Andrew S Monaghan1, Avril Mansfield2,3,4, Jessie M Huisinga5, Daniel S Peterson1,6. 1. College of Health Solutions, Arizona State University, Phoenix, Arizona, USA. 2. KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada. 3. Department of Physical Therapy, University of Toronto, Toronto, Canada. 4. Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada. 5. Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, USA. 6. Phoenix VA Medical Center, Phoenix, Arizona, USA.
Abstract
OBJECTIVE: Reactive stepping is critical for preventing falls and is impaired in people with multiple sclerosis (PwMS); however, which aspects of stepping relate to falls remains poorly understood. Identifying outcomes most related to falls is a first step toward improving rehabilitation for fall prevention. The purpose of this study was to assess whether reactive step latency or length during forward and backward losses of balance were related to a history of falls in PwMS. METHODS: Of the 111 PwMS who participated in this study, 76 reported no falls in the previous 6 months, whereas 36 reported 1 or more falls. Participants completed 3 forward and 3 backward treadmill-induced reactive steps from stance. Step length (centimeters) and step latency (milliseconds) were measured using motion capture and analyzed via MATLAB. RESULTS: Participants with a history of falls had significantly slower step latencies during backward stepping, but not forward stepping, than those without a history of falls. Step length did not differ between groups. Slower step latencies during backward stepping significantly increased the odds of having experienced a fall (β = .908, SE = 0.403, odds ratio = 2.479, 95% CI = 1.125 to 5.464). CONCLUSION: PwMS and a history of falling show delayed step onsets during backward reactive stepping. Specifically, for every 10-millisecond increase in step latency, PwMS were 2.5 times more likely to have a fall history. Although clinical trials are necessary to determine whether interventions targeting reactive stepping reduce falls in PwMS, the current work indicates that the latency of steps may be a relevant target for this work. IMPACT: Subsequent fall prevention clinical trials should consider targeting backward reactive step latency to further assess its relevance for rehabilitation in PwMS. LAY SUMMARY: If you have MS and a history of falls, you may be more likely to have delayed reactive step latencies.
OBJECTIVE: Reactive stepping is critical for preventing falls and is impaired in people with multiple sclerosis (PwMS); however, which aspects of stepping relate to falls remains poorly understood. Identifying outcomes most related to falls is a first step toward improving rehabilitation for fall prevention. The purpose of this study was to assess whether reactive step latency or length during forward and backward losses of balance were related to a history of falls in PwMS. METHODS: Of the 111 PwMS who participated in this study, 76 reported no falls in the previous 6 months, whereas 36 reported 1 or more falls. Participants completed 3 forward and 3 backward treadmill-induced reactive steps from stance. Step length (centimeters) and step latency (milliseconds) were measured using motion capture and analyzed via MATLAB. RESULTS: Participants with a history of falls had significantly slower step latencies during backward stepping, but not forward stepping, than those without a history of falls. Step length did not differ between groups. Slower step latencies during backward stepping significantly increased the odds of having experienced a fall (β = .908, SE = 0.403, odds ratio = 2.479, 95% CI = 1.125 to 5.464). CONCLUSION: PwMS and a history of falling show delayed step onsets during backward reactive stepping. Specifically, for every 10-millisecond increase in step latency, PwMS were 2.5 times more likely to have a fall history. Although clinical trials are necessary to determine whether interventions targeting reactive stepping reduce falls in PwMS, the current work indicates that the latency of steps may be a relevant target for this work. IMPACT: Subsequent fall prevention clinical trials should consider targeting backward reactive step latency to further assess its relevance for rehabilitation in PwMS. LAY SUMMARY: If you have MS and a history of falls, you may be more likely to have delayed reactive step latencies.
Authors: Tobia Zanotto; Mikaela L Frechette; Stephen R Koziel; Katherine L Hsieh; Jacob J Sosnoff Journal: Mult Scler Relat Disord Date: 2021-06-24 Impact factor: 4.339