- •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.
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)
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.
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
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
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.
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Published online: August 16, 2021
Accepted: August 14, 2021
Received in revised form: June 14, 2021
Received: February 13, 2020
*We would like to gratefully acknowledge Sydney Y. Schaefer, PhD for her contributions in editing the manuscript.
Published by Elsevier B.V.