Abstract
Many falls in persons with multiple sclerosis (PwMS) occur during daily activities such as negotiating obstacles or changing direction. While increased gait variability is a robust biomarker of fall risk in PwMS, gait variability in more ecologically related tasks is unclear. Here, the effects of turning and negotiating an obstacle on gait variability in PwMS were investigated. PwMS and matched healthy controls were instrumented with inertial measurement units on the feet, lumbar, and torso. Subjects completed a walk and turn (WT) with and without an obstacle crossing (OW). Each task was partitioned into pre-turn, post-turn, pre-obstacle, and post-obstacle phases for analysis. Spatial and temporal gait measures and measures of trunk rotation were captured for each phase of each task. In the WT condition, PwMS demonstrated significantly more variability in lumbar and trunk yaw range of motion and rate, lateral foot deviation, cadence, and step time after turning than before. In the OW condition, PwMS demonstrated significantly more variability in both spatial and temporal gait parameters in obstacle approach after turning compared to before turning. No significant differences in gait variability were observed after negotiating an obstacle, regardless of turning or not. Results suggest that the context of gait variability measurement is important. The increased number of variables impacted from turning and the influence of turning on obstacle negotiation suggest that varying tasks must be considered together rather than in isolation to obtain an informed understanding of gait variability that more closely resembles everyday walking.
Highlights
Multiple sclerosis is a chronic, progressive neurodegenerative disease that affects approximately 2.3 million people worldwide and is characterized by the demyelination of neurons disrupting the conduction of electrical impulses [1]
The unique aspect of our study was the investigation of gait variability while walking and turning as well as walking and crossing an obstacle using body-worn motion sensors to examine both spatiotemporal parameters and body-based measures
The findings indicate that turning further impacted straight line walking when readying to cross an obstacle and, as previously suggested, the lack of body-based variability in Persons with multiple sclerosis (PwMS) post-turn may limit their recovery from making the turn and negatively influence their ability to successfully approach and negotiate the upcoming obstacle
Summary
Multiple sclerosis is a chronic, progressive neurodegenerative disease that affects approximately 2.3 million people worldwide and is characterized by the demyelination of neurons disrupting the conduction of electrical impulses [1]. Persons with multiple sclerosis (PwMS) experience a variety of symptoms that can be unpredictable, vary in type and severity, and may be relapsing and remitting [2]. Some common symptoms experienced by PwMS include fatigue, weakness, poor coordination, imbalance, numbness, tingling, vision, cognitive problems, and pain [2]. Approximately 75–90% of PwMS experience mobility issues [3] and PwMS fall at a higher rate and more often than those aging without neurologic impairment [4]. Over half of PwMS fall in any 6-month period [5], with many experiencing repeated falls and falls-related injury [6]. Falls can intensify already existing fear of falling [7], decrease physical activity [6], and reduce quality of life [8]
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