Clinical assessment, management and rehabilitation of walking impairment in MS: An Expert Review.

2020 
INTRODUCTION One of the most common and life-altering consequences of Multiple Sclerosis (MS) is walking impairment. The distance, speed and Gait pattern functions are components of the International Classification of Functioning, Disability and Health (ICF) and are also predictors of dependency in terms of daily living activities in patients with MS (pwMS). AREAS COVERED This article provides an overview of walking impairment in pwMS, with focus on the assessment of gait and the rehabilitation approaches. EXPERT OPINION The authors recommend that pwMS undergo gait assessment integrating the ICF perspective using validated clinical outcome measures that cover spatiotemporal gait parameters. Moreover, assessment of walking speed with short walking capacity tests such as the Timed-25-Foot-Walk (T25FW) or the 10-meter-walk-test (10MWT) and tests for walking distance with middle distance tests such as the 2-Minute-Walk-Test (2MWT) and the 6-Minute-Walk-Test (6MWT). This review further highlights strategies that may restore walking function including pharmacological symptomatic treatment and non-pharmacological rehabilitation approaches such as exercise and task specific training providing an appraisal of mobility targeted therapies to be considered when planning multidisciplinary comprehensive-care of pwMS. Finally, new and novel strategies such as motor imagery and rhythmic auditory stimulation have been developed to improve walking speed and distance in pwMS.
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