Associating white matter microstructural integrity and improvements in reactive stepping in people with Parkinson's Disease.

Reactive steps are rapid responses after balance challenges. People with Parkinson's Disease (PwPD) demonstrate impaired reactive stepping, increasing fall-risk. Although PwPD can improve steps through practice, the neural mechanisms contributing to improved reactive stepping are poorly understood.

Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease.

Background And Purpose: Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task.

Cognitive Predictors of Responsiveness to Reactive Step Training in People with Parkinson's Disease at Fall-Risk.

Reactive stepping can be improved in people with Parkinson's Disease (PwPD). However, there is variability in the responsiveness to such training. This study examined if cognition could predict the responsiveness of PwPD to a two-week reactive step training intervention.

Stability Changes in Fall-Prone Individuals With Parkinson Disease Following Reactive Step Training.

Background And Purpose: Poor reactive steps may lead to falls in people with Parkinson disease (PwPD). However, whether reactive steps can be improved in PwPD at risk for falls or whether step training reduces falls remains unclear. This study aimed to determine whether 2 weeks of reactive step training result in (1) immediate and retained improvements in stepping and (2) fewer prospective falls in PwPD at fall risk.

Digital measures of freezing of gait across the spectrum of normal, non-freezers, possible freezers and definite freezers.

Over the course of the disease, freezing of gait (FoG) will gradually impact over 80% of people with Parkinson's disease (PD). Clinical decision-making and research design are often based on classification of patients as 'freezers' or 'non-freezers'. We derived an objective measure of FoG severity from inertial sensors on the legs to examine the continuum of FoG from absent to possible and severe in people with PD and in healthy controls.

Using the Instrumented Sway System (ISway) to Identify and Compare Balance Domain Deficits in People With Multiple Sclerosis.

Objective: To develop a multiple sclerosis (MS)-specific model of balance and examine differences between (1) MS and neurotypical controls and (2) people with MS (PwMS) with (MS-F) and without a fall history (MS-NF).

Design And Setting: A cross-sectional study was conducted at the Gait and Balance Laboratory at the University of Kansas Medical Center. Balance was measured from the instrumented sway system (ISway) assessment.

Directional virtual time-to-contact: A new measure for investigating temporal, spatial, and control aspects of postural balance control.

Virtual time-to-contact (VTC) is a promising approach for investigating postural balance control. However, current VTC calculation approaches are limited as they (1) cannot be used to evaluate directional components of balance, and (2) only assess a single, temporal aspect of balance control. This study introduces a new approach for VTC calculation, namely directional VTC, expanding VTC to assess temporal, spatial, and control aspects of balance.

Rehabilitation to Improve Gaze and Postural Stability in People With Multiple Sclerosis: A Randomized Clinical Trial.

Background: People with multiple sclerosis (PwMS) frequently experience dizziness and imbalance that may be caused by central vestibular system dysfunction. Vestibular rehabilitation may offer an approach for improving dysfunction in these people.

Objective: To test the efficacy of a gaze and postural stability (GPS) retraining intervention compared to a strength and endurance (SAE) intervention in PwMS.

Effects of gender on dual-tasking and prioritization in older adults.

Background: The ability to produce effective posture and balance while distracted (dual-tasking; DT), is critical for mobility. In particular, individuals implicit prioritization across posture and secondary, distracting stimuli may impact fall risk. However, the impact of gender on DT and prioritization during gait is poorly understood.

Examining the Relationship Between Reactive Stepping Outcomes and Falls in People With Multiple Sclerosis.

Objective: Reactive stepping is critical for preventing falls and is impaired in people with multiple sclerosis (PwMS); however, which aspects of stepping relate to falls remains poorly understood. Identifying outcomes most related to falls is a first step toward improving rehabilitation for fall prevention. The purpose of this study was to assess whether reactive step latency or length during forward and backward losses of balance were related to a history of falls in PwMS.

The impact of divided attention on automatic postural responses: A systematic review and meta-analysis.

Quick responses to a loss of balance or "automatic postural responses" (APRs) are critical for fall prevention. The addition of a distracting task- dual-tasking (DT), typically worsens performance on mobility tasks. However, the effect of DT on APRs is unclear.

Bridging the callosal gap in gait: corpus callosum white matter integrity's role in lower limb coordination.

Bilateral coordination of the lower extremities is an essential component of mobility. The corpus callosum bridges the two hemispheres of the brain and is integral for the coordination of such complex movements. The aim of this project was to assess structural integrity of the transcallosal sensorimotor fiber tracts and identify their associations with gait coordination using novel methods of ecologically valid mobility assessments in persons with multiple sclerosis and age-/gender-matched neurotypical adults.

Upper extremity biomechanics in native and non-native signers.

Background: Individuals fluent in sign language (signers) born to non-signing, non-deaf parents (non-natives) may have a greater injury risk than signers born to signing, deaf parents (natives). A comprehensive analysis of movement while signing in natives and non-natives has not been completed and could provide insight into the greater injury prevalence of non-natives.

Objective: The objective of this study was to determine differences in upper extremity biomechanics between non-natives and natives.

Evaluating the contribution of reactive balance to prediction of fall rates cross-sectionally and longitudinally in persons with multiple sclerosis.

Background: Falls are common in persons with multiple sclerosis (PwMS). Reactive postural control-one's response to a balance perturbation-is likely an aspect of fall risk; however, the relationship between reactive posture and falls is poorly understood in PwMS.

Objective: We evaluated tibialis anterior muscle onset latency (TA latency) after balance perturbations as a predictor of fall rates in PwMS, controlling for clinical, functional, sensory, psychological, and cognitive factors.

Assessing the impact of dual-task reactive step practice in people with Parkinson's disease: A feasibility study.

Reactive stepping is impaired in people with Parkinson's Disease (PD) but can be improved with training. However, it is unclear if reactive steps can be improved when performing a concurrent cognitive task, a common and fall-relevant circumstance. We assessed the feasibility and preliminary effectiveness of dual-task reactive step training.

Perturbation practice in multiple sclerosis: Assessing generalization from support surface translations to tether-release tasks.

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.

Characterizing gaze and postural stability deficits in people with multiple sclerosis.

Background: People with Multiple Sclerosis (PwMS) experience a wide range of symptoms that can alter function and limit activity and community participation. Symptoms including sensory changes, weakness, fatigue and others have been well documented. However, symptoms related to changes in vestibular related function, including gaze and postural stability have not been fully explored.

Change in 'first-trial' performance after protective step practice in people with multiple sclerosis.

Background: Multiple sclerosis (MS) is a debilitating, neurodegenerative disorder causing considerable gait and balance dysfunction. Reactive balance (i.e.

The application of principal component analysis to characterize gait and its association with falls in multiple sclerosis.

People with multiple sclerosis (PwMS) demonstrate gait impairments that are related to falls. However, redundancy exists when reporting gait outcomes. This study aimed to develop an MS-specific model of gait and examine differences between fallers and non-fallers.

The assessment of center of mass and center of pressure during quiet stance: Current applications and future directions.

This perspective article provides a brief review of our understanding of how center of pressure (CoP) and center of mass (CoM) are traditionally utilized to measure quiet standing and how technological advancements are allowing for measurements to be derived outside the confines of a laboratory setting. Furthermore, this viewpoint provides descriptions of what CoP and CoM outcomes may reflect, a discussion of recent developments in selected balance outcomes, the importance of measuring instantaneous balance outcomes, and directions for future questions/research. Considering the enormous number and cost of falls annually, conclusions drawn from this perspective underscore the need for more cohesive efforts to advance our understanding of balance performance.

Post-stroke cognitive impairments and responsiveness to motor rehabilitation: A review.

Purpose Of Review: a)This review discusses the prevalence of cognitive deficits following stroke and their impact on responsiveness to therapeutic intervention within a motor learning context.

Recent Findings: b)Clinical and experimental studies have established that post-stroke cognitive and motor deficits may impede ambulation, augment fall risk, and influence the efficacy of interventions. Recent research suggests the presence of cognitive deficits may play a larger role in motor recovery than previously understood.

Dual-Task Effects During a Motor-Cognitive Task in Parkinson's Disease: Patterns of Prioritization and the Influence of Cognitive Status.

People with Parkinson's disease (PD) experience greater difficulties during dual task (DT) walking compared to healthy controls, but factors explaining the variance in DT costs remain largely unknown. Additionally, as cognitive impairments are common in PD it is important to understand whether cognitive status influences the strategies used during DT paradigms. The study aimed to (1) explore DT costs on gait and cognition during DT walking, (2) investigate factors associated with DT costs, and (3) to investigate to what extent patterns of DT costs and prioritization differed according to cognitive status.