BACKGROUND:Slowed somatosensory conduction in multiple sclerosis (MS) increases postural instability and decreases proprioception. Despite these delays, individuals with MS rely more on proprioception for balance compared to controls. This heightened reliance, combined with slowed signal transduction, increases fall risk. Backward walking (BW) increases proprioceptive reliance by reducing visual cues. However, no study has conclusively linked proprioception to BW. This study aims to assess proprioception's role in BW compared to forward walking (FW) in MS and to compare differences in proprioception between MS fallers and non-fallers. METHODS:Fifty participants (average age: 50.34 ± 11.84, median Patient Determined Disease Steps [PDDS]: 2) completed the study. Participants completed BW and FW at comfortable and fast speeds. We have previously established vibration sensation as a proxy measure for proprioception. Vibration thresholds were quantified at the great toe bilaterally using a 2-alternative forced-choice procedure. RESULTS:Significant correlations were seen for vibration sensation and FW comfortable ( ρ  = 0.35), FW fast ( ρ  = 0.34), BW comfortable ( ρ  = 0.46), and BW fast ( ρ  = 0.46). After controlling for age, sex, and PDDS, vibration sensation significantly predicted performance during all walking tasks, with larger beta coefficients seen during BW (comfortable β  = 0.57; fast β  = 0.58) compared to FW (comfortable β  = 0.41; fast β  = 0.45). Fallers performed significantly worse than non-fallers for vibration sensation ( P = 0.04). DISCUSSION AND CONCLUSIONS:Considering the notable decrease in proprioception in participants with MS and the clear distinction between fallers and non-fallers, it is crucial to conduct fall risk assessments and interventions focusing on proprioception. With its heightened reliance on proprioception, BW offers a promising method for assessing fall risk and could be an effective exercise intervention. Video Abstract available for more insights from the authors (see the Supplemental Digital Content available at: http://links.lww.com/JNPT/A490 ).

Gait adaptability is crucial for meeting environmental demands, and impaired gait adaptation increases fall risk, particularly in older adults. While prior research exists on older adults’ gait adaptation, particularly in perturbation studies, the specific contributions of temporal and spatial adaptation strategies to step length asymmetry (SLA) during split-belt treadmill walking require further examination. This study fills this gap by evaluating how distinct adaptation strategies contribute to SLA in healthy young and older adults. 19 healthy young adults (20.4 ± 1.1 years) and 19 healthy older adults (68.3 ± 8.1 years) walked on a split-belt treadmill requiring their non-dominant leg to move twice as fast as their dominant leg. Repeated measures ANOVA investigated (1) spatial and temporal contributions to SLA, (2) SLA across gait adaptation epochs, and (3) rates of adaptation and deadaptation. Older adults displayed reduced temporal contributions to SLA compared to younger adults (F1,36 = 6.42, p = .02, ŋ2 = .15), but no group differences were observed in spatial contributions to SLA (F1,36 = 3.23, p = .08, ŋ2 = .082). SLA during adaptation and deadaptation did not differ by age group, nor did the rate of adaptation (F1,34.7 = 0.594, p = .45) or deadaptation F1,33.6 = 2.886, p = .09). These findings suggest that while older adults rely less on temporal strategies for gait adaptation, but maintain overall adaptability comparable to younger adults. Findings enhance our understanding of age-related changes in gait adaptation mechanisms and may inform targeted interventions to improve gait adaptability in older populations.

ABSTRACT BACKGROUND: People with multiple sclerosis (MS) experience mobility impairments that elevate fall risk, increasing the need to identify clinical measures that accurately predict falls. Backward walking (BW) better differentiates fallers from nonfallers in MS. However, no studies have reported the measurement properties of the backward walking Timed 25-Foot Walk (B-T25-FW) and BW metrics, like BW velocity. Additionally, it is unknown whether BW can predict future falls in MS or its link to activity levels. This study assessed the reliability and responsiveness of B-T25-FW and BW metrics, including BW velocity. It also examined whether BW could predict falls at 3 and 6 months and its association with activity levels. METHODS: During 2 separate visits, 23 people with MS completed the forward walking Timed 25-Foot Walk (F-T25-FW) and B-T25-FW, as well as forward walking and BW assessments in which spatiotemporal measures were recorded. Test-retest reliability was determined with intraclass correlation coefficients, and minimum detectable changes were calculated. Correlation analyses explored the relationship between BW velocity, B-T25-FW, prospective falls, and activity levels. RESULTS: B-T25-FW and BW velocity exhibited excellent test-retest reliability. Large effect sizes to interpret clinically meaningful change in the B-T25-FW and BW velocity were also found. Both metrics demonstrated modest negative correlations with falls at 3 and 6 months and correlated strongly with very active minutes at 3- and 6-months post study. CONCLUSIONS: The B-T25-FW and BW velocity are effective and reliable in clinical use for evaluating functional mobility in people with MS, are sensitive enough to detect subtle changes, and may be a meaningful marker for tracking disease progression and treatment efficacy.

Adapting to different environments throughout daily activities requires flexibility in allocating attention. Compromised dual-tasking can hinder mobility, increase fall risk, and decrease functional independence in patients with essential tremor, who exhibit both mobility and cognitive impairments. We evaluated motor and cognitive dual-task effects and task prioritization in 15 people with Essential Tremor (ET) and 15 age-matched people without ET during a standard and more challenging water-carry TUG. Task-specific interference was evaluated by calculating motor and cognitive dual-task effects, whereas task prioritization was assessed by contrasting the cognitive dual-task effect with the motor dual-task effect. The simultaneous performance of two tasks did not differentially impact motor or cognitive performance in either group, and both groups prioritized cognitive task performance in standard and water-carry TUG assessments. This study enhances our understanding of motor-cognitive interactions in individuals with essential tremor. These insights could lead to patient-centered approaches to therapy to improve functional performance in dynamic daily environments.

Background & Purpose Concern about falling (CAF) is a prevalent issue in multiple sclerosis (MS) with negative implications for activity curtailment and mobility impairments. Importantly, this issue affects both individuals who have and have not fallen. The objective of this study was to determine the contribution of avoidance behavior to CAF-related mobility impairments. We hypothesized that the relationship between CAF and mobility deficits would be mediated by avoidance behavior, and that this relationship would be consistent across fallers and non-fallers. Methods To test this hypothesis, participants completed questionnaires regarding CAF, avoidance behavior, and self-reported walking impairment, as well as laboratory walking and balance assessments. Applied structural equation modeling tested a hypothesized mediation model in which the relationship between CAF and mobility impairments would be partially mediated by avoidance behavior. Within the model, self-reported walking impairment and performance on the walking and balance assessments were used to construct a mobility latent factor. The model was subsequently stratified by fallers and non-fallers to test whether this relationship was consistent across fall status. Results Participants included 52 individuals with MS, including 35 fallers and 17 non-fallers. 46.96% of the significant total effect of CAF on mobility was accounted for by avoidance behaviors. In the follow-up model, no significant differences were found between fallers and non-fallers, suggesting that the relationship among CAF, avoidance behavior, and mobility was consistent regardless of fall status. Discussion Our findings underscore the role of avoidance behavior in partially accounting for the effects of CAF on mobility deficits among persons with MS. Importantly, this effect was statistically equivalent across those who have and have not fallen, highlighting the pervasive impact of avoidance behavior on mobility impairments in MS.

BACKGROUND:Decreased gait speed is common in persons with Multiple Sclerosis (PwMS) and has been associated with elevated fall risk. The walking speed reserve (WSR) indicates the ability to increase gait speed on demand and has previously been examined in PwMS. Backward walking is a sensitive measure of fall risk in PwMS; however, no studies have reported on the utility of backward walking speed reserve (BW-WSR) as a clinical assessment tool of functional mobility or fall risk in PwMS, nor have they associated this measure with cognition.METHODS:23 PwMS completed walking trials at their preferred walking speed (PWS) and maximal walking speed (MWS). Participants performed these walking trials in both the forward (FW) and backward direction (BW). The forward walking speed reserve (FW-WSR) was calculated as the difference between MWS and PWS in the forward direction, while the backward walking speed reserve (BW-WSR) was calculated as the difference between MWS and PWS in the back backward direction. Correlation analyses examined the relationship between the FW- and BW-WSR with clinical assessments of functional mobility (the timed up-and-go) as well as cognitive functioning (the Symbol Digit Modalities Test, the Brief Visuospatial Memory Test-Revised, the California Verbal Learning Test, and the Trail Making Test A and B). Correlations also examined the relationship between FW- and BW-WSR with prospective falls.RESULTS:A lower BW-WSR was associated with disease severity and poorer performance on clinical walking and balance assessment, as well as with decreased information processing speed and attentional performance. Interestingly, FW-WSR showed similar relations. Neither FW- or BW-WSR were associated with prospective risk in this small sample of PwMS.CONCLUSION:The BW-WSR did not offer a distinct advantage over other measures, such as the FW-WSR, PWS, or MWS, in the forward or backward direction. The selection of the most sensitive clinical measures of functional mobility and fall risk is crucial; our study holds valuable clinical implications for PwMS by providing novel insights into functional mobility assessments in PwMS.

Purpose: Persons with multiple sclerosis (MS) experience changes in balance, such as poor and reactive stepping, as well as altered fall-related psychological factors, such as increased concern about falling and feared consequences about falling. Such concerns and fear may relate to and influence mobility. However, these relations are poorly understood in people with MS. This study aimed to investigate the relation between reactive stepping performance and fall-related psychological factors, as well as to assess how these relations differ between individuals who have and have not fallen. Methods: In a single session, participants completed measures regarding fall-related psychological factors (balance confidence, concern about falling, and feared consequences of falling) and completed reactive stepping tasks. Following the visit, participants completed weekly surveys for 3 months to report their falls. Spearman rho correlations were computed to examine associations between participants’ reactive stepping performance and their fall-related concerns, confidence, and consequences, with a stratified analysis to compare these associations between fallers and non-fallers. Results: 44 individuals with MS participated in our study, with 27 individuals experiencing 0 falls (non-fallers) and 17 individuals experiencing at least 1 fall (fallers) in the 3-month follow-up period. Better reactive stepping performance was correlated with fewer concerns, greater confidence, and lower feared consequences related to falling. The stratified analysis revealed a greater number of significant associations for non-fallers than fallers, although the small sample of fallers reduced our ability to detect a relationship in this group. Conclusions: Reactive stepping was associated with fall-related psychological factors. Interventions targeting reactive stepping may be beneficial in enhancing fall-related psychological well-being in the MS community.

Balance impairment and accidental falls are a pervasive challenge faced by persons with multiple sclerosis (PwMS), significantly impacting their quality of life. While exercise has proven to be an effective intervention for improving mobility and functioning in PwMS, current exercise approaches predominantly emphasize forward walking (FW) and balance training, with variable improvements in balance and fall rates. Backward walking (BW) has emerged as a promising intervention modality for enhancing mobility and strength outcomes; however, significant gaps remain. Specifically, there is limited knowledge about the efficacy of BW interventions on outcomes such as static, anticipatory, and reactive balance, balance confidence, falls, and cognition. This randomized controlled trial aims to determine the feasibility, acceptability, and impact of 8-weeks of backward walking training (TRAIN-BW) as compared to forward walking training (TRAIN-FW). Ninety individuals with MS with self-reported walking dysfunction or ≥ 2 falls in the past 6 months will be randomized in blocks, stratified by sex and disease severity to either the TRAIN-BW or TRAIN-FW intervention groups. Adherence and retention rates will be used to determine feasibility and the Client Satisfaction Questionnaire will be used to assess acceptability. The primary outcomes will be static, anticipatory, and reactive balance. Secondary outcomes include walking velocity, balance confidence, concern about falling, cognition, physical activity, and fall rates measured prospectively for 6 months after post-testing. Additionally, the extent to which cognitive functioning influences response to intervention will be examined. Backward walking training may be an innovative intervention to address balance impairments and falls in persons with MS.

Objective: To establish the inter- and intra-rater reliability of The Step Test Evaluation of Performance on Stairs (STEPS) for people with multiple sclerosis (PwMS) and examine its relation to clinical mobility measures, cognition, and activity levels. Design and Setting: STEPS performance was rated by 3 raters at the initial visit. Two raters observed the STEPS performance via videotape at the initial visit and then 1 week later. Participants also completed in lab clinical mobility tests and cognitive assessments at their initial visit. Activity levels were tracked for the subsequent 6 months. Participants: In total, 23 people with relapsing-remitting MS (N=23). Main Outcome Measure(s): Intraclass correlation coefficients (ICCs) were used to assess intra-rater and inter-rater reliability, while correlation analyses compared STEPS performance with cognition, clinical mobility assessments, and activity levels. The inter-rater reliability analysis among the 3 raters included scoring from only the initial evaluation. For the intra-rater reliability, 2 raters viewed and rated the videotaped session for each of the participants and then repeated the same process 1 week later. Results: Total STEPS scores demonstrated excellent agreement by ICC for inter- (ICC=0.97) and intra-rater reliability (ICC>0.95) and significant correlations with established clinical mobility assessments in PwMS. Better performance on STEPS was associated with information processing speed and prospective activity levels in PwMS. Conclusions: Stair ambulation is a challenging task, integral for mobility and independence, therefore, having a sensitive and valid reliable assessment of stair performance is critical for PwMS. The STEPS assessment is a quick, easily administered, reliable, and valid tool for assessing stair ambulation in PwMS. (c) 2024 by the American Congress of Rehabilitation Medicine.

Flexibility in performing various movements like standing, walking, and turning is crucial for navigating dynamic environments in daily life. Individuals with essential tremor often experience movement difficulties that can affect these postural transitions, limiting mobility and independence. Yet, little research has examined the performance of postural transitions in people with essential tremor. Therefore, we assessed postural transition performance using two versions of the timed up and go test: the standard version and a more complex water-carry version. We examined the total duration of the standard and water-carry timed up and go in 15 people with and 15 people without essential tremor. We also compared the time taken for each phase (sit-to-stand phase, straight-line walk phase, stand-to-sit phase) and the turning velocity between groups. Our findings revealed decreased performance across all phases of standard and water-carry timed up and go assessments. Further, both ET and non-ET groups exhibited reduced performance during the water-carry timed up and go compared to the standard timed up and go. Evaluating specific phases of the timed up and go offers valuable insights into functional movement performance in essential tremor, permitting more tailored therapeutic interventions to improve functional performance during activities of daily living.

As age increases, a decline in lower extremity strength leads to reduced mobility and increased fall risks. This decline outpaces the age-related reduction in muscle mass, resulting in mobility limitations. Older adults with varying degrees of mobility-disability use different stepping strategies. However, the link between functional lower extremity strength and stepping strategy is unknown. Therefore, understanding how age-related reductions in functional lower extremity strength influence stepping strategy is vital to unraveling mobility limitations. Participants were recruited and tested at a local community event, where they were outfitted with IMUs and walked across a pressurized walkway. Our study reveals that older adults with normal strength prefer adjusting their step time during walking tasks, while those with reduced strength do not exhibit a preferred stepping strategy. This study provides valuable insights into the influence of functional lower extremity strength on stepping strategy in community-dwelling older adults during simple and complex walking tasks. These findings could aid in diagnosing gait deviations and developing appropriate treatment or management plans for mobility disability in older adults.

BACKGROUND: People with ET exhibit an upper extremity action tremor, and surprisingly also display worse gait and balance performance, cognition, and sleep quality. To date, non-tremor symptoms, such as gait and sleep, are infrequently examined. Understanding the impact of sleep quality on walking and balance in people with ET will yield greater insight of modifiable factors of the disease. Purpose: The purpose of this study was to examine the relationship of sleep habits on anticipatory control, reactive postural control, sensory orientation and dynamic gait using the Mini Balance Evaluation Systems Test (miniBEST) in people with ET. METHODS: Participants (n = 7) were adults diagnosed with ET (age = 65, 4 females). Six Opal APDM sensors were placed on the participants’ ankles, wrists, sternum and lumbar. The miniBEST test was then administered to the participant. The miniBEST was used to measure anticipatory control, reactive postural control, sensory orientation and dynamic gait. Sleep efficiency (self-reported) was measured as minutes spent asleep divided by total minutes spent in bed. The total miniBEST and the subscores (anticipatory control, reactive postural control, sensory orientation, and dynamic gait) were correlated to sleep efficiency using Pearson’s correlations (alpha = 0.05). RESULTS: No relationships were significant between sleep efficiency and the miniBEST total or the subscores (Figure 1). CONCLUSION: Despite evidence of sleep impacting gait and balance in people without ET, our data suggest that there is no relationship between subscores and total of the miniBEST and sleep efficiency. More work is necessary to better understand non-tremor, non-upper extremity symptoms in people with ET to improve quality of life.

OBJECTIVE:To develop a multiple sclerosis (MS)-specific model of balance and examine differences between (1) MS and neurotypical controls and (2) people with MS (PwMS) with (MS-F) and without a fall history (MS-NF).DESIGN AND SETTING:A cross-sectional study was conducted at the Gait and Balance Laboratory at the University of Kansas Medical Center. Balance was measured from the instrumented sway system (ISway) assessment.PARTICIPANTS:In total, 118 people with relapsing-remitting MS (MS-F=39; MS-NF=79) and 46 age-matched neurotypical controls.INTERVENTION:Not applicable.OUTCOME MEASURES:A total of 22 sway measures obtained from the ISway were entered into an exploratory factor analysis to identify underlying balance domains. The model-derived balance domains were compared between (1) PwMS and age-matched, neurotypical controls and (2) MS-F and MS-NF.RESULTS:Three distinct balance domains were identified: (1) sway amplitude and velocity, (2) sway frequency and jerk mediolateral, and (3) sway frequency and jerk anteroposterior, explaining 81.66% of balance variance. PwMS exhibited worse performance (ie, greater amplitude and velocity of sway) in the sway velocity and amplitude domain compared to age-matched neurotypical controls (P=.003). MS-F also exhibited worse performance in the sway velocity and amplitude domain compared to MS-NF (P=.046). The anteroposterior and mediolateral sway frequency and jerk domains were not different between PwMS and neurotypical controls nor between MS-F and MS-NF.CONCLUSIONS:This study identified a 3-factor, MS-specific balance model, demonstrating that PwMS, particularly those with a fall history, exhibit disproportionate impairments in sway amplitude and velocity. Identifying postural stability outcomes and domains that are altered in PwMS and clinically relevant (eg, related to falls) would help isolate potential treatment targets.

IntroductionThe purpose of this study was to explore relationships between patient-specific characteristics and initial ankle-foot prosthesis prescription patterns among U.S. Service members with unilateral transtibial limb loss.MethodsA retrospective review of health records identified 174 individuals with unilateral transtibial limb loss who received care at Walter Reed National Military Medical Center between 2001 and 2019. We examined patient-specific factors such as demographics, participant duty status at injury and amputation, amputation etiology, and timing between injury, amputation, and initial prescription. The type of first prescribed ankle-foot prosthesis was categorized as energy storing and return - nonarticulating, energy storing and return - articulating, or computer controlled.ResultsSex, amputation etiology, time from injury to initial prescription, and time from amputation to initial prescription differed by type of initial ankle-foot prosthesis prescription. Service members with shorter intervals between injury-initial prescription and amputation-initial prescription, and those injured by combat blast, were more likely to receive a non-articulating device. Incorporating sex, time from injury-initial prescription, time from amputation-initial prescription, and amputation etiology as predictors of prosthesis type, we were able to correctly classify 72% of all first prostheses prescribed.DiscussionPatient-specific characteristics such as sex, the time between injury-initial prescription, time from amputation-initial prescription and amputation etiology are essential characteristics that influence initial ankle-foot prosthesis prescription patterns in U.S. Service members.

BACKGROUND:The maintenance of stability during walking is critical for successful locomotion. While targeted balance training can improve stability, it is unclear how simply meeting recommended physical activity guidelines may impact dynamic stability in healthy young adults.RESEARCH QUESTION:Examining the differences in the mediolateral margin of stability (ML-MOS) and the variability of the ML-MOS in physically active and inactive young adults across a range of stability-challenging walking tasks METHOD: Twenty-one physically active and twenty inactive young adults completed four experimental walking conditions: (1) Overground Walking, (2) Tandem Walking, (3) Beam Walking, and (4) Stepping-Stones. The ML-MOS and coefficient of variation of the ML-MOS were calculated at each heel strike while participants walked at their preferred walking speed. A two-way mixed-effects ANOVA was conducted to examine the effects of group and condition and their interaction on ML-MOS and ML-MOS variability RESULTS: Neither the ML-MOS nor the variability of the ML-MOS was significantly different between physically active and physically inactive young adults during any experimental walking conditions. A significant main effect of the experimental walking condition was observed, with the ML-MOS decreasing from overground walking to the tandem and beam walking conditions. The ML-MOS also became more variable in the tandem, beam, and stepping-stones conditions than in overground gait.SIGNIFICANCE:Physical activity status did not influence frontal plane dynamic balance in healthy young adults, even in stability-challenging environments. Conditions that constrain step width, such as tandem and beam walking, are adequate for challenging frontal plane dynamic balance and indicate that trunk kinematics may be adjusted when step width is constrained.

The primary purpose of this study was to examine how the type and magnitude of changes in running behavior, as a consequence of COVID-19 pandemic restrictions, influence running-related injuries. Secondarily, we aimed to examine how lifestyle and psychosocial well-being measures may influence running behavior change. An online survey was advertised to individuals over the age of 18 that currently run or have previously participated in running for exercise. The survey questions examined injury history and new injuries sustained during COVID-19 restrictions, as well as changes related to training behavior changes, training environment changes, social behaviors, and psychosocial well-being. Changes reflected differences in running behaviors prior to COVID-19 restrictions (1 month prior to COVID-19 restrictions being imposed) and during COVID-19 restrictions (May 5 to June 10, 2020). A total of 1,035 runners were included in the analysis. Current injuries sustained during COVID-19 occurred in 9.5% of the runners. Injured runners made a greater number of total changes ( p = 0.031) as well as training-related ( p = 0.042) and environment-related ( p = 0.017) changes compared with uninjured runners. A significant relationship was found between injury and those that reported less time to exercise to changes in work environment ( p = 0017). This study highlights the multi-dimensional nature of running-related injuries and the need to consider the interaction of multiple changes in running behavior, rather than isolating single factors. Greater understanding of the underlying causes of running-related injuries can help reduce the risk of future injury.

Split-belt treadmill walking allows researchers to understand how new gait patterns are acquired. Initially, the belts move at two different speeds, inducing asymmetric step lengths. As people adapt their gait on a split-belt treadmill, left and right step lengths become more symmetric over time. Upon returning to normal walking, step lengths become asymmetric in the opposite direction, indicating deadaptation. Then, upon re-exposure to the split belts, step length asymmetry is less than the asymmetry at the start of the initial exposure, indicating readaptation. Changes in step length symmetry are driven by changes in step timing and step position asymmetry. It is critical to understand what factors can promote step timing and position adaptation and therefore influence step length asymmetry. There is limited research regarding the role of visual feedback to improve gait adaptation. Using visual feedback to promote the adaptation of step timing or position may be useful of understanding temporal or spatial gait impairments. We measured gait adaptation, deadaptation, and readaptation in twenty-nine healthy young adults while they walked on a split-belt treadmill. One group received no feedback while adapting; one group received asymmetric real-time feedback about step timing while adapting; and the last group received asymmetric real-time feedback about step position while adapting. We measured step length difference (non-normalized asymmetry), step timing asymmetry, and step position asymmetry during adaptation, deadaptation, and readaptation on a split-belt treadmill. Regardless of feedback, participants adapted step length difference, indicating that walking with temporal or spatial visual feedback does not interfere with gait adaptation. Compared to the group that received no feedback, the group that received temporal feedback exhibited smaller early deadaptation step position asymmetry (p = 0.005). There was no effect of temporal or spatial feedback on step timing. The feedback groups adapted step timing and position similarly to walking without feedback. Future work should investigate whether asymmetric visual feedback also results in typical gait adaptation in populations with altered step timing or position control.

Gait and balance deficits are significant concerns for people with multiple sclerosis (MS). Shoe cushioning can influence mobility and balance, but its effect on walking and balance remains unknown in MS. This study aimed to determine how shoe cushioning affects gait and balance in females with MS (FwMS). We hypothesized that extra cushioning would improve gait but reduce balance performance. FwMS performed gait (n = 18) and balance (n = 17) assessments instrumented using inertial sensors in two different shoe conditions: a standard-cushioned and an extra-cushioned shoe. Care was taken to ensure minimal differences between shoe types other than midsole cushioning, but shoe construction was not identical between conditions. Spatiotemporal gait parameters were assessed during a 2-min walk test, while postural sway measures were evaluated using the modified Clinical Test of Sensory Interaction and Balance. In the extra-cushioned shoe, FwMS spent less time in the double support and stance phase with more time in the single support and swing phase. No differences in stride length, gait speed, or elevation at midswing were observed between shoe conditions. Decreased path length, RMS sway, and sway velocity were observed in the extra-cushioned shoe. No differences were observed in the gait cycle’s spatial composition between shoe conditions, but FwMS demonstrated improvements in the gait cycle’s temporal parameters and postural sway in the extra-cushioned shoe. This may suggest a less cautious walking strategy and improved balance when wearing a shoe with extra cushioning.

Most human movement research takes place within controlled laboratories where researchers observe participant movement. Because a majority of daily activity is performed without observation, we hypothesized movement within a laboratory would vary when there was a small, large or absence of research group. We also hypothesized that personality type would influence movement during observation. Participants completed a personality questionnaire, then walked in a laboratory during three different conditions: no research group (no researchers), small research group (2 researchers), and large research group (6–10 researchers). Results revealed spatiotemporal parameters were altered between conditions, however personality type did not influence changes in movement. As the number of researchers increased, gait speed, cadence, and stride length increased, and step duration decreased. Gait speed increased by .03 m/s from the no research group to the small research group, by .06 m/s from the no research group to the large research group, and by .03 m/s from the small to large research group (all p values < .001). Understanding how researcher observation modifies movement is important and affects the replicability of results, as well as the interpretation of laboratory-based movement studies to activities of daily living in real world settings.

Kalron et al. (Kalron A, Allali G, Achiron A. J Neurol 265: 809-816, 2018.) report that people with multiple sclerosis (PwMS) who fall show a decreased cerebellar volume along with decreased overall cognition compared with nonfallers. While their paper focuses on cerebellar and cognitive alterations in PwMS, these findings may also be explained by additional factors such as aging and have the potential for broader impact in additional clinical populations who simultaneously experience cognitive and mobility dysfunction.