College of Health Solutions, Arizona State University, Phoenix, Arizona, USA.
KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
Phys Ther. 2022 Jun 3;102(6). doi: 10.1093/ptj/pzac041.
Reactive stepping is critical for preventing falls and is impaired in people with multiple sclerosis (PwMS); however, which aspects of stepping relate to falls remains poorly understood. Identifying outcomes most related to falls is a first step toward improving rehabilitation for fall prevention. The purpose of this study was to assess whether reactive step latency or length during forward and backward losses of balance were related to a history of falls in PwMS.
Of the 111 PwMS who participated in this study, 76 reported no falls in the previous 6 months, whereas 36 reported 1 or more falls. Participants completed 3 forward and 3 backward treadmill-induced reactive steps from stance. Step length (centimeters) and step latency (milliseconds) were measured using motion capture and analyzed via MATLAB.
Participants with a history of falls had significantly slower step latencies during backward stepping, but not forward stepping, than those without a history of falls. Step length did not differ between groups. Slower step latencies during backward stepping significantly increased the odds of having experienced a fall (β = .908, SE = 0.403, odds ratio = 2.479, 95% CI = 1.125 to 5.464).
PwMS and a history of falling show delayed step onsets during backward reactive stepping. Specifically, for every 10-millisecond increase in step latency, PwMS were 2.5 times more likely to have a fall history. Although clinical trials are necessary to determine whether interventions targeting reactive stepping reduce falls in PwMS, the current work indicates that the latency of steps may be a relevant target for this work.
Subsequent fall prevention clinical trials should consider targeting backward reactive step latency to further assess its relevance for rehabilitation in PwMS.
If you have MS and a history of falls, you may be more likely to have delayed reactive step latencies.
反应性跨步对于防止跌倒至关重要，多发性硬化症（MS）患者的反应性跨步能力受损；然而，与跌倒相关的跨步的哪些方面仍知之甚少。确定与跌倒最相关的结果是改善跌倒预防康复的第一步。本研究的目的是评估向前和向后失去平衡时的反应性跨步潜伏期或长度是否与 MS 患者的跌倒史有关。
在参与本研究的 111 名 MS 患者中，有 76 名报告在过去 6 个月内没有跌倒，而有 36 名报告有 1 次或多次跌倒。参与者从站立位完成 3 次向前和 3 次向后跑步机诱发的反应性跨步。使用运动捕捉测量步长（厘米）和步长潜伏期（毫秒），并通过 MATLAB 进行分析。
有跌倒史的参与者在向后跨步时的步潜伏期明显慢于无跌倒史的参与者，而向前跨步时则不然。组间步长无差异。向后跨步时较慢的步潜伏期显著增加了跌倒经历的几率（β=0.908，SE=0.403，优势比=2.479，95%置信区间=1.125 至 5.464）。
MS 患者和跌倒史患者在向后反应性跨步时显示出延迟的步起始。具体来说，步潜伏期每增加 10 毫秒，MS 患者跌倒史的几率就增加 2.5 倍。尽管需要进行临床试验来确定针对反应性跨步的干预措施是否可以减少 MS 患者的跌倒，但目前的工作表明，跨步潜伏期可能是该工作的一个相关目标。
随后的跌倒预防临床试验应考虑针对向后反应性步潜伏期进行治疗，以进一步评估其在 MS 患者康复中的相关性。
如果您患有多发性硬化症并且有跌倒史，您可能更有可能出现延迟的反应性步潜伏期。
