A Preliminary Investigation of the Effects of Obstacle Negotiation and Turning on Gait Variability in Adults with Multiple Sclerosis

Abstract

Many falls in persons with multiple sclerosis (PwMS) occur during daily activities such as negotiating obstacles or changing direction. While increased gait variability is a robust biomarker of fall risk in PwMS, gait variability in more ecologically related tasks is unclear. Here, the effects of turning and negotiating an obstacle on gait variability in PwMS were investigated. PwMS and matched healthy controls were instrumented with inertial measurement units on the feet, lumbar, and torso. Subjects completed a walk and turn (WT) with and without an obstacle crossing (OW). Each task was partitioned into pre-turn, post-turn, pre-obstacle, and post-obstacle phases for analysis. Spatial and temporal gait measures and measures of trunk rotation were captured for each phase of each task. In the WT condition, PwMS demonstrated significantly more variability in lumbar and trunk yaw range of motion and rate, lateral foot deviation, cadence, and step time after turning than before. In the OW condition, PwMS demonstrated significantly more variability in both spatial and temporal gait parameters in obstacle approach after turning compared to before turning. No significant differences in gait variability were observed after negotiating an obstacle, regardless of turning or not. Results suggest that the context of gait variability measurement is important. The increased number of variables impacted from turning and the influence of turning on obstacle negotiation suggest that varying tasks must be considered together rather than in isolation to obtain an informed understanding of gait variability that more closely resembles everyday walking.

Open-source dataset reveals relationship between walking bout duration and fall risk classification performance in persons with multiple sclerosis

“…The reason for this change in gait is unknown, however, it can be speculated that shorter walking bouts may elicit more goal-direction actions towards activities other than walking while longer bouts are more purposeful [ 54 ]. Further expanding on the involuntary nature of shorter walking bouts, subjects may be more likely to be dual-task walking, in other words focused on more than just walking, and may be more impacted by the start-up and stopping strides [ 63 ]. This conjecture aligns with research on dual-task walking in PwMS that shows dual-task walking is more discriminative of impairment than single task walking [ 64 ].…”

Multiple Sclerosis in the Digital Health Age: Challenges and Opportunities - A Systematic Review

“…Such indices include normalized velocity, stride length and hip range motion 67 . PwMS demonstrated a higher variability in their lumbar yaw range and lateral food deviation, particularly after turning and stepping over an object 68 . Similar to this finding, another study found more asymmetrical sway patterns when comparing PwMS with HC 69 .…”

“…When conducting this extensive review, we found out that the vast majority of the studies used walking tasks to collect and analyse IMU and other motion-capture-based data [67][68][69][70][71][72][73] to assess gait and balance issues in PwMS. Overall, motion capture devices have revealed significant correlations between gait indices and subjective and objective walking abilities.…”

Advancing Digital Medicine with Wearables in the Wild

“…One leverages temperature measurements to provide accurate differentiation between non-wear time, sleep time, and sedentary wake time [16]. The other demonstrates the importance of context in interpreting gait variability measures in persons with multiple sclerosis [17].…”