Angle-angle diagrams in the assessment of locomotion in persons with multiple sclerosis: a preliminary study

Gait analysis is clinically relevant in persons with multiple sclerosis (PwMS) and consists
of several joint angular displacement–time relationships and spatiotemporal parameters. However, it
lacks representation by means of diagrams in which knee-angle/hip-angle and knee-angle/ankleangle
variations are plotted against each other at the same points of time. Three-dimensional
kinematic analysis was performed on 20 subjects (10 PwMS/10 healthy controls, HCs), and the
knee-angle/hip-angle and knee-angle/ankle-angle diagrams of both lower limbs were determined in
the sagittal plane while walking on a motorized treadmill. The area (a quantifier of range of motion)
and the perimeter (a quantifier of coordination) of angle-angle diagram loops were calculated.
PwMS showed reduced knee-angle/ankle-angle loops compared to HCs (p < 0.05), whereas the
hip-angle/ankle-angle loops between the PwMS and HCs was not significant (p > 0.05). Similarly, the
activation of leg muscles showed significant differences between PwMS and HCs (p ranged from 0.05
to 0.001). The results indicate that the proposed knee-angle/hip-angle diagram is feasible and could
be applied as a reliable tool in future studies aimed at assessing the acute and long-term effects of
specific exercise programmes and/or pharmacological treatment in PwMS.