Dynamic balance in persons with multiple sclerosis who have a falls history is altered compared to non-fallers and to healthy controls

Around 60% of persons with multiple sclerosis (MS) experience falls, however the dynamic balance differences between those who fall and those who don't are not well understood. The purpose of this study is to identify distinct biomechanical features of dynamic balance during gait that are different between fallers with MS, non-fallers with MS, and healthy controls. 27 recurrent fallers with MS, 28 persons with MS with no falls history, and 27 healthy controls walked on a treadmill at their preferred speed for 3 min. The variability of trunk accelerations and the average and variability of minimum toe clearance, spatiotemporal parameters, and margin of stability were compared between groups. Fallers with MS exhibited a slower cautious gait compared to non-fallers and healthy controls, but had decreased anterior-posterior margin of stability and minimum toe clearance. Fallers walked with less locally stable and predictable trunk accelerations, and increased variability of step length, stride time, and both anterior-posterior and mediolateral margin of stability compared to non-fallers and healthy controls. The present work provides evidence that within a group of persons with MS, there are gait differences that are influenced by falls history. These differences indicate that in persons with MS who fall, the center of mass is poorly controlled through base of support placement and the foot is closer to the ground during swing phase relative to the non-fallers. These identified biomechanical differences could be used to evaluate dynamic balance in persons with MS and to help improve fall prevention strategies.