Preliminary investigation of gait initiation and falls in multiple sclerosis.

OBJECTIVE

To examine the relationship between gait initiation, fall history, and physiological fall risk in individuals with multiple sclerosis (MS) during both cognitive distracting and nondistracting conditions.

DESIGN

Single time point cross-sectional analysis.

SETTING

University research laboratory.

PARTICIPANTS

Ambulatory individuals (N=20) with MS ranging in age from 28 to 76 years.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Gait initiation time was quantified as the time to toe-off of the first step after an auditory cue. Gait initiation was performed with and without a concurrent cognitive challenge of reciting alternating letters of the alphabet. Additionally, participants underwent a test of fall risk using the Physiological Profile Assessment (PPA) and provided a self-report of the number of falls in the previous 3 months.

RESULTS

Gait initiation times ranged from .67 to 1.12 seconds during the single-task condition and .73 to 1.84 seconds during the cognitive challenge condition. PPA scores ranged from -.80 to 3.87. Participants reported a median of 0.0 falls (interquartile range, 0.0-2.75) in the previous 3 months. There was a significant correlation between PPA score and gait initiation times only in the cognitive distraction condition (ρ=.50). There was also a correlation between cognitive distraction gait initiation times and fall history (ρ=.60).

CONCLUSIONS

The observations provide preliminary evidence that gait initiation during cognitive challenge may represent a target for fall prevention strategies in MS.