title: Fatigue induced changes to kinematic and kinetic gait parameters following six minutes of walking in people with multiple sclerosis.
abstract: OBJECTIVE
  The aim of this study was to examine the effect of 6 min of walking on fatigue, exertion and spatiotemporal, kinematic and kinetic gait parameters in people with multiple sclerosis (MS).
  
  
  METHODS
  Thirty-four people with MS with moderate levels of disability completed measures of fatigue, exertion and instrumented gait analysis before and after 6-min trials of rest and walking (using a modified 6-min walk test, m6MWT). Ten age- and gender-matched healthy controls completed analysis before and after the m6MWT.
  
  
  RESULTS
  The MS group had a significant increase in self-reported fatigue following the m6MWT; however, there was no effect on spatiotemporal gait parameters. During stance on the more affected side ankle dorsiflexion at initial contact decreased, while knee and hip flexor moments and hip power absorption increased. On the less affected side ankle and knee power absorption, and hip extensor moment all increased. Healthy controls showed increases in joint kinetics likely due to increased walking speeds following m6MWT.
  
  
  CONCLUSIONS
  For people with MS, ankle dorsiflexion angle reduces at initial contact following walking induced fatigue, while increased power absorption at the hip, knee and ankle indicate gait inefficiencies that may contribute to higher levels of fatigue and exertion.
  
  
  CONCLUSIONS
  The modified 6-min walk test (m6MWT) leads to significant increases in self-reported fatigue and exertion in people with MS. Following the m6MWT, there is significantly reduced ankle dorsiflexion angle at initial contact in the more affected leg in people with MS. This reveals an important walking-induced kinematic change that should be the target of future orthotic and strengthening interventions. In people with MS, increased power absorption primarily during the stance phase of gait following the m6MWT reveals important walking-induced muscle weakness that should also be monitored in future strengthening and gait retraining interventions.
authors.affiliation: a Department of Rehabilitation , Aged & Extended Care, Flinders University , Adelaide , South Australia, Australia .|b School of Public Health and Community Medicine, University of New South Wales , Sydney , Australia .
authors.forename: James Vincent
authors.initials: JV
authors.lastname: McLoughlin
authors.affiliation: a Department of Rehabilitation , Aged & Extended Care, Flinders University , Adelaide , South Australia, Australia .
authors.forename: Christopher John
authors.initials: CJ
authors.lastname: Barr
authors.affiliation: c South Australian Movement Analysis Centre, Repatriation General Hospital , Adelaide , South Australia, Australia , and.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Patritti
authors.affiliation: a Department of Rehabilitation , Aged & Extended Care, Flinders University , Adelaide , South Australia, Australia .
authors.forename: Maria
authors.initials: M
authors.lastname: Crotty
authors.affiliation: b School of Public Health and Community Medicine, University of New South Wales , Sydney , Australia .|d Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales , Sydney , Australia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
authors.affiliation: b School of Public Health and Community Medicine, University of New South Wales , Sydney , Australia .|d Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales , Sydney , Australia.
authors.forename: Daina L
authors.initials: DL
authors.lastname: Sturnieks
mesh_terms: D000328:Adult; D001315:Australia; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D005080:Exercise Test / Q000379:methods*; D005221:Fatigue / Q000209:etiology*; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000534:rehabilitation*; D018908:Muscle Weakness / Q000209:etiology*; D057566:Self Report; D016138:Walking
keywords: Fatigue; gait; multiple sclerosis; physical exertion