Men and women with Multiple Sclerosis exhibit different kinematics of gait: implications for rehabilitation

Background: it is known that Multiple Sclerosis (MS) affects men and women differently in terms of prevalence, cognitive impairments, disability accumulation, and overall risk of a poorer prognosis. However sex-related issues still remain partly unexplored. For instance, although walking impairments represent a common feature in MS and thus have been extensively investigated, it is unknown whether men and women with MS exhibit different gait patterns. Aims: to assess the existence of possible sex-related differences in terms of spatio-temporal and kinematic parameters of gait in people with with MS (pwMS) using computerized three-dimensional gait analysis Methods: Sixty pwMS (32F, 28M) stratified in two groups (low disability, EDSS 1-3, n = 28, mild-moderate disability EDSS 3.5-5.5, n = 32) underwent a computerized 3D gait analysis performed using a motion-capture system composed of 8 infrared cameras. Trend of flexion-extension and dorsi- plantar-flexion at hip, knee and ankle joints were calculated together with main spatial-temporal parameters. One-way ANOVA was performed to investigate differences associated with sex on all variables of interest. Results: When normalized considering individuals’ anthropometry, no significant differences were found between men and women with MS in speed, stride length, cadence and stance/swing phase’s duration. In contrast, men exhibited significantly reduced ankle plantar-flexion at the terminal stance/initial swing, increased knee flexion at initial contact and increased hip flexion at initial-mid stance and terminal swing with respect to women. However, when analyzed according to their disability level, some changes become either more evident (hip joint) or tend to disappear (ankle joint) as the disease progresses. Conclusions: The obtained results suggest that it is crucial to investigate gait dysfunctions in pwMS without neglecting their sex. Such an approach may be useful not only in better understanding the pathophysiology of gait disturbances originated by MS, but also in supporting a better orientation of rehabilitative treatments.