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MS research update – Variations in walking pattern increase the risk of falling in MS – 8 February 2016

Summary

This study aimed to see if there was a relationship between walking variations and the risk of falls in people with MS.

17 people with MS and 17 age matched adults without MS took part in the study. All were aged between 50 and 75 years old. They were assessed in several ways, including several tests to determine their risk of falling and walking tests with sensors attached to their legs.

The study found that the participants with MS had a significantly higher fall risk and this was related to changes and variations in the way they walked. The results also suggested these changes in the way someone walked were related to increased postural sway, that is to say they had to adjust more to keep their balance and remain upright.

The researchers suggest that these variations in walking and swaying could be targets for rehabilitation interventions that could help people with MS work on these areas and help reduce the risk of falls.

Background

Once we learn to walk as a small child, walking becomes an automatic function, so we no longer need to consciously think about each step we are taking. However as lots of actions need to be coordinated with each step to occur, such as touch and knowing where your feet are in relation to other things around you, walking can be affected by something going wrong with any one of these actions.

There is evidence that MS can affect the speed of walking, how big steps are, step time (the time between the first foot hitting the floor to the other foot hitting the floor) and also the natural fluctuations between steps when walking (also referred to as gait variability).

This study aimed to see if there was a relationship between walking variations and the risk of falls in people with MS.

How this study was carried out

17 people with MS and 17 age matched adults without MS took part in the study. All were aged between 50 and 75 years old and able to walk for six minutes, with or without a walking aid. To be included the participants with MS needed to have had a fall in the preceding 12 months.

Each participant provided information about their health history and any falls they had in the last three months.

The researchers performed an assessment to determine participants falls risk, using the physiological profile assessment (PPA). This is a standardised test that involves several assessments of:

  • vision
  • reaction times
  • proprioception – which is the unconscious perception of movement and where you are in space and in relation to other things
  • strength of the quadriceps – which are the muscles at the front of the thigh which are crucial for the action of walking
  • postural sway – which is the amount of movement required to retain balance and remain upright, which makes you sway slightly as you constantly adjust your position and weight.

The outcome of each test is then combined to give a score. Below −1 is considered a very low risk for falling, a score between 0 and 1 is a mild risk for falling, and a score of 1 and above is considered a moderate to marked risk for falling.

Participants walking was tested using motion trackers attached to their legs to pick up movement and the 6-minute walk test (6MWT). In the walking test participants were instructed to walk as fast as possible to cover as much distance as possible in the six minutes in a hallway that was 21 metres long.

What was found

The study found that nine out of the 17 participants with MS had two or more falls in the previous three months, while none in the control group had fallen in the same period. The participants with MS also walked slower and covered less distance in the six minute walk than the control participants.

The participants with MS also had a significantly higher fall risk and this was related to changes and variations in the way they walked. The way the participants with MS walked was more variable between steps, rather than having a constant timing and pattern.  The results also suggested these changes in the way someone walked were related to increased postural sway, that is to say they had to adjust more to keep their balance and remain upright.

What does it mean?

The results show that variations in walking and swaying are related to the risk of falling in people with MS. The researchers suggest that these therefore could be targets for rehabilitation that could help people with MS work on these areas, make their walking more consistent and help reduce the risk of falls.

The study had strengths such as measuring walking over a longer distance, so the participants could get into their walking rhythm, other studies have used shorter walking areas which means the participants have to turn around more often which can be disruptive. Although the authors do highlight that the study has several limitations including the small size of the groups involved and not investigating the effect of others factors that might also affect the risk of falls, such as medications (this was covered in another recent research update) and other MS symptoms that may affect walking and balance.

Moon Y, Wajda DA, Motl RW, Sosnoff JJ.
Stride-time variability and fall risk in persons with multiple sclerosis.
Mult Scler Int. 2015;2015:964790. doi: 10.1155/2015/964790. Epub 2015 Dec 30.
Abstract
Read the full text of this paper

More about walking difficulties, falls and rehabilitation

Many people with MS have some difficulties with walking but walking problems vary considerably from one person with MS to another. Common difficulties include: unsteadiness on walking or turning, tripping, stumbling, weakness of the leg when weight is on it and difficulty placing the foot on the ground. Other MS symptoms can also make walking more difficult, such as vision problemsbalance problems and pain. Having trouble walking can mean people with MS are more vulnerable to tripping and falling. It can also use up more energy and people may alter how they walk to try and compensate for the difficulty they are having. This alteration in walking can result in bad posture which can lead to pain and strains.

If you are experiencing walking difficulties, you can speak to your MS nurse or GP who may refer you to physiotherapy services. The best way forward depends on what is causing the difficulties. Treatment may involve physiotherapy or drug treatments to alleviate specific underlying symptoms such as spasticity or pain.

If you are concerned about falls, you might like to read Falls: managing the ups and downs of MS, which gives tips and suggestions for reducing the risks of falling. This can be read online, downloaded as a pdf or ordered as a printed version.

Rehabilitation

Rehabilitation involves helping an individual achieve their personal goals. Rehabilitation professionals, including nurses, rehabilitation consultants, physiotherapists and occupational therapists can help someone work out ways of dealing with some of the common problems MS can cause and support them to draw up practical goals for living the way they want to. This might mean finding solutions to difficulties at home or work, such as walking difficultiesmemory problemsfatigue or pain. However as rehabilitation services, often shorted to 'rehab', involve several different types of health professional, there are many more things that rehab can help with.

You can read more about rehabilitation in MS in the May 2014 issue of our newsletter Open Door which had a special feature on the subject, talking to professionals working in the area explaining how the can help and also people with MS describing their experiences of rehab. You can read an online version of the full issue or read the rehab section online to learn more.

MS rehab services do vary depending on where you live. If you have an MS nurse, they are often the best people to ask what's available locally. If you have an MS therapy centre near you they might also be able to help you find a physiotherapist or other rehab professionals. You might need a referral from your GP to access some of these services.

You can use our online map to find MS health professionals and services near you.

Research by topic areas...

Assessment tools

Schiavolin S, Giovannetti AM, Leonardi M, et al.
Multiple Sclerosis Questionnaire for Job Difficulties (MSQ-Job): definition of the cut-off score.
Neurol Sci. 2016 Feb 3. [Epub ahead of print]
Abstract

Co-existing conditions

Marck CH, Neate SL, Taylor KL, et al.
Prevalence of comorbidities, overweight and obesity in an international sample of people with multiple sclerosis and associations with modifiable lifestyle factors.
PLoS One. 2016;11(2):e0148573.
Abstract
Read the full text of this paper

Disease modifying drugs

Lublin F, Miller DH, Freedman MS, et al.
Oral fingolimod in primary progressive multiple sclerosis (INFORMS): a phase 3, randomised, double-blind, placebo-controlled trial.
Lancet. 2016 Jan 27. [Epub ahead of print]
Abstract

Drugs in development

Lin YC, Winokur P, Blake A, et al.
Patients with MS under daclizumab therapy mount normal immune responses to influenza vaccination.
Neurol Neuroimmunol Neuroinflamm. 2016 Feb;3(1):e196.
Abstract

Cortese I, Ohayon J, Fenton K, et al.
Cutaneous adverse events in multiple sclerosis patients treated with daclizumab.
Neurology. 2016 Feb 3. [Epub ahead of print]
Abstract

Falls

Allali G, Laidet M, Herrmann FR, et al.
Gait variability in multiple sclerosis: a better falls predictor than EDSS in patients with low disability.
J Neural Transm (Vienna). 2016 Feb 4. [Epub ahead of print]
Abstract

Physical activity

Cleland BT, Ingraham BA, Pitluck MC, et al.
Reliability and validity of ratings of perceived exertion in persons with multiple sclerosis.
Arch Phys Med Rehabil. 2016 Jan 30. [Epub ahead of print]
Abstract

Ensari I EdM, Sandroff BM PhD, Motl RW PhD.
Intensity of treadmill walking exercise on acute mood symptoms in persons with multiple sclerosis.
Anxiety Stress Coping. 2016 Feb 1:1-29. [Epub ahead of print]
Abstract
Read the full text of this paper (pdf)

Prognosis

Lawton M, Tilling K, Robertson N, et al.
A longitudinal model for disease progression was developed and applied to multiple sclerosis.
J Clin Epidemiol. 2015 Nov;68(11):1355-65.
Abstract
Read the full text of this paper

Psychological aspects

Kolahkaj B, Zargar F.
Effect of mindfulness-based stress reduction on anxiety, depression and stress in women with multiple sclerosis.
Nurs Midwifery Stud. 2015 Dec;4(4):e29655.
Abstract
Read the full text of this paper

Quality of life

Hughes AJ, Hartoonian N, Parmenter B, et al.
Cognitive impairment and community integration outcomes in individuals living with multiple sclerosis.
Arch Phys Med Rehabil. 2015 Nov;96(11):1973-9.
Abstract

Relapses

Šabanagić-Hajrić S, Suljić E, Sulejmanpašić-Arslanagić G.
Depression during multiple sclerosis relapse: relation to disability and relapse severity.
Med Glas (Zenica). 2016 Feb 1;13(1):44-9.
Abstract
Read the full text of this paper (pdf)

Self-management

Storoni M, Plant GT.
The therapeutic potential of the ketogenic diet in treating progressive multiple sclerosis.
Mult Scler Int. 2015;2015:681289.
Abstract
Read the full text of this paper

Ehde DM, Elzea JL, Verrall AM, et al.
Efficacy of a telephone-delivered self-management intervention for persons with multiple sclerosis: a randomized controlled trial with a one-year follow-up.
Arch Phys Med Rehabil. 2015 Nov;96(11):1945-58.e2.
Abstract
Read the full text of this paper

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