Gait initiation in multiple sclerosis

Individuals with multiple sclerosis (MS) often have poor balance control that is especially apparent during dynamic tasks such as gait initiation (GI). The purpose of this study was to investigate how balance symptoms due to MS alter spatiotemporal variables, coordination, and temporal margins within the stability boundary during gait initiation. Twelve women with MS (Expanded Disability Status Scale [EDSS] mean = 4.0, SD = 1.4) and 12 women without MS (control group) initiated gait at their preferred speed. MS participants attained a slower anterior velocity because of smaller anterior center of mass displacements and took longer to complete the initiation of gait than the control group. MS participants exhibited a smaller posterior shift in center of pressure during GI and stepped with a longer dual support time than the control group. However, these changes may be due to differences in initiation velocity. Relative timing analysis showed invariance in postural and locomotor phases of gait initiation between groups. The MS group showed different coordination between anterior-posterior and medio-lateral center of pressure components while increasing temporal margins to the posterior and lateral stability boundaries in comparison with the control group. Overall, during gait initiation at their preferred speed the MS participants adopted a functional strategy that produces lower speed and reduced proximity to the stability boundaries prior to stepping.