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Kazanski ME, Cusumano JP, Dingwell JB. How older adults maintain lateral balance while walking on narrowing paths. Gait Posture 2024; 113:32-39. [PMID: 38833762 PMCID: PMC11381164 DOI: 10.1016/j.gaitpost.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/09/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Older adults have difficulty maintaining side-to-side balance while navigating daily environments. Losing balance in such circumstances can lead to falls. We need to better understand how older adults adapt lateral balance to navigate environment-imposed task constraints. RESEARCH QUESTION How do older adults adjust mediolateral balance while walking along continually-narrowing paths, and what are the stability implications of these adjustments? METHODS Eighteen older (71.6±6.0 years) and twenty younger (21.7±2.6 years) healthy adults traversed 25 m-long paths that gradually narrowed from 45 cm to 5 cm. Participants switched onto an adjacent path when they chose. We quantified participants' lateral center-of-mass dynamics and lateral Margins of Stability (MoSL) as paths narrowed. We quantified lateral Probability of Instability (PoIL) as the probability that participants would take a laterally unstable (MoSL<0) step as they walked. We also extracted these outcomes where participants switched paths. RESULTS As paths narrowed, all participants exhibited progressively smaller average MoSL and increasingly larger PoIL. However, their MoSL variability was largest at both the narrowest and widest path sections. Older adults exhibited consistently both larger average and more variable MoSL across path widths. Taken into account together, these resulted in either comparable or somewhat larger PoIL as paths narrowed. Older adults left the narrowing paths sooner, on average, than younger. As they did so, older adults exhibited significantly larger average and more variable MoSL, but somewhat smaller PoIL than younger. SIGNIFICANCE Our results directly challenge the predominant interpretation that larger average MoSL indicate "greater stability", which we argue is inconsistent with the principles underlying its derivation. In contrast, analyzing step-to-step gait dynamics, together with estimating PoIL allows one to properly quantify instability risk. Furthermore, the adaptive strategies uncovered using these methods suggest potential targets for future interventions to reduce falls in older adults.
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Affiliation(s)
- Meghan E Kazanski
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA; Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph P Cusumano
- Department of Engineering Science & Mechanics, The Pennsylvania State University, University Park, PA 16802, USA
| | - Jonathan B Dingwell
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA.
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Gao Y, Wang N, Liu Y, Liu N. Effectiveness of virtual reality in preventing falls in non-disabled older adults: A meta-analysis and systematic review. Geriatr Nurs 2024; 58:15-25. [PMID: 38729063 DOI: 10.1016/j.gerinurse.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study was conducted to evaluate the effectiveness of virtual reality interventions in preventing falls among non-disabled older adults. METHODS We conducted a librarian-designed database search. Two researchers independently screened eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias in the included studies. RESULTS Virtual reality interventions can effectively improve gait and dynamic and static balance function, enhance lower limb muscle strength, and reduce the risk of falls in the non-disabled elderly. However, the effect of virtual reality on reducing the fear of falling remains controversial. CONCLUSION Virtual reality interventions can effectively prevent falls in nondisabled elderly individuals. Higher quality, larger sample size, and long-term follow-up studies are needed to further verify the long-term effectiveness of virtual reality training in preventing falls in non-disabled elderly individuals.
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Affiliation(s)
- Yan Gao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu Liu
- School of Nursing, China Medical University, Shenyang, China
| | - Naiquan Liu
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China.
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Poosri T, Boripuntakul S, Sungkarat S, Kamnardsiri T, Soontornpun A, Pinyopornpanish K. Gait smoothness during high-demand motor walking tasks in older adults with mild cognitive impairment. PLoS One 2024; 19:e0296710. [PMID: 38241332 PMCID: PMC10798528 DOI: 10.1371/journal.pone.0296710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/16/2023] [Indexed: 01/21/2024] Open
Abstract
Early signs of Mild Cognitive Impairment (MCI)-related gait deficits may be detected through the performance of complex walking tasks that require high gait control. Gait smoothness is a robust metric of overall body stability during walking. This study aimed to explore gait smoothness during complex walking tasks in older adults with and without MCI. Participants were 18 older adults with MCI (mean age = 67.89 ± 4.64 years) and 18 cognitively intact controls (mean age = 67.72 ± 4.63 years). Gait assessment was conducted under four complex walking tasks: walking a narrow path, walking around an obstacle, horizontal head turns while walking, and vertical head turns while walking. The index of harmonicity (IH), representing gait smoothness associated with overall body stability, was measured in anteroposterior, mediolateral, and vertical directions. A multivariate analysis was employed to compare the differences in IH between groups for each complex walking task. The MCI group demonstrated a reduction of IH in the mediolateral direction during the horizontal head turns than the control group (MCI group = 0.64 ± 0.16, Control group = 0.74 ± 0.12, p = 0.04). No significant differences between groups were found for the IH in other directions or walking conditions. These preliminary findings indicate that older adults with MCI have a decline in step regularity in the mediolateral direction during walking with horizontal head turns. Assessment of the smoothness of walking during head turns may be a useful approach to identifying subtle gait alterations in older adults with MCI, which may facilitate timely gait intervention.
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Affiliation(s)
- Thanpidcha Poosri
- Faculty of Associated Medical Sciences, Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Sirinun Boripuntakul
- Faculty of Associated Medical Sciences, Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Somporn Sungkarat
- Faculty of Associated Medical Sciences, Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Teerawat Kamnardsiri
- Department of Digital Game, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Atiwat Soontornpun
- Faculty of Medicine, Department of Internal Medicine, Chiang Mai University and Northern Neuroscience Center, Chiang Mai, Thailand
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Khan MJ, Kannan P, Wong TWL, Fong KNK, Winser SJ. A Systematic Review Exploring the Theories Underlying the Improvement of Balance and Reduction in Falls Following Dual-Task Training among Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16890. [PMID: 36554771 PMCID: PMC9778940 DOI: 10.3390/ijerph192416890] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Balance impairment causes frequent falls in older adults, and preventing falls remains challenging. Dual-task (DT) training reduces falls by improving balance, but the precise theory is not fully understood. This review aims to explore the theories underlying the effectiveness of DT in improving balance and reducing falls in older adults. METHODS Eleven electronic databases were searched from database inception to June 2022. Two reviewers independently performed study screening and data extraction. The risk of bias (RoB) in the included studies was assessed using the Cochrane Collaboration RoB 2 tool. RESULTS The searches yielded 1478 citations, of which 30 studies met the inclusion criteria and were included in the review. Twenty-two of the 30 included studies utilized the motor-cognitive type of DT for training, while six used motor-motor and two utilized cognitive-cognitive DT. The included studies reported 20 different theories to explain the effectiveness of DT for improving balance and reducing falls in older adults. The predominant theory identified in the included studies was attention theory (n = 14). Overall, 26 studies reported improved balance and five studies found a reduction in fall incidence following DT training. Balance and falls improved significantly in 15 motor-cognitive DT intervention studies. CONCLUSION Attention shifting between two tasks is reported to occur following DT training. Motor-cognitive DT training improves balance and reduces fall incidence in older adults by shifting attention based on the difficulty and priority of a task from the motor to the cognitive task.
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Psychometric Evaluation of the Narrow Corridor Walk Test (NCWT) on Advanced Walking Balance in People with Stroke. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1436715. [DOI: 10.1155/2022/1436715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
Objectives. To investigate (i) the interrater and test-retest reliabilities of completion time and number of steps in the Narrow Corridor Walking Test (NCWT); (ii) the minimal detectable changes (MDCs) in NCWT results; (iii) the correlations between NCWT results and stroke-specific outcome measures; and (iv) the optimal cut-off values of NCWT results for discriminating the difference in advanced balance ability between people with stroke and healthy older adults. Design. Cross-sectional. Subjects. Thirty people with stroke and 30 healthy older adults. Methods. People with stroke completed the NCWT on two separate days with a 7- to 10-day interval. The Fugl-Meyer Assessment (FMA), ankle dorsiflexor and plantarflexor muscle strength, Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and the Chinese version of the Community Integration Measure (CIM) were used to assess. The healthy older adults completed the NCWT once. Results. The NCWT completion time and NCWT steps showed excellent interrater reliability and test-retest reliability and significant correlations with FMA, affected ankle dorsiflexor muscle strength, BBS score, and TUG completion time. A cut-off value of 7.40 s for NCWT completion time and 13.33 for the NCWT steps distinguished people with stroke from healthy older adults. The MDCs of the NCWT completion time and NCWT steps were 6.87 s and 5.50, respectively. Conclusion. The NCWT is a reliable clinical measurement tool for the assessment of advanced balance ability in people with stroke.
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The identification of fall risk through tests of mediolateral stability during gait. Exp Gerontol 2022; 163:111803. [DOI: 10.1016/j.exger.2022.111803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/18/2022] [Accepted: 04/04/2022] [Indexed: 11/20/2022]
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Bayot M, Dujardin K, Dissaux L, Tard C, Defebvre L, Bonnet CT, Allart E, Allali G, Delval A. Can dual-task paradigms predict Falls better than single task? - A systematic literature review. Neurophysiol Clin 2020; 50:401-440. [PMID: 33176988 DOI: 10.1016/j.neucli.2020.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022] Open
Abstract
With about one third of adults aged 65 years and older being reported worldwide to fall each year, and an even higher prevalence with advancing age, aged-related falls and the associated disabilities and mortality are a major public health concern. In this context, identification of fall risk in healthy older adults is a key component of fall prevention. Since dual-task outcomes rely on the interaction between cognition and motor control, some studies have demonstrated the role of dual-task walking performance or costs in predicting future fallers. However, based on previous reviews on the topic, (1) discriminative and (2) predictive powers of dual tasks involving gait and a concurrent task are still a matter of debate, as is (3) their superiority over single tasks in terms of fall-risk prediction. Moreover, less attention has been paid to dual tasks involving postural control and transfers (such as gait initiation and turns) as motor tasks. In the present paper, we therefore systematically reviewed recent literature over the last 7 years in order to answer the three above mentioned questions regarding the future of lab-based dual tasks (involving posture, gait initiation, gait and turning) as easily applicable tests for identifying healthy older adult fallers. Despite great heterogeneity among included studies, we emphasized, among other things, the promising added value of dual tasks including turns and other transfers, such as in the Timed Up and Go test, for prediction of falls. Further investigation of these is thus warranted.
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Affiliation(s)
- Madli Bayot
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Clinical Neurophysiology, F-59000 Lille, France
| | - Kathy Dujardin
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Neurology and Movement Disorders, F-59000 Lille, France
| | - Lucile Dissaux
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Clinical Neurophysiology, F-59000 Lille, France
| | - Céline Tard
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Neurology and Movement Disorders, F-59000 Lille, France
| | - Luc Defebvre
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Neurology and Movement Disorders, F-59000 Lille, France
| | - Cédrick T Bonnet
- Univ. Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, CNRS UMR 9193, F-59000 Lille, France
| | - Etienne Allart
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Neurorehabilitation Unit, F-59000 Lille, France
| | - Gilles Allali
- Department of Neurology, Geneva University Hospitals and University of Geneva, Geneva 1211, Switzerland, Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, US
| | - Arnaud Delval
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Clinical Neurophysiology, F-59000 Lille, France.
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Barber SJ, Hamel K, Ketcham C, Lui K, Taylor-Ketcham N. The effects of stereotype threat on older adults' walking performance as a function of task difficulty and resource evaluations. Psychol Aging 2020; 35:250-266. [PMID: 31971413 PMCID: PMC7543189 DOI: 10.1037/pag0000440] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Stereotype threat occurs when people are concerned about confirming a negative stereotype about their social group, and this often leads people to underperform within the threatened domain. Although this is well-documented, the majority of prior studies examining stereotype threat in older adults have focused on cognitive outcomes and comparatively less research has focused on how stereotype threat affects physical outcomes. In this study, we examined whether negative age-based evaluations invoke stereotype threat and adversely affect older adults' gait, and whether this depends upon the difficulty of the gait task and upon participants' evaluations of their own resources to cope with the demands of the gait task. To test this, we recruited 163 healthy, community-dwelling older adults and asked them to complete either an "easy" gait task (i.e., walking at their own comfortable pace) or a "difficult" gait task (i.e., walking within a 15 cm narrow base of support) along a 24' temporospatial-measuring walkway. This was done in either the presence or absence of a negative age-based evaluation. Results showed that the adverse effects of stereotype threat (i.e., walking slower, with relatively more variability in speed, and with more step errors) were generally limited to participants completing the difficult gait task who were not confident that they had sufficient resources to cope with the demands of the task. Thus, stereotype threat can impair older adults' physical performance, but the magnitude of this effect depends upon the task's objective difficulty and on participants' subjective evaluations of their own resources. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Kang L, Han P, Wang J, Ma Y, Jia L, Fu L, Yu H, Chen X, Niu K, Guo Q. Timed Up and Go Test can predict recurrent falls: a longitudinal study of the community-dwelling elderly in China. Clin Interv Aging 2017; 12:2009-2016. [PMID: 29238175 PMCID: PMC5716394 DOI: 10.2147/cia.s138287] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Falling is a major health problem in community-dwelling elderly individuals. The aim of the present study was to conduct a prospective investigation to evaluate the accuracy of the Timed Up and Go Test (TUGT), 4-meter walking test, and grip strength test to screen for the risk of falls and to determine a cutoff point to be used clinically. Patients and methods This was a prospective study that included 541 participants. The fall data were obtained via face-to-face interview, and the date, site, and circumstances of any falls were recorded. TUGTs were recorded as part of a comprehensive geriatric assessment. We collected the same data at baseline and after follow-up via comprehensive geriatric assessment. Results The incidence of falls of our study subjects was 20.8%. The recurrent-fall group had a fall rate of 6.8% during the follow-up year. The standard area under the curve (AUC) of our screening tool was >0.70, and hence our tool can be used for clinical purposes. After adjusting for age and gender, the AUC of TUGT became 0.642, so it cannot be used as a predictive tool for measuring any types of falls. However, when recurrent falls were adjusted for age and gender, the TUGT’s AUC improved to 0.733 and a score of 15.96 seconds is used as a cut-point to screen recurrent falls in community-dwelling elderly Chinese individuals. Conclusion Future falls were best predicted by TUGT in recurrent fallers at baseline. A score of 15.96 seconds is used as a cut-point to screen recurrent falls in community-dwelling elderly Chinese individuals.
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Affiliation(s)
- Li Kang
- Department of Rehabilitation Medicine, Tianjin Economic-Technological Development Area International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University.,Department of Rehabilitation Medicine
| | | | | | - Yixuan Ma
- Department of Rehabilitation Medicine
| | - Liye Jia
- Department of Rehabilitation Medicine
| | - Liyuan Fu
- Department of Rehabilitation Medicine
| | - Hairui Yu
- Department of Rehabilitation Medicine
| | | | - Kaijun Niu
- Nutritional Epidemiology Institute.,School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Tianjin Economic-Technological Development Area International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University.,Department of Rehabilitation Medicine
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Sawers A, Hafner BJ. A study to assess whether fixed-width beam walking provides sufficient challenge to assess balance ability across lower limb prosthesis users. Clin Rehabil 2017; 32:483-492. [PMID: 28948848 DOI: 10.1177/0269215517732375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the feasibility of fixed-width beam walking for assessing balance in lower limb prosthesis users. DESIGN Cross-sectional. SETTING Laboratory. SUBJECTS Lower limb prosthesis users. METHODS Participants attempted 10 walking trials on three fixed-width beams (18.6, 8.60, and 4.01 wide; 5.5 m long; 3.8 cm high). MAIN MEASURES Beam-walking performance was quantified using the distance walked to balance failure. Heuristic rules applied to each participant's beam-walking distance to classify each beam as "too easy," "too hard," or "appropriately challenging" and determine whether any single beam provided an appropriate challenge to all participants. The number of trials needed to achieve stable beam-walking performance was quantified for appropriately challenging beams by identifying the last inflection point in the slope of each participant's trial-by-trial cumulative performance record. RESULTS In all, 30 unilateral lower limb prosthesis users participated in the study. Each of the fixed-width beams was either too easy or too hard for at least 33% of the sample. Thus, no single beam was appropriately challenging for all participants. Beam-walking performance was stable by trial 8 for all participants and by trial 6 for 90% of participants. There was no significant difference in the number of trials needed to achieve stable performance among beams ( P = 0.74). CONCLUSION Results suggest that a clinical beam-walking test would require multiple beams to evaluate balance across a range of lower limb prosthesis users, emphasizing the need for adaptive or progressively challenging balance tests. While the administrative burden of a multiple-beam balance test may limit clinical feasibility, alternatives to ease this administrative burden are proposed.
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Affiliation(s)
- Andrew Sawers
- 1 Department of Kinesiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Brian J Hafner
- 2 Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Reliability and Concurrent Validity of the Narrow Path Walking Test in Persons With Multiple Sclerosis. J Neurol Phys Ther 2017; 41:43-51. [PMID: 27977520 DOI: 10.1097/npt.0000000000000161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE About 90% of people with multiple sclerosis (PwMS) have gait instability and 50% fall. Reliable and clinically feasible methods of gait instability assessment are needed. The study investigated the reliability and validity of the Narrow Path Walking Test (NPWT) under single-task (ST) and dual-task (DT) conditions for PwMS. METHODS Thirty PwMS performed the NPWT on 2 different occasions, a week apart. Number of Steps, Trial Time, Trial Velocity, Step Length, Number of Step Errors, Number of Cognitive Task Errors, and Number of Balance Losses were measured. Intraclass correlation coefficients (ICC2,1) were calculated from the average values of NPWT parameters. Absolute reliability was quantified from standard error of measurement (SEM) and smallest real difference (SRD). Concurrent validity of NPWT with Functional Reach Test, Four Square Step Test (FSST), 12-item Multiple Sclerosis Walking Scale (MSWS-12), and 2 Minute Walking Test (2MWT) was determined using partial correlations. RESULTS Intraclass correlation coefficients (ICCs) for most NPWT parameters during ST and DT ranged from 0.46-0.94 and 0.55-0.95, respectively. The highest relative reliability was found for Number of Step Errors (ICC = 0.94 and 0.93, for ST and DT, respectively) and Trial Velocity (ICC = 0.83 and 0.86, for ST and DT, respectively). Absolute reliability was high for Number of Step Errors in ST (SEM % = 19.53%) and DT (SEM % = 18.14%) and low for Trial Velocity in ST (SEM % = 6.88%) and DT (SEM % = 7.29%). Significant correlations for Number of Step Errors and Trial Velocity were found with FSST, MSWS-12, and 2MWT. DISCUSSION AND CONCLUSIONS In persons with PwMS performing the NPWT, Number of Step Errors and Trial Velocity were highly reliable parameters. Based on correlations with other measures of gait instability, Number of Step Errors was the most valid parameter of dynamic balance under the conditions of our test.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A159).
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