Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS

Abstract

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.

System Comparison for Gait and Balance Monitoring Used for the Evaluation of a Home-Based Training

“…Similarly, stride time and cadence values during backward gait were comparable between the literature [45] and between all three gait analysis systems. However, in our study, velocity values were 20-60% lower during backward gait compared to the literature ( [45,46] measured on force plates). For step width, force plate values during backward gait were in line with the literature [45], whereas the mocap system values were lower (~29%), which is likely related to the calibration, as mentioned in Section 4.1.…”

Motor Cognitive Dual-Task Testing to Predict Future Falls in Multiple Sclerosis: A Systematic Review

“…Furthermore, dual-task obstacle crossing is ecologically valid and has been associated with fall risk in PwMS. 48 Also, dual-task backward walking was more sensitive than dual-task forward walking in detecting fallers with MS. 29 In this later study, fall was measured retrospectively at 6 months, highlighting the potential of including dual-task backward walking in fall risk assessments. 29 Still, it must be noted that backward walking is rarely completed in the real-world and may not be ecologically valid.…”

“…48 Also, dual-task backward walking was more sensitive than dual-task forward walking in detecting fallers with MS. 29 In this later study, fall was measured retrospectively at 6 months, highlighting the potential of including dual-task backward walking in fall risk assessments. 29 Still, it must be noted that backward walking is rarely completed in the real-world and may not be ecologically valid. Therefore, more studies analyzing the associations between dual-task backward walking and prospective falls are needed to confirm this observed relationship.…”

“…While Wajda et al 25 used the Physiological Profile Assessment (PPA) to estimate fall risk, other studies utilized retrospective or prospective fall status in their analyses. 27,29 Also, the reviews by Rooney et al 24 and Postigo-Alonso et al 30 highlighting inconsistent associations between dual-task and falls included studies that evaluated falls prospectively and retrospectively. However, it is well-known that retrospective fall reporting is subject to recall bias and has been shown to be inaccurate to determine fall status of PwMS.…”

Prefrontal hemodynamics during forward and backward walking, with and without a cognitive task, in people with MS: An fNIRS study

“…30 Furthermore, pwMS, when administered with a cognitive DT, display more prominent deficits during backward walking than during normal walking. 31,32 A question of interest is whether ST forward walking and ST backward walking require different neural activity at the PFC. Moreover, the effect of a concurrent cognitive DT during backward walking on the neural activity in the PFC, is unknown.…”