Stride-Time Variability and Fall Risk in Persons with Multiple Sclerosis.

Yaejin Moon,Douglas A Wajda,Robert W Motl,Jacob J Sosnoff

doi:10.1155/2015/964790

Yaejin Moon, Douglas A Wajda + Show 2 more

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https://doi.org/10.1155/2015/964790

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Abstract

Gait variability is associated with falls in clinical populations. However, gait variability's link to falls in persons with Multiple Sclerosis (PwMS) is not well established. This investigation examined the relationship between stride-time variability, fall risk, and physiological fall risk factors in PwMS. 17 PwMS (62.8 ± 7.4 years) and 17 age-matched controls (62.8 ± 5.9 years) performed the 6-minute walk test. Stride-time was assessed with accelerometers attached to the participants' shanks. Stride-time variability was measured by interstride coefficient of variation (CV) of stride-time. The participant's fall risk was measured by the short form physiological profile assessment (PPA). A Spearman correlation analysis was used to determine the relationship between variables. Increased fall risk was strongly associated with increased stride-time CV in both PwMS (ρ = 0.71, p < 0.01) and the controls (ρ = 0.67, p < 0.01). Fall risk was not correlated with average stride-time (p > 0.05). In PwMS, stride-time CV was related to postural sway (ρ = 0.74, p < 0.01) while in the control group, it was related to proprioception (ρ = 0.61, p < 0.01) and postural sway (ρ = 0.78, p < 0.01). Current observations suggest that gait variability is maybe more sensitive marker of fall risk than average gait parameters in PwMS. It was also noted that postural sway may be potentially targeted to modify gait variability in PwMS.

Highlights

Multiple sclerosis (MS) is a neurodegenerative disease that affects over 2 million people worldwide and an estimated 400,000 people in the United States [1]
This study focused on stride-time variability which was previously reported as the most sensitive gait parameter to distinguish fallers from nonfallers in the geriatric population [15]
It was observed that gait variability was positively correlated with physiological fall risk while average gait parameters were not in persons with Multiple Sclerosis (PwMS)

Summary

Introduction

Multiple sclerosis (MS) is a neurodegenerative disease that affects over 2 million people worldwide and an estimated 400,000 people in the United States [1]. MS is associated with inflammatory demyelination and progressive axonal damage [2]. This damage causes conduction delays in neuronal pathways and results in a myriad of symptoms including impairments in balance and gait [3]. There is increasing evidence that MS negatively impacts traditional spatiotemporal parameters of gait (e.g., velocity, stride length, and step time) and the natural fluctuations observed between steps (e.g., gait variability) [4]. This observation is congruent with the view that gait variability is a unique indicator of the control of walking [5]. The review noted a sizeable gap concerning our understanding of gait variability and MS, namely, the practical importance of gait variability [4]

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