Reduced walking endurance is common in people with multiple sclerosis (PwMS), leading to reduced social participation and increased fall risk. This highlights the importance of identifying which gait aspects should be mostly targeted by rehabilitation to maintain/increase walking endurance in this population. A total of 56 PwMS and 24 healthy subjects (HSs) executed the 6 min walk test (6 MWT), a clinical measure of walking endurance, wearing three inertial sensors (IMUs) on their shanks and lower back. Five IMU-based digital metrics descriptive of different gait domains, i.e., double support duration, trunk sway, gait regularity, symmetry, and local dynamic instability, were computed. All metrics demonstrated moderate–high ability to discriminate between HSs and PwMS (AUC: 0.79–0.91) and were able to detect differences between PwMS at minimal (PwMS_mFR) and moderate–high fall risk (PwMS_FR). Compared to PwMS_mFR, PwMS_FR walked with a prolonged double support phase (+100%), larger trunk sway (+23%), lower stride regularity (−32%) and gait symmetry (−18%), and higher local dynamic instability (+24%). Normative cut-off values were provided for all metrics to help clinicians in detecting abnormal scores at an individual level. The five metrics, entered into a multiple linear regression model with 6 MWT distance as the dependent variable, showed that gait regularity and the three metrics most related to dynamic balance (i.e., double support duration, trunk sway, and local dynamic instability) were significant independent contributors to 6 MWT distance, while gait symmetry was not. While double support duration and local dynamic instability were independently associated with walking endurance in both PwMS_mFR and PwMS_FR, gait regularity and trunk sway significantly contributed to 6 MWT distance only in PwMS_mFR and PwMS_FR, respectively. Taken together, the present results allowed us to provide hints for tailored rehabilitation exercises aimed at specifically improving walking endurance in PwMS.

Importance: Task-specific balance deficits are common in people with neurological disorders (PwND), significantly affecting their Activities of Daily Living (ADLs). However, the relationship between balance deficits and ADLs measured by patient-reported outcomes is poorly understood, thus limiting the selection of specific static and dynamic tasks to be used to train for a given activity. Objective: The aim of the study was to provide a clinical framework linking ADLs, balance tasks, and balance resources (Horak, 2009) to support clinicians’ decision-making when planning task-oriented balance rehabilitation for PwND. Design: This was an observational study with a cross-sectional design. Setting: This study examined clinical contexts involving PwND. Participants: This study involved people with Parkinson disease, stroke, or multiple sclerosis. Exposure: The study used the Activities-Specific Balance Confidence Scale (ABC) for patient-reported outcomes to assess perceived balance during ADLs, and the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) to evaluate static and dynamic balance. Main Outcomes and Measures: Kendall tau correlations (τ) were used to identify meaningful associations between ABC and BBS-DGI items, matching ADLs with specific balance tasks. Results: The study sample comprised 299 people with Parkinson disease (n = 94), stroke (n = 94), and multiple sclerosis (n = 111) with a median (IQR) age of 63 (52.0–71.5) years, all exhibiting moderate to severe balance impairments. Moderate correlations (τ ≥ 0.39) were found between dynamic and semi-dynamic challenging outdoor ADLs with static and dynamic tasks involving sensory orientation and the use of vestibular and proprioceptive systems. Moreover, stability limits-verticality, anticipatory postural adjustments, and stability in gait are the primary balance resources to consider when designing ad hoc rehabilitation interventions. Conclusions: This study establishes associations between specific ADLs and balance tasks, offering a clinical framework to identify relevant balance resources for rehabilitation. It provides clinicians with a structured approach for planning task-oriented, needs-based balance rehabilitation for PwND, focusing on the training of specific balance resources to enhance ADLs. Relevance: This study provides a clinical framework to help clinicians in planning task-oriented and needs-based balance rehabilitation for PwND, suggesting which balance resources should be trained to improve specific ADLs.

Background. Wearable powered exoskeletons could be used to provide robotic-assisted gait training (RAGT) in people with stroke (PwST) and walking disability. The study aims to compare the differences in cardiac function, fatigue, and workload during activities of daily living (ADLs), while wearing an exoskeleton. Methods. Five PwST were recruited in this pilot cross-sectional study. We observed three experimental conditions: walking without and with the UAN.GO exoskeleton and walking with the UAN.GO combined with the OPTIGO walker. Each condition included five trials related to ADLs such as sitting and walking. Results. No statistically significant difference was found between heart rate and R–R of ECG data while comparing all the observed conditions during each respective trial. The NASA Task Load Index did not show significant differences across all trials, except for a significant difference between Condition 2 and Condition 3 in Trial 4 (p = 0.043). However, walking and sit-to-stand tasks seem to be more challenging according to the NASA-TLX. Only one participant scored over 70 points on the System Usability Scale. The TSQ-WT scores for conditions 2 and 3 were 62 (56.5–72.5) and 70 (66.5–75) points, respectively. Conclusions. This study suggests that UAN.GO exoskeleton could be used for RAGT in PwST with disability without compromising cardiovascular function.

Background and objectives: Gait and balance impairments are common and disabling in People with Multiple Sclerosis (PwMS), significantly affecting mobility and quality of life. Although several clinical and instrumental tools exist to assess these functions, there is no consensus on the most appropriate measures for detecting changes at the clinical, movement quality, and neural levels. This study aims to establish expert consensus on the most appropriate tools for assessing gait and balance in PwMS to support an individualized approach to rehabilitation. Methods: The process will begin with a focus group to gather initial feedback from a few experts, followed by a Delphi study consisting of iterative rounds of anonymous surveys with international experts to reach consensus on the most appropriate tools. The Delphi process will be conducted using an electronic platform to ensure anonymity and international participation. Experts will evaluate the proposed tools over several rounds until consensus is reached. The consensus threshold will be predefined, and statistical measures of agreement will guide the analysis. Discussion and conclusion: By identifying a core set of outcome measures covering clinical, movement quality, and neural aspects, this study aims to address the current fragmentation in clinical practice and research in PwMS. This comprehensive approach will improve the assessment of gait and balance and facilitate the design of tailored rehabilitation interventions that meet the specific needs and recovery potential of each patient. In addition, the study will establish a consensus-based framework for gait and balance assessment in MS rehabilitation, promoting consistency across clinical and research settings. The results are expected to inform future studies on patient stratification, treatment effectiveness, and precision rehabilitation strategies, ultimately leading to improved functional outcomes and quality of care.

Background Motor and cognitive dysfunctions are common and disabling features in multiple sclerosis (MS) that remain challenging to treat. Here, we aimed to explore the effect of exergames as a stand-alone approach for people with MS and impaired processing speed. Methods This was a three-arm, randomised, rater-blinded, sham-controlled trial. People with MS and impaired processing speed were randomised in a 1:1:1 ratio to an 8-week home-based training with exergames (intervention of interest), adaptive Cognitive Training Kit (COGNI-TRAcK) (working memory training as comparator intervention) or sham intervention. A postintervention assessment was scheduled at week 16 postrandomisation. Statistical analyses were conducted to test the hypotheses that exergames were superior to sham intervention and non-inferior to adaptive COGNI-TRAcK on the symbol digit modalities test (SDMT). Results We screened 165 people with MS, of whom 102 were randomised (34 per arm). At week 8, both exergames and adaptive COGNI-TRAcK yielded improvements in SDMT, with adjusted mean differences versus sham intervention of 4.3 (95% CI 0.1 to 8.5) and 5.7 (95% CI 1.3 to 10.1) points, respectively. The non-inferiority analysis was inconclusive, as the mean between-arm difference (adaptive COGNI-TRAcK versus exergames) was 1.3 points (90% CI –1.7 to 4.3), crossing the predefined non-inferiority margin of 4 SDMT points. Exergames additionally demonstrated benefits on executive function, dynamic balance, fatigue and reduced work absenteeism. None of these benefits was retained at week 16. Conclusion This study provides evidence that home-based exergames are suitable as a standalone approach to improve some specific MS-related cognitive and motor dysfunctions, but there is no evidence about their non-inferiority to working memory training. Trial registration number NCT04169750.