Strategies used by individuals with multiple sclerosis and with mild disability to maintain dynamic stability during a steering task

Abstract

Changing direction during walking is a common task humans encounter every day. This destabilizing event requires the central nervous system (CNS) to quickly produce an appropriate response, maintain stability, and propel the body in the intended direction. Previous research has demonstrated that 'individuals with multiple sclerosis' (IwMS) with mild balance impairment display differences in gait characteristics during clinical tests compared with controls. The current study used dynamic stability margin [DSM, difference between COM (i.e. the weighted average of the central point of an individual's total body mass) and lateral BOS (i.e. the most lateral border of the foot that is in contact with the ground)] calculations in addition to gait kinematics to determine whether dynamic stability differences during a steering task were present between IwMS with mild balance impairment and 'healthy age-matched individuals' (HAMI) as well as between IwMS with mild balance impairment and 'community-dwelling older adults' (OA). All IwMS reported mild balance impairment with expanded disability status scale scores ranging between 1.0 and 3.0. The steering task required participants to walk 3 m towards a pressure sensitive trigger mat that would illuminate one of five lights to indicate the future direction of travel (i.e. straight, 45° or 60° to the left or right of the midline). Results revealed that IwMS displayed reduced walking speed and cadence during the approach phase in addition to a smaller DSM range (i.e. COM remained close to lateral BOS) during the entire steering task when compared with HAMI. However, when compared to OAs, IwMS did not display differences in any of the gait kinematics or DSM calculations. Findings suggest that the IwMS displayed a conservative gait strategy in order to maintain stability during the steering task. Lack of dynamic stability differences between IwMS and OAs indicate that both groups use similar strategies to adapt locomotion as a result of impaired somatosensory quality and/or processing.