Gait Assessment and Intervention in Multiple Sclerosis

Gait disturbance is among the most disabling and prevalent symptoms in people with multiple sclerosis (MS), manifesting as reduced walking speed, altered kinematics and increased variability. Precise assessment of gait informs prognosis, guides personalised therapies and evaluates intervention efficacy. Traditional clinical scales, such as the Expanded Disability Status Scale (EDSS), are complemented by instrumented tests including the six-minute walk test (6MWT), three-dimensional motion analysis and force-plate dynamics. The advent of wearable sensors and mobile-phone systems has expanded assessment beyond the clinic, allowing continuous monitoring of spatial–temporal parameters such as step length, cadence and symmetry. Interventions range from pharmacological management and task-specific physiotherapy to advanced technologies such as functional electrical stimulation and real-time biofeedback. Evidence supports tailored exercise programmes to improve strength and coordination, while emerging digital tools enable adaptive gait training and remote rehabilitation. A holistic approach, integrating objective metrics with patient-reported outcomes, is crucial to address the complex interplay of motor fatigue, neural injury and compensatory strategies. Ultimately, standardised, accessible gait assessment and intervention protocols hold global significance for optimising mobility, reducing falls and enhancing quality of life in MS.

Research from Nature Portfolio

Recent studies have combined complementary analytical techniques to refine the characterisation of gait deviations in MS. One approach merges the Gait Profile Score, which summarises multi-joint kinematic deviations, with Statistical Parametric Mapping to pinpoint specific phases of the gait cycle affected by altered hip, knee and ankle motion. This synergy has revealed reduced ankle dorsiflexion and diminished knee flexion during pre-swing and swing phases, with greater deviations in individuals with higher disability and poorer walking performance.

Foundational work profiling gait dysfunction has employed cluster and principal component analyses to identify distinct pathological patterns—spastic-paretic, ataxia-like and unstable gait—in treadmill and overground settings. These profiles demonstrated pronounced restrictions in knee and ankle excursion, elevated variability and impaired dynamic stability. Longitudinal follow-up confirmed deterioration, particularly in spastic-paretic patterns, underscoring the value of personalised gait phenotyping to inform patient-tailored exercise regimens and sensitive outcome measures for clinical trials.

Gait Assessment and Intervention in Multiple Sclerosis publication trend

The graph below shows the total number of articles in gait assessment and intervention in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Expanded Disability Status Scale (EDSS): A standardised scale (0–10) to quantify neurological impairment and disability in MS, emphasising ambulation and functional system scores.

Six-Minute Walk Test (6MWT): A submaximal exercise test measuring the distance an individual can walk in six minutes, used to assess endurance and mobility.

Inertial Sensors: Wearable accelerometers and gyroscopes that record body segment accelerations and angular velocities to quantify gait parameters over time.

Gait Profile Score (GPS): A summary metric that condenses multi-joint kinematic deviations into a single angle-based score, facilitating comparison between individuals and groups.

Statistical Parametric Mapping (SPM): A statistical framework for analysing continuous biomechanical data over the gait cycle, enabling detection of phase-specific differences in kinematics or kinetics.

References

1. Smartphone-based gait analysis in the assessment of fatigue and fatigability in people with multiple sclerosis: a supervised cohort study. Journal of Neurology (2025).
2. Uncovering Subtle Gait Deterioration in People with Early-Stage Multiple Sclerosis Using Inertial Sensors: A 2-Year Multicenter Longitudinal Study. Sensors (2023).
3. Complementary use of statistical parametric mapping and gait profile score to describe walking alterations in multiple sclerosis: a cross-sectional study. Scientific Reports (2023).
4. Profiling walking dysfunction in multiple sclerosis: characterisation, classification and progression over time. Scientific Reports (2018).
5. Wearable sensors can reliably quantify gait alterations associated with disability in people with progressive multiple sclerosis in a clinical setting. Journal of Neurology (2020).