Jebb G. Remelius

Leg power asymmetry and postural control in women with multiple sclerosis.

UNLABELLED The extent of and the interactions between muscle strength, walking speed, postural control, and symptomatic fatigue in multiple sclerosis (MS) are not known, nor are the effects of bilateral strength asymmetries on these variables. PURPOSE To quantify the magnitude of and the associations between bilateral strength and limb-loading asymmetries, postural control, and symptomatic fatigue in women with MS. METHODS Peak knee extensor (KE) and dorsiflexor (DF) isometric torque and isotonic power were assessed bilaterally in 12 women with MS (Expanded Disability Status Scale = 4 +/- 1) and 12 age-matched female controls using a Biodex dynamometer (Biodex Medical, Shirley, NY). Center of pressure (CoP) variability during 20 s of quiet stance was measured in the anteroposterior (AP) and the mediolateral (ML) directions using adjacent force plates. Bilateral asymmetry scores were calculated for power and torque. Normal and brisk walk times (25 ft) and symptomatic fatigue (Visual Analog Fatigue Scale and Fatigue Severity Scale) were measured before strength and balance testing. RESULTS Fatigue was greater and walk times (normal and brisk) were longer in MS (P < or = 0.01). Dorsiflexor (DF) isometric torque and power and knee extensor (KE) isometric strength were similar between groups. KE power was lower (mean +/- SD = 21.5 +/- 16.2%; P < or = 0.05) and KE power asymmetry was greater in MS than in controls (9.2 +/- 6.9%; P = 0.02). Postural variability of the CoP was greater in the AP direction in MS than in controls (7.52 +/- 3.02 and 4.33 +/- 1.79 mm, respectively; P = 0.005). KE power asymmetry was associated with fatigue and walk times (P < or = 0.02), and AP CoP variability was correlated with fatigue, walk times, and power asymmetries (P < or = 0.05). CONCLUSIONS These data provide new evidence of a potential role for KE strength asymmetries in the symptomatic fatigue and physical dysfunction of persons with MS, possibly through an effect on postural stability.

Postural control in women with multiple sclerosis: effects of task, vision and symptomatic fatigue.

People with multiple sclerosis (MS) often report problems with balance, which may be most apparent during challenging postural tasks such as leaning or reaching, and when relying on non-visual sensory systems. An additional obstacle facing people with MS is a high incidence of symptomatic fatigue (>70%). The purpose of this study was to investigate the changes in balance during upright stance in individuals with mild-to-moderate disability due to MS under normal and restricted vision and different levels of self-reported fatigue. Limb loading asymmetry, sway and magnitude of postural shift in center of pressure, and time-to-contact the stability boundary of the center of mass and center of pressure were assessed during quiet standing and maximal lean and reach tasks. Compared to controls, people with MS displayed greater postural sway, greater loading asymmetry, and shorter time-to-contact during quiet standing. In the postural perturbation tasks the MS group had smaller postural shifts and reduced stability compared to controls in the direction perpendicular to the lean and reach. Limiting vision increased loading asymmetry during quiet standing and postural instability during backward lean in the MS group. Inducing additional fatigue in the MS group did affect postural control in the more challenging balance conditions but had no impact during quiet upright standing. The results of this study indicate subtle changes in postural control during standing in people with mild-to-moderate impairments due to MS.

Gait Impairments in Persons With Multiple Sclerosis Across Preferred and Fixed Walking Speeds

OBJECTIVES To investigate (1) whether previously observed changes in gait parameters in individuals with multiple sclerosis (MS) are the result of slower preferred walking speeds or reflect adaptations independent of gait speed; and (2) the changes in spatiotemporal features of the unstable swing phase of gait in people with MS. DESIGN Cross-sectional study assessing changes in gait parameters during preferred, slow (0.6m/s), medium (1.0m/s), and fast (1.4m/s) walking speeds. SETTING Gait laboratory with instrumented walkway and motion capture system. PARTICIPANTS MS group with mild to moderate impairment (n=19, 16 women) with a median Expanded Disability Status Scale score of 3.75 (range, 2.5-6), and a sex- and age-matched control group (n=19). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gait speed, stride length, stride width, cadence, dual support time, swing time, and timing of swing foot and body/head center of mass during swing phase. RESULTS Individuals with MS walked at slower preferred speeds with longer dual support times compared with controls. In fixed-speed conditions, dual support times were longer and swing times were shorter in MS compared with controls. Stride width was wider for all speed conditions in the MS group. In fixed-speed conditions, the MS group positioned their head and body centers of mass closer to the anterior base of support boundary when entering the unstable equilibrium of the swing phase. CONCLUSIONS Longer dual support time is part of a gait strategy in MS that is apparent even when controlling for the confounding effect of slower preferred speed. However, a gait strategy featuring longer dual support times may have limitations if potentially destabilizing swing dynamics exist, which especially occur at walking speeds other than preferred for people with MS.

Prospective dynamic balance control during the swing phase of walking: Stability boundaries and time-to-contact analysis

This study examined the prospective control of the swing phase in young healthy adults while walking at preferred speed over unobstructed ground and during obstacle clearance. Three aspects of swing were examined: (1) the relation of the body Center of Mass (CoM) to the stability boundaries at the base of support; (2) a dynamic time-to-contact analysis of the CoM and swing foot to these boundaries; and (3) the role of head movements in the prospective control of gait and field of view assessment. The time-to-contact analysis of CoM and swing foot showed less stable swing dynamics in the trail foot compared to the lead foot in the approach to the unstable equilibrium, with the CoM leading the swing foot and crossing the anterior stability boundary before the swing foot. Compensations in temporal coupling occurred in the trail limb during the late swing phase. Time-to-contact analysis of head movement showed stronger prospective control of the lead foot, while fixation of the field of view occurred earlier in swing and was closer to the body in the obstacle condition compared to unobstructed walking. The dynamic time-to-contact analysis offers a new approach to assessing the unstable swing phase of walking in different populations.

Enhancing Postural Stability and Adaptability in Multiple Sclerosis

People living with multiple sclerosis (MS) consistently rate balance and gait impairments as having the greatest negative impacts on their quality of life. Our research aims to understand the sensorimotor contributions to balance dysfunction and difficulty with walking in people with MS, with specific attention paid to how fatigue, muscle weakness, and sensory loss interact to limit physical function and mobility. Here, we relate aspects of somatosensory loss and symptomatic fatigue to balance function, and provide new insights in our understanding of the mechanisms of balance and gait dysfunction in MS through the use of novel analytical methods and experimental paradigms. We first review the existing methods and paradigms to assess postural and gait stability in research on MS. Next, we introduce novel measures to assess the stability and adaptability of posture and gait in people with MS that are based on nonlinear and complex systems methods. These novel methods include (1) boundary-relevant measures of postural stability and control (postural “time to contact”), and (2) entropy measures for assessing postural and gait adaptability. These novel methods allow us to differentiate between postural and gait variability caused by dysfunction that may interfere with movement control, and variability that is functional and provides stable and adaptable movement patterns. Finally, we discuss how these methods and paradigms could help to develop innovative treatments for balance and gait dysfunction in people with MS.

Time-To-Contact Analysis of Gait Stability in the Swing Phase of Walking in People With Multiple Sclerosis.

This study investigated timing and coordination during the swing phase of swing leg, body center of mass (CoM) and head during walking people with multiple sclerosis (MS; n = 19) and controls (n = 19). The MS group showed differences in swing phase timing at all speeds. At imposed but not preferred speeds, the MS group had less time to prepare for entry into the unstable equilibrium, as the CoM entered this phase of swing earlier. Time-to-contact coupling, quantifying the coordination between the CoM and the swing foot, was not different between groups. The projection of head motion on the ground occurred earlier after toe-off and was positioned closer to the body in the MS group, illustrating increased reliance on visual exproprioception in which vision of the body in relation to the surface of support is established. Finally, prospective control, linking head movements to the swing foot time-to-contact and next step landing area, was impaired in the MS group at higher gait speeds.