Multiple sclerosis (MS) deficits in gait stability and automaticity can limit walking endurance. Treadmill training challenges dynamic stability in a repetitive way while allowing for adjustments in exercise's intensity. Body weight support (BWS) facilitate this training for MS-individuals with reduced walking independency, reliance on walking aids and risk of falling. However, harness-based BWS removes the balance challenge and alter the gait pattern, reducing over-ground transfer of gains. Alter-G applies the BWS adaptively, around the pelvis, prompting balance control and gait pattern adaptations.

A 38-year-old female with secondary progressive MS (EDSS=6.5) underwent a BWS-treadmill intervention (5 weeks, twice-weekly) incorporating Alter-G walking (30min, 2.5km/h, BWS=80%) preceded and followed by mobility and balance exercises. Outcome measures of endurance (6-minutes-walk test - 6MWT), safety (Tinetti scale) and fatigue (Modified fatigue impact scale - MFIS) were assessed before, one-week, and six-weeks after intervention.

At one-week post-intervention, improvements were observed in walking endurance (56% increase in 6MWT), along with enhanced walking safety (from 15/28 to 21/28 on Tinetti scale) and reduced perceived impact of fatigue (MFIS score from 41/84 to 24/84). At six-weeks these effects were partially maintained.

This intervention improved ambulatory function in an individual with severe MS-related disability. Alter-G training likely led to a more stable overground walk: the adapted gait pattern included more symmetrical steps and rhythmic weight transfers, resulting in a smoother forward progression and reducing the effort. The removal of visual control and challenges to trunk stability and lower limb coordination likely enhanced automatic multisensory integration, reducing the need for corrective motor plans while walking. Considering the promising results of this case study, we propose to investigate, in appropriately sized samples and with the presence of a control group, the efficacy of this assisted task-specific training in PwMS, with a particular focus on ambulation endurance.

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