Highlights
- •People with MS may generalize improvements in protective steps across balance tasks.
- •Mediation analyses may be a unique approach to assess generalization via rehabilitation.
- •Generalization of protective stepping supports further study of step training in MS.
Abstract
Objective
To determine whether improvements in protective stepping experienced after repeated
support surface translations generalize to a different balance challenge in people
with multiple sclerosis (PwMS)
Background
MS affects almost 1 million people in the United States and impairs balance and mobility.
Perturbation practice can improve aspects of protective stepping in PwMS, but whether
these improvements generalize is unknown.
Methods
Fourteen PwMS completed two visits, 24hrs apart. The balance tasks included tether-release
trials and support surface translations on a treadmill eliciting backward protective
stepping. Margin of stability, step length, and step latency were calculated. Generalization
was assessed via multilevel mediation models (MLMM) with bootstrapping to produce
percentile and bias corrected confidence intervals
Results
There were no mediated effects for margin of stability or step latency; however, mediation
was observed for step length, indicating that participants increased step length throughout
the treadmill trials, and this generalized to tether-release trials
Discussion
MLMM may be useful for evaluating generalization of motor training to novel balance
situations, particularly in small sample sizes. Using these analyses, we observed
PwMS generalized improvements in step length, suggesting that aspects of protective
step training may translate to improvements in other reactive balance tasks in PwMS.
Keywords
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Article info
Publication history
Published online: August 16, 2021
Accepted:
August 14,
2021
Received in revised form:
June 14,
2021
Received:
February 13,
2020
Footnotes
*We would like to gratefully acknowledge Sydney Y. Schaefer, PhD for her contributions in editing the manuscript.
Identification
Copyright
Published by Elsevier B.V.
