Research: falls and feet in MSers

Epub: Coote et al. Falls in people with MS who use a walking aid: Prevalence, factors and effect of balance and strengthening interventions. Arch Phys Med Rehabil. 2012 Nov 2. doi:pii: S0003-9993(12)01077-5. 10.1016/j.apmr.2012.10.020. 

OBJECTIVE: To investigate falls prevalence, factors associated with falling and the effects of balance and strengthening interventions on falls in MSers.

DESIGN: 111 MSers who use bilateral support for gait were assessed with group and one-on-one physiotherapy .

MAIN OUTCOME MEASURES: Falls prevalence was assessed using retrospective recall. Demographic information, assessment of impairments of body function, Berg Balance Scale (BBS), 6 minute walk test (6MWT), multiple sclerosisimpact scale-29v2 (MSIS) physical and psychological scores and the modified fatigue impact scale(MFIS) were collected.

RESULTS: The prevalence of falls in a three month period was 50.5% of whom 28% had more than one fall. Fallers had greater physical (mean difference -3.9, p=0.048) and psychological (median difference -4.5, p=0.001) impact of MS and greater impact of fatigue (mean difference -9.4 p = 0.002). A logistic regression analysis found that the MFIS score made a unique significant contribution to the model (OR 1.048, 95% CI 1.018 to 1.079) correctly identifying 68% of fallers. A 10 week group physiotherapy intervention significantly reduced both the number of fallers (58.3% pre to 22.9% post, p=0.005) and the number of falls (63 pre, 25 post, p=0.001).

CONCLUSION: The prevalence of falls is high in this population of MSers and fallers have significantly greater impact of MS and impact of fatigue. Development and evaluation of interventions to reduce falls risk and the transition to faller or multiple faller status is required.

Epub: Socie et al. Footfall Placement Variability and Falls in Multiple Sclerosis. Ann Biomed Eng. 2012 Nov 7.

Background: Gait variability (i.e. fluctuations in walking) provides unique information about the control of movement and is associated with falls. 

Objective: This investigation examined the association between gait variability and falls in MSers and healthy controls. 

Methods: Traditional distributional metrics of gait variability (i.e., coefficient of variation (CV)) and a novel metric based on Fourier series analysis of footfall placement variability were determined for 41 MSers and 20 age- and sex-matched controls. Spatiotemporal parameters of gait were collected using a 7.9 m electronic walkway that recorded individual footfalls during steady state comfortable walking. MSers were divided into two groups based on fall history (non-fallers and recurrent fallers). 

Results: Overall, MSers had greater gait variability than controls as indexed by CV and Fourier-based variability (p’s < 0.05). Moreover, recurrent fallers with MS had greater Fourier-based variability than non-fallers with MS (p = 0.025), whereas there was no difference in MS groups in traditional gait variability metrics (p > 0.05). 

Conclusion: These observations highlight that footfall placement variability is related to fall status in MS. Future work determining the sensitivity of footfall placement variability to dysfunction is warranted.

“Bone health and falls are a bit of a hobby horse of mine at the moment. I have 6 MSers under my care who have fallen in the last year and sustained fractures. If we are to make a difference to MSers we need to be proactive about falls and bone health and make sure that we try and prevent them, or at least reduce the danger of falls, and prevent fractures. This is part of my holistic approach to MS management drive. We have therefore developed an algorithm to address this problem that will eventually include a self-assessment tool to make sure you are empowered to assess your own risk of falling and of sustaining a fracture. As soon as it is published we will set-up a site for you to access. In the interim if you are a falling, or having near falls, please let your nurse or neurologist know. You may also need a bone density scan to make sure you don’t require treatment for osteopaenia (thin bones).”

17 Oct 2012
I presented a new version of my holistic approach to MS at ECTRIMS; it is inspired by the London Underground map. A lot of people have asked me for the slide which I have distributed. I would appreciate comments and 
14 Jul 2012
My presentation to the Department of Neurology in Norwich last Wednesday (11 July 2012). Posted by Gavin Giovannoni at 16:16 · Email ThisBlogThis!Share to TwitterShare to Facebook. Labels: holistic, Norwich, Slide show 
30 Jun 2012
“I have put this map together to illustrate an holistic approach to MS; i.e. what we need to think about it when considering the services we provide MSers. Have I left anything out? Thanks”. Posted by Gavin Giovannoni at 01:17 

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