TRAIN-BW: Backward Walking Training in Multiple Sclerosis

N/AActive Not RecruitingNCT04091464

Wayne State University90 enrolled

Overview

Individuals with multiple sclerosis (MS) experience in impairments in mobility and cognition that increase the risk for accidental falls. More than 50% of individuals with MS experience injurious falls within a 6-month period. Current interventions to improve fall risk have focused on forward walking (FW) and balance training, resulting in small declines in the relative risk for falls with a large degree of variability. Interestingly, motor differences between MS and healthy controls are more pronounced in backward walking (BW), yet no studies have investigated BW training as an intervention to reduce fall risk in persons with MS. This study will investigate the feasibility, acceptability and impact of BW training compared to forward walking training on motor function and fall risk in persons with MS.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Multiple Sclerosis Gait Disorders, Neurologic Accidental Fall

Backward Walking TrainingBEHAVIORAL

Training will consist of BW training on both a treadmill and overground. All participants will receive 1x/week training with a trained member of the research team, who will progress the participant week-to-week and ensure safety. Treadmill speed will be determined by baseline BW walking speed and incrementally increased with each training week to subject tolerance. Participants will follow a home exercise program for the remainder of the week that includes BW, backward stepping, and functional exercises that incorporate BW movements.

Forward Walking TrainingBEHAVIORAL

Training will consist of FW training on both treadmill and overground. All participants will receive 1x/week training with a trained member of the research team, who will progress the participant week-to-week and ensure safety. Treadmill speed will be determined by baseline FW walking speed and incrementally increased with each training week to subject tolerance. Participants will follow a home exercise program for the remainder of the week that includes FW, forward stepping, and functional exercises that incorporate FW movements.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Diagnosis of MS * PDDS \<6, indicating ability to ambulate with or without an assistive device \>/= 50% of the time * Self-reported walking dysfunction as evidenced by a score of \>/= 30 on MSWS-12 OR reports of 2 or more falls in the prior 6 months, indicating a frequent faller. Exclusion Criteria: * MS relapse within the past 30 days * comorbid neurological disorder * acute orthopedic disorder/injury * unable to follow study-related commands

Outcomes

Primary Outcomes

Sway during quiet stance

Measured with APDM Sensors

Time frame: Change in sway at 8 weeks

Stepping latency on push-and-release test

Measured with APDM Sensors

Time frame: Change in stepping latency at 8 weeks

Secondary Outcomes

Client Satisfaction Questionnaire (CSQ-8)

Scores range from 8-32, with high scores indicating greater satisfaction with the intervention

Time frame: 8 weeks

Patient Global Impression of Change

Perceived Treatment Effect; scores range from 1-7 with higher scores indicating greater perception of improvement related to the intervention.

Time frame: 8 weeks

Number of Active Minutes

Measured with Accelerometry, passively collected for a 1 week period prior to the intervention and again after the intervention concludes 8 weeks later.

Time frame: Change in Physical Activity measures at 8 weeks

Number of Falls

Number of falls reported in 6 month period after the intervention ends

Time frame: 6 months

Forward and Backward Velocity and Double Support Time

Walking speed and double support time (spatiotemporal measures of gait)

Time frame: Change in velocity and double support time at 8 weeks

ABC Scale

Balance confidence

Time frame: Change in balance confidence at 8 weeks