Brown Diané, Yang Feng
Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA.
Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA.
Mult Scler Relat Disord. 2025 Sep;101:106587. doi: 10.1016/j.msard.2025.106587. Epub 2025 Jun 14.
Falls are common and detrimental in people with multiple sclerosis (PwMS). It is essential to identify fall risk factors to prevent PwMS from falling. Perturbation training has shown promise in reducing falls. However, whether all PwMS can learn fall-resistant skills from perturbation training remains unknown. This study identified the determinants leading PwMS to a fall on the first standing-slip and allowing them to adapt to repeated standing-slips.
Twenty-six PwMS (median Patient-Determined Disability Steps [PDDS]: 1.50) experienced five unexpected treadmill standing-slips. Two sets of comparisons were conducted regarding demographics, gait speed, PDDS, knee strength, and cognition (assessed by the Blessed-Orientation Memory Concentration test): between fallers and non-fallers on the first slip and between responders (those who fell on the initial slip but did not on later slips) and non-responders (those who fell on all five slips).
There were 17 fallers and nine non-fallers on the first slip. Among 17 fallers, nine were classified as responders and eight as non-responders. Non-fallers showed lower PDDS, faster gait speeds, and stronger knee strengths than fallers. Responders were younger, less disabled, walked faster, and had slightly better cognitive function.
Disability level, walking speed, and leg strength may be key fall determinants upon the novel standing-slip. Not all PwMS could quickly adapt to repeated standing-slips. The motor learning ability from perturbation training depends on age, disability level, gait speed, and cognition level. Our findings could provide valuable information for screening PwMS at high fall risk and implementing perturbation training for this population.
跌倒在多发性硬化症患者（PwMS）中很常见且有害。识别跌倒风险因素对于预防PwMS跌倒至关重要。扰动训练在减少跌倒方面已显示出前景。然而，是否所有PwMS都能从扰动训练中学习抗跌倒技能仍不清楚。本研究确定了导致PwMS在首次站立滑倒时跌倒并使其适应反复站立滑倒的决定因素。
26名PwMS（患者确定的残疾步幅[PDDS]中位数：1.50）经历了五次意外的跑步机站立滑倒。就人口统计学、步态速度、PDDS、膝关节力量和认知（通过Blessed定向记忆浓度测试评估）进行了两组比较：首次滑倒时跌倒者与未跌倒者之间，以及反应者（在初始滑倒时跌倒但在后续滑倒时未跌倒者）与无反应者（在所有五次滑倒时都跌倒者）之间。
首次滑倒时有17名跌倒者和9名未跌倒者。在17名跌倒者中，9名被归类为反应者，8名被归类为无反应者。未跌倒者的PDDS较低，步态速度较快，膝关节力量比跌倒者更强。反应者更年轻，残疾程度更低，行走速度更快，认知功能略好。
残疾程度、步行速度和腿部力量可能是新型站立滑倒时跌倒的关键决定因素。并非所有PwMS都能迅速适应反复站立滑倒。扰动训练的运动学习能力取决于年龄、残疾程度、步态速度和认知水平。我们的研究结果可为筛查跌倒风险高的PwMS以及对该人群实施扰动训练提供有价值的信息。
