
•Funzioni del tronco encefalico,
•Funzioni sfinteriche,
•Funzioni visive,
•Funzioni mentali,
•Altre funzioni.
In base ai punteggi ottenuti ai
singoli sistemi funzionali, si
ottiene il punteggio della
EDSS, che va da 0 (esame
neurologico normale) a 10
(morte per SM).
Da 0 a 3.5 punteggi direttamente dipendenti dall’esame neurologico.
Da 4.0 a 7.0 punteggi basati per lo più sulla capacità deambulatoria e la
necessità di assistenza durante il cammino.
Scale di valutazione
Hauser Ambulation Index (AI)
The patient is asked to walk a marked 25-foot course as quickly
and safely as possible and the examiner records the time and
type of assistance (eg, cane, walker, crutches) needed.
The time is not used directly but is used in conjunction with other
factors to rate the patient’s walking limitations and need for
assistance on an ordinal scale with 11 gradations
Misurazioni temporali
Cameron & Wagner, Curr Neurol Neurosci Rep (2011) 11:507–515
Estrema variabilità metodologica nell’esecuzione dei
‘walking test’:
 partenza (statica o dinamica)
 istruzioni (velocità abituale o rapida)
 distanza (6–15 metri)
 tempi (2–12 minuti)
Usual vs Fastest Speed
• La differenza fra il cammino a velocità abituale e quello
veloce diminuisce al crescere della disabilità
Static vs Dynamic Start
• both in subjects with mild and moderate ambulatory
dysfunction, a dynamic start significantly increased
the fastest speed over a short distance compared with
a static start.
Short vs Long Tests
• in either MS subgroup, significantly different and
generally higher gait velocities on short versus long
tests, suggesting that walking speed and walking
distance are distinct entities
Short vs Long Tests
Walking speed is sufficient for
generally describing an MS
patient’s walking capacity,
offering a quick insight into a
person’s functional and health
status (e.g. with relation to
ambulation categories and
rehabilitation needs),
confirming its designation as
the ‘sixth vital sign’.
Short vs Long Tests
For intervention studies, when
investigating the efficacy of
medical and rehabilitation
management on walking
capacity, a long test measuring
walking distance is deemed
more appropriate.
Questionari auto-somministrati
12-item Multiple Sclerosis Walking Scale
(MSWS-12)
Bassi costi – numerose informazioni
Osservazione clinica
Camminatoi attrezzati
Mean values of gait parameters in patients who were pyramidal positive – white
columns (pyramidal score >1; N = 34) and pyramidal negative – dark columns
(pyramidal score< 1; N = 23)
U. Givon et al. / Gait & Posture 29 (2009) 138–142
Mean values of gait parameters in patients who were cerebellar positive – white
columns (cerebellar score >1; N = 23) and cerebellar negative – dark columns
(cerebellar score 1; N = 34
U. Givon et al. / Gait & Posture 29 (2009) 138–142
Il trattamento riabilitativo è in grado di determinare un
miglioramento significativo della velocità, della
lunghezza del passo e della variabilità dello stride,
indicando un cammino più veloce e più stabile.
3-D Gait Analysis
“…the frequency components of GRFs in patients with MS are
significantly lower than healthy controls … patients with MS are
adapting lower oscillation frequencies in their gait compared to
healthy controls as a result of an altered neuromuscular system.
This movement pattern is most likely a result of the slowed nerve
conduction symptomatic of MS, a result of demyelination of the
axon sheath.”
Because alterations in joint torques and powers likely would
cause changes in energy expenditure during walking, it is
likely that there is a relationship between gait measures
and fatigue in persons with MS.
However, this study showed limited correlations between
FSS and MFIS scores with gait measures. The SF-36
subscale scores showed more relationships with gait
measures
GRAZIE