Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in single- and dual-task conditions in persons with MS to age- and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports. Methods. All measures were collected in a single session. A 2×2×2 mixed model ANOVA was used to compare differences in forward and backward walking in single- and dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance. Results. Eighteen individuals with relapsing-remitting MS and 14 age- and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task (p=0.015) and dual-task (p=0.014) conditions. Persons with MS demonstrated significant differences between single- and dual-task forward and backward walking velocities (p=0.023; p=0.004), whereas this difference was only apparent in the backward walking condition for healthy controls (p=0.004). In persons with MS, there were significant differences in double support time between single- and dual-task conditions in both backward (p<0.001) and forward (p=0.001) directions. More falls at six months were significantly associated with shorter backward dual-task stride length (r=−0.490; p=0.046) and slower velocity (r=−0.483; p=0.050). Conclusion. Differences in MS and age- and sex-matched healthy controls are more pronounced during backward compared to forward walking under single- and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.
Objectives
The American College of Emergency Physicians (ACEP) Geriatric Emergency Department (ED) guidelines and the Center for Disease Control (CDC) recommend that older adults be assessed for risk of falls. The standard ED assessment is a verbal query of fall risk factors, which may be inadequate. We hypothesized that the addition of a functional balance test endorsed by the CDC STEADI falls prevention guidelines, the 4 Stage Balance Test (4SBT), would improve the detection of patients at risk for falls.
Methods
Prospective pilot study of a convenience sample of ambulatory adults ≥65 years old in the ED. All participants received the standard nursing triage fall risk assessment. After patients were stabilized in their ED room, the 4SBT was administered.
Results
The 58 participants had an average age of 74.1 years (range 65–94), 40.0% were women, and 98% were community dwelling. Five (8.6%) presented to the ED for a fall-related chief complaint. The nursing triage screen identified 39.7% (n=23) as at risk for falls, while the 4SBT identified 43% (n=25). Combining triage questions with the 4SBT identified 60.3% (n=35) as high risk for falls as compared to 39.7% (n=23) with triage questions alone (p<0.01). Ten (17%) of the patients at high risk by 4SBT and missed by triage questions were in patients unaware that they were at risk for falls (new diagnoses).
Conclusions
Incorporating a quick functional test of balance into the ED assessment for fall risk is feasible, and significantly increases the detection of older adults at risk for falls.
Background.-Despite the prevalence of dual-task (e.g., walking while talking) deficits in people with multiple sclerosis (MS), no neuroimaging studies to date have examined neuronal networks used for dual-task processing or specific brain areas related to dual-task performance in this population. A better understanding of the relationship among underlying brain areas and dualtask performance may improve targeted rehabilitation programs. The objective of this study was to examine relationships between neuroimaging measures and clinical measures of dual-task performance, and reported falls in persons with MS. Materials and methods.-All participants completed measures of dual-task performance, a fall history, and neuroimaging on a 3T MRI scanner. Spearman correlations were used to examine relationships among dual-task performance, falls and neuroimaging measures. Results.-Eighteen females with relapsing-remitting MS [mean age= 45.5 ± 8.2 SD; mean symptom duration = 12.3±6.7 years; Expanded Disability Status Scale median 2.25 (range 1.5-4)] participated in this study. Structural imaging measures of supplementary motor area (SMA) interhemispheric connectivity were significantly related to dual-task walking variability. Conclusions.-The SMA interhemispheric tract may play a role in dual-task performance. Structural neuroimaging may be a useful adjunct to clinical measures to predict performance and provide information about recovery patterns in MS. Functional recovery can be challenging to *
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