Mind matters

M

New research from Brazil suggests that the act of walking when you have MS uses up greater cortical resources than if you don’t have MS; especially in the frontal and parietal cortical areas. Their hypothesis is that this increased activity is a compensatory response for the subcortical damage that occurs with MS. This is a plausible as majority of MS lesions occur in a periventricular distribution interrupting the subcortical networks.

Figure: Summary of the study findings. In the brain representation, the colors show each region of interest as follows: red =frontal cortex; yellow =motor cortex; blue =parietal cortex; green =occipital cortex. People with Multiple Sclerosis (PwMS); Control Group (CG); Obstacle Avoidance (OA); Unobstructed gait (UG); Step length (SL); Step velocity (SV); Step duration (SD); Step width (SW); Double support (DS)

My hypothesis on this is somewhat different (hear me out before you debunk it!). I think that what you’re seeing here is a switch in the brains functional networks to early childhood in an effort to relearn the ability to walk. For example, in a study using a similar technique in infants, investigators found a greater coherence in prefrontal/central scalp electrodes in novice walkers compared to pre-walkers or experienced walkers. Based on this hypothesis it is conceivable that rehabilitation in MS should be focused more on relearning, rather than simply guiding an individual with MS on their walking difficulties.

Abstract

Cortical activity and gait parameter characteristics in people with multiple sclerosis during unobstructed gait and obstacle avoidance

Felipe Balistieri Santinelli Emerson Sebastião Marina Hiromi Kuroda Vinicius Christianini Moreno Julia Pilon Luiz Henrique Palucci VieiraFabio Augusto Barbieri 

Background: People with Multiple Sclerosis (PwMS) present higher cortical activity during walking. However, the cortical activity during gait while avoiding an obstacle is still not clear.

Objective: To investigate cortical activity and gait spatial-temporal parameters in PwMS during two different gait tasks (i.e., unobstructed and obstacle avoidance).

Method: Fifteen PwMS and 15 healthy controls (CG) were recruited. Participants performed ten trials in each gait condition, wearing a 64-electrode cap electroencephalogram (EEG) at 1024 Hz. Kinematic data were obtained through 10 Vicon® cameras at 200 Hz. EEG was analyzed through four cortical areas (frontal, motor, parietal, and occipital cortex areas) and five frequency bands (delta, theta, alpha, beta, and gamma) obtained through the power spectral density. In addition, spatial-temporal gait parameters (e.g., step length and velocity) were measured. Two-way ANOVA (group x gait condition) and MANOVA (group x gait condition) were used to compare gait and EEG parameters, respectively. One-way ANOVA was used to compare groups in the crossing phase of the obstacle avoidance condition.

Results: PwMS presented lower step length and velocity, and higher cortical activity in frontal (beta and gamma) and parietal (gamma) cortical areas in both gait conditions compared to CG. Moreover, PwMS presented increased cortical activation (frontal and parietal) and decreased step length and velocity in obstacle avoidance compared with unobstructed gait. In addition, PwMS required more cortical resources (frontal and parietal) than CG to accomplish both gait conditions. During the obstacle avoidance task, it was further observed that PwMS positioned their feet closer to the obstacle, before and after the task, compared to CG.

Conclusion: PwMS demand higher cortical resources to accomplish gait tasks, mainly when it is necessary to negotiate an obstacle in the pathway. This higher cortical activity may be a compensatory mechanism to deal with damage in subcortical structures caused by multiple sclerosis.

About the author

Neuro Doc Gnanapavan

17 comments

  • Thanks for the suggestion NDG! Now instead of saying “I am not drunk I have MS”…….I can say “I have MS and I am relearning how to walk”

    It may seem minor, yet knowing how to respond to (sometimes) awkward situations is comforting.

    I do feel more control over my balance and gait when I am consistently stretching, using the Pilates reformer, and riding the stationary bike for 15 minutes. I am still a bit wobbly, just a bit less scared of falling as long as I remember to slow down (use of a cane also helps as a reminder to take it slow).

  • The funniest thing is that I feel more stable when I walk faster… I have always been a fast walker and I still hate walking slowly, before I was diagnosed with MS I used to say walking slowly makes me feel sick,, and I guess that I was kind of right, I just couldn’t really explain it. Walking slowly makes me feel real unstable (I really hate getting stuck behind people texting or reading), for some reason walking fast is better and running even better still, ok I may still look drunk but I feel better… oops isn’t that the definition of drunk? 😕

    • Anon, I get the exact same thing – walking faster it feels like my body has time to “stabilise” and I don’t notice any of the balance issues that are more apparent during slow walks (albeit not always).

      • Same, while walking faster I feel more stable, until I get fatigued, then my weaker leg shuffles more and I need to concentrate on posture and leg swing. This physical fatigue plus extreme concentration causes a fear of tripping/falling and I slow my pace. For point of reference, during a fast timed 6 min walk with turns, it occurs about halfway through.

    • Have the same, I was famously fast before walking was affected. Still am, the first 500m or so.

      Worst is stopping at a crossing and turning my head to see if traffic is coming…

      • Yeah, stopping to look left and right is not good… occasionally I’ll forget and only slow down and try to look left and right while I am still walking… there’s that drunk again!😄

    • Yes Anon!
      Aftet MS diagnosis I wobbled and crab walked when slow. Faster walking was straighter and smoother, it just meant more frequent stops as I couldn’t sustain it.
      Now walking is so bad I can’t walk fast and I am definitely ‘re-learning’ how to walk slowly from basics.
      Maybe the ‘timed walk’ should also be tested along with a ‘slow motion walk’ ?

  • I wonder if this is already inherent in neurophysio rehab. My physio used to get me to practise an exaggerated gait – i.e. being very conscious of how you place your feet (thinking, concentrating on how they’re positioned, visualising the distance between steps), plus exaggerating the hip swing and trunk rotation. This would be demonstrated/practised using walking poles. Or do you think this could lead to different teaching methods?

    • It possibly is but probably learnt from experience rather having a biological understanding of the process. Centres in Sweden use a mechanical walker to assist in walking and the principal is the same, which is retraining the walking.

  • I’ve read about the concept of ‘neurological reserves’ (I think it was called) on this blog. The ‘resources’ in this article, and ‘reserves’ I’m referring to are not the same thing?

    Sounds like a plausible idea anyway, I certainly had to relearn walking and maths after my last major relapse. I was successful with both because there are great resources out there to help. But I failed to relearn language skills, like reading comprehension. And I’ve lost the ability to make jokes. Unfortunately I don’t know any resources out there for that kind of rehabilitation.

    • I’m hypothesising here that it’s more than about reserves, but the brain resetting back to what it already knows is the pathway for walking (information coded for in your genes).

      • I’m a non science person, but I am often very surprised about things that are unknown by doctors about MS rehab, and this relearning vs “guiding” an MSer to walk is a great example. After a severe flare I did not drive for 3 years and took occupational driving therapy before driving again. I did not need or use any assistive devices, I voluntarily did it because I wanted to be confident that I could drive a car safely with my then young children in the car. My vocabulary about this has always been that “I had to relearn how to drive”. Similarly, After the same flare, my speech was awkward or forced. Through speech therapy, I learned that my breathing patterns were off as well tongue placement when pronouncing certain sounds. I felt that I had to relearn how to speak. Understand that I had to be taught very specific steps for breath and tongue placement, which previously was innate knowledge. Similar to you Jemima, my reading skills also took a hit. A speech therapist and or occupational might be helpful to you. Over the years, I’ve use the following compensation strategies to aid me: Rereading. A bore but deliberate rereads with highlights or writing a
        A summary allows me to absorb written material I can’t ignore. I use a transparent yellow ruler if my eyes are having problem tracking or finding spot. I will Visualize instructions by creating a flow chart or a chronology with a timeline. I must note that I require a fresh day, caffeine and provigil to do cognitive work and I know without these stimulants, reading comprehension will very quickly use up my cognitive reserve. This means planning is also key to scheduling when I undertake such work. Instead of feeling less than because I must take these additional steps, I actually feel confidence that my brain can still absorb new information, just not as easily as before. I suspect this clinically supports or is consistent with what NEURO DOC GNANAPAVAN states here about the brain processes?.??. With regard to pleasure reading, sadly, I have felt for many years that my motivation to reread the same paragraph or chapter repeatedly is lacking when I’m reading for enjoyment. But This year, I found something almost as good! During the pandemic, my public library offered a large catalog of audiobooks, and it has been life changing! I’ve always been the type of person who had 3 or more books on my nightstand, but with audiobooks, I have probably have 5 or more I’m listening to depending on my mood, switching between non-fiction and fiction, spiritual and health books. Audiobooks have a helpful tool that allow one to slow or quicken the pace and Repeat any section. So in some ways, I’ve been able to relearn the joy of reading for pleasure. 😊. I hope my comment is helpful to you Jemima. Based on my own experience, I would bet that your joke telling issues are more about how quickly your brain processes conversation rather than loss of humor. I may not be able to tell as good a yarn in the same way as before, but I still can enjoy the shared experience of a good chuckle with friends and knee slapping laughs if worthy 😉. MS does change our abilities, but be sure to celebrate how much your brain can still do. Pretty remarkable.

        • Very interesting post. My physio has also told me two things that changed forever how I manage the Ms. a) that the brain doesn’t even register that you want it to do something differently (i.e. create a neural pathway to compensate for a deficit) until you have made the new movement A MINIMUM OF 500 TIMES. At that point, it will start the process. b) however imperfect a movement is, if you fail to continue making it, at some point the memory is lost in the brain cortex. When that happens, the entire movement is lost and unrecoverable. The physio mantra is: move every muscle every day.

          • On wlaking fast and slow.

            I agree with Doc that relearning to walk better should be an important part of physio – based on my own experience rather than an understanding of neural processes. I suspect though that although we share many common difficulties, e.g. with walking, each one of us presents with an individual set of problems. I doubt that there is an off the peg solution or a standard six week NHS fix to Physio any more than there is for exercise (and I’m sure that is not what you are arguing for).

            If I might add something on the walking faster paradox that several have mentioned. Having learnt very slowly and painfully over a period of years to get my legs to ‘walk by themselves’ I eventually settled for walking with some adapted nordic walking poles. On a good day I can walk quite fast in open countryside (bliss) for an hour or more with just gentle touches on the poles – as long as I don’t have to dodge out of the way of obstacles – human or otherwise. But get me on a busy street and within 5 minutes I’m exhausted. How can this be?

            In addition to any neural challenges I think the answer lies in energy or rather the lack of it. If each step is difficult and tiring we are clearly going to struggle, which was what was happening to me until I recovered my gait. In my case part of the trick was to keep my legs relaxed. It seems the a little extra push from the poles allows me to do this and keep a good forward momentum. But how can such a small push make such a big difference? I think I found the answer from reading an article about the mechanics of walking. When people walk at a normal speed, two thirds of the energy used is stored and recovered in your leg muscles which if you are weak will make all the difference. But once you slow down or keep stopping and starting you lose this energy recovery and walking takes at least 3 times more effort.

            We face a double whammy – neural and energy deficit. I use an aid (my poles) to work around this, but it doesn’t work in crowds.

        • Thank you for the detailed response Suebee. I’m actual right alongside you! I have used almost all of those strategies (going to get a yellow rule now!). And it is reading novels I only have trouble with now. And yes, I’m an audiobook addict now too. I think I found heaven this year, doing jigsaws while listening to audiobooks. It’s amazing where how simple some of life’s greatest pleasures are. I probably wouldn’t have got there for another few years without MS. Funnily enough, I can read a novel, if it’s one I have read before MS.

    • With my first relapses, it also took months before I could walk “normally” again without drifting and having no contact with the ground. When I walk fast I am fine, Am I n a store and have to take small steps and watch out for obstacles I get dizzy and nauseous and my legs are very heavy.
      While walking (or sitting) I cannot quickly move my head side to side for a long period of time because then I get dizzy in my head. Cycling or driving in traffic is therefore no longer possible. This has never been restored. But there are less and better days.

      I compare the fast and slow walking effect a bit with fast or slow cycling, the slower the sooner you fall over. The more speed, the more stable.

      I was always a fast reader, since I have MS I can only read by reading aloud in my head, which means that it takes longer. Also, reading (which I also read in another comment) only works when I have taken Ritalin.
      You mentioned audiobooks, I can no longer (with attention) listen to music / audiobooks and do something on the side. It’s either listening or doing something.

      Do you also have that when you are in bed and wide awake, you do not feel (without moving) which side you are lying on?

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