Understanding Mediolateral Stability During Gait in Persons with Early-Stage Multiple Sclerosis

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Elliott, Tessa
Multiple Sclerosis , Gait , Balance , Exploratory , Mediolateral
Background: Among the most common and disabling symptoms associated with multiple sclerosis (MS) are problems with balance, during both stance and gait. Balance during gait is highly dependent on stability in the mediolateral (M-L) direction. It is currently unknown how M-L stability is affected in those with low levels of disability due to MS. The objective of this multiple case series was to explore how M-L stability during gait is affected in persons with early-stage MS using narrow-base walking. Narrow-base walking has not previously been used in the MS population. The secondary objective was to explore the other common symptoms of this disease that may contribute to the experience of postural instability, using of both commonly used and novel testing techniques for the MS population. Methods: Three individuals with early stage MS (MS1 = female aged 25, MS2 = female aged 33, MS3 = female aged 23) were included in this study and compared to healthy age and sex-matched controls. Balance during gait was assessed using a narrow-base walking paradigm on a path 25cm in width while participants were instrumented with body-worn motion sensors. Center of mass (COM) displacement and velocity as well as head movement were assessed during these trials. Standing balance was assessed using a force-plate to derive center of pressure (COP) displacement and velocity data. Levels of fatigue, muscle weakness, sensory function, physical activity, falls frequency, and mood were also assessed. Results: All three participants with MS showed slight changes in M-L stability during gait as compared to healthy controls. This was evidenced in differing ways between participants and included increased peak and average M-L COM velocity and decreased gait speed. All participants with MS showed an increase in sensory thresholds on a measure of ankle proprioception and increased COP displacement while standing with their eyes closed on a foam surface. Conclusion: Subtle differences in M-L stability could be detected using the narrow-base walking paradigm. Using body-worn motion sensors to assess stability during gait in the MS population may be a useful technique in detecting small changes to stability early in the disease.
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