Effects of dual tasking on the postural performance of people with and without multiple sclerosis: a pilot study

People with multiple sclerosis (MS) exhibit both cognitive and postural impairments. This study examined the effects of MS and of dual tasking on postural performance, and explored associations among dual-task postural performance, cognitive capacity, fear of falling, and fatigue. Thirteen subjects with MS (Expanded Disability Status Scale: 0-4.5) and 13 matched subjects without MS performed three tasks of standing postural control, with and without dual tasking amid an auditory Stroop task: (1) step initiation, (2) forward leaning to the limits of stability, and (3) postural responses to rotations of the support surface. Two-factor general linear models were used to evaluate differences between the groups (with or without MS) and two conditions (single or dual tasking) for each postural task. During step initiation, dual tasking significantly delayed the onset of the anticipatory postural adjustment (APA) more for the subjects with MS than for those without MS, and step lengths increased for the subjects with MS but decreased for those without MS. No other significant group-by-condition interactions were evident on the recorded variables of stepping, leaning, postural responses, or Stroop-response accuracies and latencies. The scores for the subjects with MS on the Modified Fatigue Impact Scale significantly associated with the change between single-task to dual-task conditions in APA onset and foot-lift onset during step initiation as well as in lean position variability and lean onset times during forward leaning. The results suggest dual-task effects were more evident during step initiation and are associated with levels of fatigue for subjects with MS.